Renal denervation is a minimally invasive procedure that treats resistant?hypertension. This procedure uses radiofrequency ablation to burn the nerves in the renal arteries and finally causes a reduction in the nerve activity, decreasing the blood pressure.
A group of researchers conducted five sham-controlled trials ( HTN-OFF MED pivot-1,?HTN-OFF MED pivotal-2,?-HTN SOLO-3,? HTN-ON MED pilot-4, and?-HTN TRIO-5) to demonstrate a reduction in ambulatory blood pressure using?renal denervation?technique. The denervation was achieved using the Symplicity Spyral radiofrequency catheter (Medtronic) or the ultrasound-based paradise system (ReCor Medical) in patients with / without concomitant therapy.
According to all these five studies, the reduced average systolic BP ranged from 9.0 to 10.8 mm Hg in the office and 4.7 to 9.0 mm Hg on ambulatory monitoring. The procedure is safe for a broad range of patients with hypertension.
Lowering the systolic office BP by 5 mm Hg is associated with lower relative risks of heart failure (20-25 %), stroke (20%) and ischemic heart disease (10%).
Renal denervation as a third main option for the treatment of hypertension requires a structured procedure that ensures the appropriate performance of the endovascular process and adequate selection of hypertensive population.
As most of the patients require lifestyle changes but they are difficult to follow over time and poor medication adherence might be an issue, renal denervation could be part of the therapeutic strategy. The major concerns renal denervation, include safety, efficacy, and durability. In case of poor adherence to antihypertensive medications, renal denervation has a legitimate role for the treatment of hypertension.
The authors conclude that the renal denervation procedure should be considered complementary to the other two options, i.e. lifestyle changes and drugs.