Catheter-based Renal Denervation for Therapy of Hypertension: Is There a Hope for Its Resurgence?

Abstract

Hypertension (HTN) is the most common chronic cardiovascular disease with increasing prevalence all over the world. Despite the availability of many effective antihypertensive drugs, blood pressure control to target values remains low. Resis tant hypertension is defined as ‘blood pressure above goal in adherent patients despite a triple antihypertensive therapy in maximum or maximum tolerated doses, inclu ding a diuretic, which is found in approximately 8 to 18% of all hyper tensives’. Treatment requires a multimodal therapy concept, including—polypharmacy, lifestyle modification and a systematic identification of secondary causes of HTN or pseudoresistance. Increased activity of the sympathetic nervous system has been identified as main contributor to the develop ment and maintenance of resistant HTN. Catheterbased renal dener vation has been introduced as a minimal invasive option for patients with resistant HTN. However, the clinical evidence in support of renal denervation as an effective inter ventional technique is conflicting. A number of observa tional studies and four randomized, controlled trials (Symplicity HTN-2, Prague 15, RSD-LEIPZIG and DENERHTN) support both safety and efficacy of this new therapy, but some smaller studies and the large, single-blind, randomized, sham-controlled Symplicity HTN-3 trial failed to show superiority of renal denervation when compared to medical therapy alone. The present review aims at providing an overview about catheter-based renal denervation for treatment of HTN.