International Expert Consensus Statement: Percutaneous Transluminal Renal Denervation for the Treatment of Resistant Hypertension

Perspective:

The following are 10 points to remember about this international Expert Consensus Statement:

1. Catheter-based radiofrequency ablation technology to disrupt renal nerves has recently been introduced to clinical medicine following the demonstration of significant systolic and diastolic blood pressure (BP) reductions.

2. The effects of renal denervation (RDN) appear to be mediated via interference with both efferent sympathetic and afferent sensory nerves, and may extend beyond BP control.

3. Clinical trial data available thus far have been obtained primarily in patients with resistant hypertension defined as standardized systolic clinic BP of ≥160 mm Hg despite appropriate pharmacologic treatment with at least three antihypertensive drugs including a diuretic. Accordingly, these criteria and BP thresholds should be borne in mind when selecting patients for renal nerve ablation.

4. Secondary forms of hypertension and pseudoresistance, such as nonadherence with medication, intolerance of medication, and white-coat hypertension, should be ruled out prior to consideration for catheter-based radiofrequency ablation.

5. It is not known whether RDN may be useful in less severe forms of hypertension or in other conditions characterized by heightened renal sympathetic nerve activity such as heart failure, metabolic syndrome, arrhythmias such as atrial fibrillation, chronic and end-stage renal disease, and others. It is therefore not recommended to perform RDN in these patient cohorts outside of appropriately designed clinical trials.

6. As there are theoretical concerns with regard to renal safety, selected patients should have preserved renal function with an estimated glomerular filtration rate of at least ≥45 ml/min/1.73 m2.

7. Optimal periprocedural management of volume status and medication regimens in specialized and experienced centers equipped with adequate infrastructure to cope with potential procedural complications will minimize potential patient risks.

8. Long-term safety and efficacy data are limited to 3 years of follow-up in small patient cohorts; thus, efforts to monitor treated patients are crucial to define long-term performance of the procedure.

9. Information on long-term safety and efficacy of the RDN procedure is being collected in national and international registries.

10. Clinicians and patients must balance the desirability of BP control, the individual patient’s desire to feel confident that BP is controlled, their reluctance to take very large numbers of tablets, their reluctance to undergo irreversible and invasive procedures, and the cost of the procedure versus the cost and consequences of letting BP continue uncontrolled while considering RDN. For addressing these issues, an accurate assessment of daily life BP control is an essential requirement, and systematic use of home and/or ambulatory BP monitoring is indicated.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension

Keywords: Denervation, Kidney Failure, Chronic, Diuretics, Blood Pressure, Metabolic Syndrome X, Cardiology, Heart Failure, Blood Pressure Monitoring, Ambulatory, White Coat Hypertension, Glomerular Filtration Rate, Catheter Ablation, Hypertension


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