Top Things to Know: Renal Denervation for the Treatment of Hypertension
Published: August 05, 2024
Prepared by Oliva Blazek, MD, Indiana University School of Medicine and Naomi DL Fisher, MD, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School
- Renal nerve denervation (RDN) is a catheter-based therapy for hypertension (HTN) that works by reducing sympathetic nervous system activity.
- Radiofrequency and ultrasound RDN are approved by the US Food and Drug Administration for the adjunctive treatment of HTN in patients for whom lifestyle and antihypertensive medications do not adequately control blood pressure (BP).
- RDN has been proven effective in patients with mild, moderate, and resistant hypertension, with a BP-lowering efficacy of RDN comparable to that of an effective antihypertensive drug.
- RDN is performed once, usually as an outpatient procedure, with ablation of renal arteries bilaterally. The durability of effect has been demonstrated up to 36 months in clinical trials.
- While most patients experience a modest reduction in BP, RDN is not effective in everyone. To date, the only consistent predictor of effective responses is higher baseline BP. Further studies are needed to define individual characteristics that may predict efficacy.
- RDN therapy has a favorable safety profile with a very low incidence of major adverse events. Medium- to longer-term safety data show no evidence of associated kidney dysfunction or new or worsening renal artery stenosis, but the continued collection of safety data is important.
- Appropriate patient selection for RDN begins with considering only patients with sustained, uncontrolled HTN. Proper out-of-office home BP assessment to exclude white coat HTN is essential.
- Patients with resistant HTN, HTN with high cardiovascular risk, and those who cannot tolerate or adhere to sufficient medical therapy to control their HTN are appropriate candidates for consideration of RDN.
- It is important that patients are evaluated for possible secondary causes of hypertension which have targeted therapies when clinically indicated. It is also important to ensure there are no contraindications to the procedure.
- Appropriate implementation of RDN requires multidisciplinary teams, including hypertension specialists and adequately trained interventionalists. Shared decision making between clinicians and all patients who are potential candidates for RDN is advised.
Citation
Cluett JL, Blazek O, Brown AL, East C, Ferdinand KC, Fisher NDL, Ford CD, Griffin KA, Mena-Hurtado CI, Sarathy H, Vongpatanasin W, Townsend RR; on behalf of the American Heart Association Council on Hypertension; Council on Cardiovascular and Stroke Nursing; Council on the Kidney in Cardiovascular Disease; and Council on Peripheral Vascular Disease. Renal denervation for the treatment of hypertension: a scientific statement from the AmericanHeart Association. Hypertension. Published online August 5, 2024. doi: 10.1161/HYP.0000000000000240