Abstract
Among cardiovascular risk factors, arterial hypertension has the highest prevalence and is poorly controlled. 1 Stanaway JD Afshin A Gakidou E et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392: 1923-1994 Summary Full Text Full Text PDF PubMed Scopus (1438) Google Scholar The sympathetic nervous system targeting the kidney via efferent and afferent nerves, thereby contributing to hypertension and potentially other cardiovascular conditions, 2 Böhm M Linz D Ukena C Esler M Mahfoud F Renal denervation for the treatment of cardiovascular high risk-hypertension or beyond?. Circ Res. 2014; 115: 400-409 Crossref PubMed Scopus (62) Google Scholar can be modulated with different denervation technologies. 3 Lauder L Azizi M Kirtane AJ Böhm M Mahfoud F Device-based therapies for arterial hypertension. Nat Rev Cardiol. 2020; 17: 614-628 Crossref PubMed Scopus (17) Google Scholar Rigorously controlled clinical trials without 4 Böhm M Townsend RR Kario K et al. Rationale and design of two randomized sham-controlled trials of catheter-based renal denervation in subjects with uncontrolled hypertension in the absence (SPYRAL HTN-OFF MED Pivotal) and presence (SPYRAL HTN-ON MED Expansion) of antihypertensive medications: a novel approach using Bayesian design. Clin Res Cardiol. 2020; 109: 289-302 PubMed Google Scholar , 5 Böhm M Kario K Kandzari DE et al. Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial. Lancet. 2020; 395: 1444-1451 Summary Full Text Full Text PDF PubMed Scopus (102) Google Scholar , 6 Townsend RR Mahfoud F Kandzari DE et al. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet. 2017; 390: 2160-2170 Summary Full Text Full Text PDF PubMed Scopus (374) Google Scholar and with 7 Kandzari DE Böhm M Mahfoud F et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet. 2018; 391: 2346-2355 Summary Full Text Full Text PDF PubMed Scopus (302) Google Scholar antihypertensive medications have shown a significant reduction in blood pressure with high-frequency energy. Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, sham-controlled trialCompared with a sham procedure, ultrasound renal denervation reduced blood pressure at 2 months in patients with hypertension resistant to a standardised triple combination pill. If the blood pressure lowering effect and safety of renal denervation are maintained in the long term, renal denervation might be an alternative to the addition of further antihypertensive medications in patients with resistant hypertension. Full-Text PDF
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