Renal Sympathetic Denervation for Hypertension

Abstract

Arterial hypertension is the most prevalent global modifiable risk factor for cardiovascular morbidity and mortality. Despite the availability of numerous pharmacologic treatments, many patients do not achieve guideline-recommended blood pressure targets. Therefore, renal sympathetic denervation (RDN), a process in which catheter-directed techniques are used to ablate portions of the renal artery to reduce sympathetic activity, has been extensively investigated as a complementary and nonpharmacologic approach for the treatment of arterial hypertension. This review seeks to discuss the pathophysiological rationale of this strategy, to survey its history and development, and to highlight the current clinical evidence and possible future directions of its employment. In sum, RDN has demonstrated itself to be a safe and well-tolerated endovascular intervention that can reliably contribute to improved blood pressure control and, perhaps ultimately, significant cardiovascular prognosis.

Keywords: Denervation; Endovascular; Hypertension; Radiofrequency; Renal; Ultrasound.

Figure 1

Change in systolic blood pressure with renal sympathetic denervation. Association between baseline office systolic blood pressure and systolic pressure reductions at 6 months after renal denervation in major clinical trials. Trial sizes are reflected by the sizes of the bubbles.

Figure 2

Alcohol-mediated renal denervation using the Peregrine system infusion catheter. Reprinted with permission from Medical Illustration by Justin A. Klein, CMI © 2022