Abstract
Hypertension remains a major public health problem and one of the most relevant causes of cardiovascular mortality and morbidity worldwide. Roughly 10% of hypertensive individuals are considered as "resistant" as they are not able to achieve and maintain optimal blood pressure values despite the concurrent use of 3 antihypertensive agents of different classes at optimal doses. As resistant hypertension conveys a higher risk of adverse outcomes, the search for effective treatments to properly manage this condition has progressively surged as a true health priority. The renal nerve plexus plays a central role in regulating arterial blood pressure and renal sympathetic overactivity is a major component in the development and progression of hypertension. On these premises, minimally-invasive catheter based devices for renal nerve ablation have been developed and tested as an alternative treatment for resistant hypertension, but clinical study results have been ambiguous. This review provides a historical perspective on the scientific evidence forming the foundation of renal never ablation from accrued clinical evidence to possible future applications, reaching a tentative conclusion that more research and clinical experience is needed to fully reveal limits and potential indications of this procedure.
Highlights
The prevalence of hypertension is constantly on the rise at the global level
Recent American guidelines (ACC/AHA) define hypertension as “resistant” when blood pressure values persist above target in spite of the concurrent use of 3 antihypertensive agents of different classes at optimal doses (Whelton et al, 2018)
From the type of device and technique used, the procedure of renal nerve ablation usually starts with engagement of the femoral artery
Summary
The prevalence of hypertension is constantly on the rise at the global level. Over one billion people are estimated to be affected by hypertension worldwide, and accounts for over ten million annual deaths due to cardiovascular complications (Benjamin et al, 2019; GBD 2017 Risk Factor Collaborators, 2018). Despite optimal drug and lifestyle prescriptions, the frequency of hypertensive individuals unable to achieve target blood pressure remains exceedingly high, spanning from 10% to 30% of the overall hypertensive population (Buhnerkempe et al, 2019). Recent American guidelines (ACC/AHA) define hypertension as “resistant” when blood pressure values persist above target in spite of the concurrent use of 3 antihypertensive agents of different classes at optimal doses (Whelton et al, 2018). The contribution of renal sympathetic overactivity to the development and progression of hypertension is a well-acknowledged concept (Fig. 1). This represents a plausible basis for renal denervation as a potential way to approach poorlymanageable cases of hypertension
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