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Can J Cardiol. 2014 Jan;30(1):16-21. doi: 10.1016/j.cjca.2013.07.008. Epub 2013 Oct 23.

Renal denervation therapy for the treatment of resistant hypertension: a position statement by the Canadian Hypertension Education Program.

Author information

1
Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: nakhanubc@gmail.com.
2
Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada.
3
Division of Nephrology, Department of Medicine, and Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
4
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
5
Division of Nephrology, University of Toronto, Toronto, Ontario, Canada.
6
Department of Medicine, Western University, London, Ontario, Canada.
7
Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
8
Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

Abstract

Renal denervation is a novel catheter-based, percutaneous procedure using radiofrequency energy to ablate nerves within the renal arteries. This procedure might help to significantly lower blood pressure (BP) in patients with resistant hypertension, defined as BP > 140/90 mm Hg (> 130/80 mm Hg for those with diabetes) despite use of ≥ 3 optimally dosed antihypertensive agents, ideally including 1 diuretic agent. The Canadian Hypertension Education Program Recommendations Task Force reviewed the current evidence on safety and efficacy of this procedure. Eleven studies on renal denervation were examined and most of the evidence evaluating renal denervation was derived from the Symplicity studies. In patients with systolic BP ≥ 160 mm Hg (≥ 150 mm Hg for patients with type 2 diabetes) despite use of ≥ 3 antihypertensive agents, bilateral renal denervation was associated with significantly lower BP (-22/11 to -34/13 mm Hg) at 6 months with a low periprocedural complication rate. Few patients underwent 24-hour ambulatory BP monitoring and ambulatory BP monitoring showed more modest BP lowering (0 to -11/7 mm Hg). Although early results on short-term safety and blood pressure-lowering are encouraging, there are no long-term efficacy and safety data, or hard cardiovascular end point data. The discrepancy between office BP reductions and 24-hour ambulatory BP monitor reductions needs to be further investigated. Until more data are available, renal sympathetic denervation should be considered as a treatment option of last resort for patients with resistant hypertension who have exhausted all other available medical management options.

PMID:
24269056
DOI:
10.1016/j.cjca.2013.07.008
[Indexed for MEDLINE]
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