Up to 10% of patients with high blood pressure are resistant to treatment, which puts them at increased risk of cardiovascular events, including myocardial infarction.
Clinical trials have shown that catheter-based renal denervation reduces blood pressure in patients who do not respond to conventional drug therapy.
Use of the technique is increasing in Europe and worldwide and several National Societies have published guidance on which patients with hypertension should receive treatment.
The European Society of Cardiology ( ESC ) and the European Association of Percutaneous Cardiovascular Interventions ( EAPCI ) has decided it was time for a European view and have developed an expert consensus document on catheter-based renal denervation.
The paper provides guidance on patient selection, centre selection, efficacy, safety, limitations and potential new indications for referring physicians, interventionalists and healthcare providers. It is published in European Heart Journal.
The technique involves radiofrequency ablation of the renal sympathetic nerves via a catheter. It resets renal blood pressure regulation and reduces whole body sympathetic nerve activity.
Increased activity of the sympathetic nervous system occurs in other conditions including heart failure, diabetes, arrhythmias, chronic kidney disease and obstructive sleep apnea, and pilot studies indicate that renal denervation may be an effective therapy.
The paper states that renal denervation is currently indicated for blood pressure control in patients with treatment resistant hypertension ( defined as systolic blood pressure greater than 160 mmHg or greater than 150 mmHg in type 2 diabetes ) despite treatment with at least three antihypertensive drugs of different types in adequate doses, including one diuretic, and lifestyle modification.
Screening should be conducted to exclude patients with secondary causes of hypertension that are potentially curable.
Centres should be specialised in the management of hypertension. At least one hypertension expert should be involved in treatment and screening and the intervention should be performed by interventional cardiologists or angiologists with training in percutaneous renal artery access. Centres should perform more than 25 renal artery interventions per year to ensure they have the required experience.
The Symplicity HTN-1 trial has showen that renal denervation had a sustained blood pressure lowering effect over three years but longer efficacy data is needed. ( Xagena )
Source: European Society of Cardiology ( ESC ), 2013