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Heart. 2019 Jul 10. pii: heartjnl-2019-315098. doi: 10.1136/heartjnl-2019-315098. [Epub ahead of print]

Joint UK societies' 2019 consensus statement on renal denervation.

Author information

1
William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK.
2
Department of Cardiovascular Medicine, Barts Heart Centre, Barts Health NHS Trust, London, UK.
3
Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
4
Department of Cardiology, Exeter Hospital, University of Exeter, Exeter, UK.
5
Department of Cardiology, Imperial College Healthcare Trust, London, UK.
6
Department of Cardiology, James Cook University Hospital, Middlesborough, UK.
7
The National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK.
8
Sheffield Vascular Institute, Sheffield Teaching Hospitals NHSFT, Northern General Hospital, Sheffield, UK.
9
Department of Interventional Radiology, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK.
10
Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK.
11
Diagnostic Imaging, Barts Health NHS Trust, London, UK.
12
Warwick Medical School, University of Warwick, Coventry, UK.
13
University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.

Abstract

Improved and durable control of hypertension is a global priority for healthcare providers and policymakers. There are several lifestyle measures that are proven to result in improved blood pressure (BP) control. Moreover, there is incontrovertible evidence from large scale randomised controlled trials (RCTs) that antihypertensive drugs lower BP safely and effectively in the long-term resulting in substantial reduction in cardiovascular morbidity and mortality. Importantly, however, evidence is accumulating to suggest that patients neither sustain long-term healthy behaviours nor adhere to lifelong drug treatment regimens and thus alternative measures to control hypertension warrant further investigation. Endovascular renal denervation (RDN) appears to hold some promise as a non-pharmacological approach to lowering BP and achieves renal sympathectomy using either radiofrequency energy or ultrasound-based approaches. This treatment modality has been evaluated in clinical trials in humans since 2009 but initial studies were compromised by being non-randomised, without sham control and small in size. Subsequently, clinical trial design and rigour of execution has been greatly improved resulting in recent sham-controlled RCTs that demonstrate short-term reduction in ambulatory BP without any significant safety concerns in both medication-naïve and medication-treated hypertensive patients. Despite this, the joint UK societies still feel that further evaluation of this therapy is warranted and that RDN should not be offered to patients outside of the context of clinical trials. This document reviews the updated evidence since our last consensus statement from 2014 and provides a research agenda for future clinical studies.

KEYWORDS:

hypertension; interventional cardiology and endovascular procedures

PMID:
31292190
DOI:
10.1136/heartjnl-2019-315098
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Conflict of interest statement

Competing interests: MDL is funded by the Barts Charity and is a consultant to: Medtronic, Ablative Solutions, ReCor Medical, Vascular Dynamics, ROX Medical, Tarilian Laser Technologies and has received speaker fees from CVRx. AS is a consultant for Medtronic and Recor Medical and has received speaker fees from Medtronic. VK is funded by the Barts Charity. JD has served as a consultant for and has received significant research funding from Volcano Corporation; has received grants and personal fees from Medtronic, ReCor Medical and AstraZeneca; and is the co-inventor of the instantaneous wave-free ratio (iFR) and holds patents pertaining to this. MAdB has participated in an advisory board for Medtronic. NC is an investigator for the SPYRAL and RADIANCE studies and has received speaker fees from Medtronic and ReCor Medical. ID has received an unrestricted research grant from Medtronic. MS has received speaker fees from Recor Medical. FPC is president and trustee of the British and Irish Hypertension Society. He is head of a WHO collaborating centre and a scientific advisor to the WHO in areas unrelated to renal denervation. All other authors have reported that they have no relationships relevant to the contents of this paper.

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