Renal Denervation: An Update

Sinny Delacroix,Stephen J Nicholls,Adam Nelson,Stephen G Worthley,Ramesh G Chokka

doi:10.17987/jatamis.v1i0.235

Abstract

<p>Resistant hypertension is a growing cardiovascular problem worldwide and despite significant pharmacological advances medical management of the pathology remains challenging. In early clinical trials renal denervation, a catheter based therapy that denervates renal afferent and efferent sympathetic nervous system has demonstrated significant blood pressure reduction in patients with resistant hypertension. However, Symplicity HTN-3, the recent randomized controlled trial has challenged the efficacy of the procedure and underscored that there remain key issues to overcome before the procedure can be used as a standard of care in patients with resistant hypertension. This review provides a balanced update on the recent preclinical and clinical studies in the field and, focuses on the important advances required to enhance the forward progression of a technique that has the potential to treat this highly heterogenous pathology.</p>

Highlights

Systemic hypertension remains a major health problem worldwide with an estimated 1 billion people affected by the disease and this figure is projected to reach 1.5 billion by 2025.1,2 Resistant hypertension is defined as failure to attain goal blood pressures (BP’s) despite treatment with optimal doses of three or more antihypertensive medications including a diuretic
The exact prevalence of true Resistant hypertension (rHTN) is difficult to gauge due to suboptimal therapies, variations in patient compliance and secondary causes of HTN, it is estimated that approximately 1015% of patients diagnosed with Systemic hypertension (sHTN) are resistant to treatment.[3,4]
The 36 months follow up results of Symplicity HTN-2 showed that the blood pressure reduction was sustained at 3 years post procedure and that there was no safety concerns associated with the technique.[29]

Summary

Introduction

Systemic hypertension (sHTN) remains a major health problem worldwide with an estimated 1 billion people affected by the disease and this figure is projected to reach 1.5 billion by 2025.1,2 Resistant hypertension (rHTN) is defined as failure to attain goal blood pressures (BP’s) despite treatment with optimal doses of three or more antihypertensive medications including a diuretic. Techniques such as ultrasound, β radiation (vascular brachytherapy) and pharmaceuticals have been used to control blood pressures in patients with uncontrolled hypertension.[24,25,26,27] Kona Medical, Inc. utilizes externally delivered, focused ultrasound waves to disrupt sympathetic nerves leading to and fro from the kidney and, they have recently begun the WAVE I clinical trial to demonstrate the safety and efficacy of this procedure.[26] the Peregrine SystemTM uses a three needle-based device to deliver alcohol into the perivascular space of the renal artery to achieve renal sympathetic denervation.

Results

Conclusion