Renal sympathetic denervation

Renal sympathetic denervation
Other namesRenal denervation

Renal sympathetic denervation (RSDN) is a minimally invasive, endovascular catheter based procedure using radiofrequency ablation or ultrasound ablation aimed at treating resistant hypertension (high blood pressure not controlled by medication).[1] Nerves in the wall of the renal artery are ablated by applying radiofrequency pulses or ultrasound to the renal arteries. This causes reduction of sympathetic afferent and efferent activity to the kidney and blood pressure can be decreased.[2] Early data from international clinical trials without sham controls was promising - demonstrating large blood pressure reductions in patients with treatment-resistant hypertension.[2][3] However, in 2014 a prospective, single-blind, randomized, sham-controlled clinical trial failed to confirm a beneficial effect on blood pressure.[4] A 2014 consensus statement from The Joint UK Societies did not recommend the use of renal denervation for treatment of resistant hypertension on current evidence.[5] More recent sham-controlled trials suggest renal denervation can lead to lower systolic blood pressure.[6][7][8]

  1. ^ Goel A (3 June 2016). "Renal sympathetic denervation". Radiopaedia. doi:10.53347/rID-37149. Retrieved 8 June 2022.
  2. ^ a b Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Böhm M (December 2010). "Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial". Lancet. 376 (9756): 1903–9. doi:10.1016/S0140-6736(10)62039-9. PMID 21093036. S2CID 22838976. S2CID link provides full text access with a free registration; DOI link requires a subscription to get full text access.
  3. ^ Symplicity HTN-1 Investigators (May 2011). "Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months". Hypertension. 57 (5): 911–7. doi:10.1161/HYPERTENSIONAHA.110.163014. PMID 21403086.{{cite journal}}: CS1 maint: numeric names: authors list (link)
  4. ^ Bhatt DL, Kandzari DE, O'Neill WW, D'Agostino R, Flack JM, Katzen BT, Leon MB, Liu M, Mauri L, Negoita M, Cohen SA, Oparil S, Rocha-Singh K, Townsend RR, Bakris GL, et al. (SYMPLICITY HTN-3 Investigators) (April 2014). "A controlled trial of renal denervation for resistant hypertension". The New England Journal of Medicine. 370 (15): 1393–401. doi:10.1056/NEJMoa1402670. PMID 24678939.
  5. ^ Lobo MD, de Belder MA, Cleveland T, Collier D, Dasgupta I, Deanfield J, Kapil V, Knight C, Matson M, Moss J, Paton JF, Poulter N, Simpson I, Williams B, Caulfield MJ, et al. (British Cardiovascular Intervention Society) (January 2015). "Joint UK societies' 2014 consensus statement on renal denervation for resistant hypertension". Heart. 101 (1): 10–6. doi:10.1136/heartjnl-2014-307029. PMC 4283620. PMID 25431461.
  6. ^ Bohm (2020). "Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial". Lancet. 395 (10234): 1444–1451. doi:10.1016/S0140-6736(20)30554-7. PMID 32234534. S2CID 214699992.(subscription required)
  7. ^ Kandzari (2018). "Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial" (PDF). Lancet. 391 (10137): 2346–2355. doi:10.1016/S0140-6736(18)30951-6. PMID 29803589. S2CID 44126211. S2CID link provides free access (with registration) to an apparent draft of the manuscript. DOI full text access requires a subscription.
  8. ^ Azizi (2018). "Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial" (PDF). Lancet. 391 (10137): 2335–2345. doi:10.1016/S0140-6736(18)31082-1. PMID 29803590. S2CID 44132340.(subscription required)