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. 2024 Apr 15;20(8):e467-e478.
doi: 10.4244/EIJ-D-23-00836.

Renal denervation in the management of hypertension

Lucas Lauder  1 , David E Kandzari  2 , Thomas F Lüscher  3   4   5   6 , Felix Mahfoud  1   7
Affiliations

Renal denervation in the management of hypertension

Lucas Lauder et al. EuroIntervention. .

Abstract

Arterial hypertension is a global leading cause of cardiovascular, cerebrovascular, and renal disease, as well as mortality. Although pharmacotherapy is safe and effective in lowering blood pressure (BP) and cardiovascular disease risk, BP control remains poor, and the mortality rates associated with high BP have been steadily increasing. Device-based therapies have been investigated to overcome barriers to pharmacotherapy, including non-adherence and low rates of persistence to daily medications. Among these device-based therapies, catheter-based renal denervation (RDN) has been most extensively examined over the past 15 years. In this state-of-the-art article, we summarise the rationale for RDN, review the available evidence, provide recommendations for a safe procedure, and discuss the role of RDN in current guidelines and clinical practice.

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Conflict of interest statement

L. Lauder has received speaker honoraria from AstraZeneca, Medtronic, Pfizer, and ReCor Medical. D.E. Kandzari has received institutional research and grant support from Medtronic and Ablative Solutions; personal consulting honoraria from Medtronic and Ablative Solutions; and holds equity in BioStar Ventures, but none related to Ablative Solutions. T.F. Lüscher has received, outside of this work, educational and research grants from Abbott, Amgen, AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, Medtronic, Novartis, Novo Nordisk, Sanofi, Servier, and CSL Vifor; and honoraria from Ablative Solutions, Daiichi Sankyo, Menarini Foundation, Novartis, Novo Nordisk, and Pfizer. F. Mahfoud is supported by Deutsche Gesellschaft für Kardiologie (DGK), Deutsche Forschungsgemeinschaft (SFB TRR219), and Deutsche Herzstiftung; he has received scientific support (to the institution) from Medtronic and ReCor Medical; and speaker honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Inari, Medtronic, Merck, and ReCor Medical.

Figures

Figure 1
Figure 1. BP changes in second-generation sham-controlled RDN trials.
Mean change (95% confidence intervals) in office (A) and 24-hour (B) systolic BP in published second-generation sham-controlled RDN trials. The SPYRAL HTN-OFF Pivotal and SPYRAL HTN-ON trials used a Bayesian design with an informative prior (outcome analyses included data from the pilot and pivotal trials). BP: blood pressure; RDN: renal denervation
Figure 2
Figure 2. Key components of a safe and effective procedure.
ACT: activated clotting time; AE: adverse events; Fr: French; IMA: internal mammary artery; JR: Judkins right coronary; MP: multipurpose; PA: posteroanterior; RDC: renal double curve
Figure 3
Figure 3. Nerve distribution along the renal artery.
The plots show the percentage of nerves in regions within <2, <4, <6, <8, and <10 mm from the renal arteries’ lumen. The red circle represents a penetration depth of 4 mm. Modified with permission from Struthoff et al.
Central illustration
Central illustration. Recommendations for renal denervation in the management of hypertension.
ABPM: ambulatory blood pressure monitoring; CE: European conformity; EAPCI: European Association of Percutaneous Cardiovascular Interventions; eGFR: estimated glomerular filtration rate; ESC: European Society of Cardiology; ESH: European Society of Hypertension; FDA: U.S. Food and Drug Administration; Fr: French; RF: radiofrequency; US: ultrasound
See this image and copyright information in PMC

References

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