Renal denervation for uncontrolled hypertension: critical review of the evidence.

Abstract

Hypertension (HTN) is a major global public health problem. Endovascular catheter-based radiofrequency ablation of renal sympathetic nerve endings (renal denervation) is a novel treatment option for uncontrolled HTN. Early clinical studies primarily in Australia and Europe established renal denervation as a well tolerated and feasible procedure that resulted in a sustained reduction in blood pressure among individuals with severe resistant HTN. A recent randomized controlled trial in the United States using a sham procedure in the control arm, however, did not show a significant additional benefit in blood pressure lowering from renal denervation. This review summarizes and critically examines the evidence for renal denervation in HTN management and identifies areas for future research. Renal denervation is a potentially promising treatment option for drug-resistant uncontrolled HTN. Future efforts should focus on refining the denervation technology and identifying individuals who are most likely to benefit from the denervation procedure.