renal nerve ablation; renal sympathetic denervation
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Indications
- persistent hypertension not responsive to medical therapy[1][2]
Procedure
- radiofrequency ablation within each renal artery
Complications
- renal artery dissection
- pseudoaneurysm at the femoral access site
Notes
- did not lower blood pressure significantly in a sham-controlled trial[3]
- trials to continue after the catheters modified[4]
- did lower blood pressure significantly in a sham-controlled trial[5]
- lowered systolic blood pressure 9.0 vs 1.6 & 8.5 vs 2.2 mm Hg in 2 sham controlled trials[6]
- delaying renal denrvation does not diminish anit-hypertensive effectiveness of procedure[7]
- sustained blood pressure reduction with use of multiple antihypertensives[8]
- blood pressure reduction is variable, reductions of systolic BP of ~ 5 mm Hg observed in many trials[9]
- systolic BP reductions of > 10 mm Hg not observed in recent sham controlled trials[9]
More general terms
References
- ↑ 1.0 1.1 Krum H et al. Catheter-based renal sympathetic denervation for resistant hypertension: A multicentre safety and proof-of-principle cohort study. Lancet 2009 Mar 30; [e-pub ahead of print] http://dx.doi.org/10.1016/S0140-6736(09)60566-3
Doumas M and Douma S. Interventional management of resistant hypertension. Lancet 2009 Mar 30; [e-pub ahead of print]. http://dx.doi.org/10.1016/S0140-6736(09)60624-3
Krum H et al. Percutaneous renal denervation in patients with treatment- resistant hypertension: Final 3-year report of the Symplicity HTN-1 study. Lancet 2013 Nov 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24210779 - ↑ 2.0 2.1 Brandt MC et al. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol 2012 Mar 6; 59:901. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22381425
Zile MR and Little WC. Effects of autonomic modulation: More than just blood pressure. J Am Coll Cardiol 2012 Mar 6; 59:910. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22381426 - ↑ 3.0 3.1 Bhatt DL, Kandzari DE, O'Neill WW et al SYMPLICITY HTN-3 Investigators. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014 Apr 10;370(15):1393-401 PMID: https://www.ncbi.nlm.nih.gov/pubmed/246789393
Bhatt DL, Bakris GL. Renal denervation for resistant hypertension. N Engl J Med. 2014 Jul 10;371(2):184. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25006731 - ↑ 4.0 4.1 Husten L, Sadough S, Sofair A Companies Plan To Resume Renal Denervation Trials Physician's First Watch, Feb 23, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
- ↑ 5.0 5.1 Townsend RR, Mahfoud F, Kandzari DE et al. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): A randomised, sham-controlled, proof-of-concept trial. Lancet. 2017 Aug 25. pii: S0140-6736(17)32281-X <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28859944 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32281-X/fulltext
Azizi M. Catheter-based renal denervation for treatment of hypertension. Lancet 2017 Aug 28 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28859945 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32293-6/fulltext - ↑ 6.0 6.1 Kandzari DE, Bohm M, Mahfoud F et al 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/ Lancet. May 23, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29803589 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30951-6/fulltext
Azizi M, Schmieder RE, Mahfoud F et al Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial. Lancet. May 23, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29803590 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31082-1/fulltext
Blankestijn PJ, Bots ML Renal denervation in uncontrolled hypertension: the story continues to unfold. Lancet. May 23, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29803591 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31112-7/fulltext
Kjeldsen SE, Esler MD Take a blood pressure pill or undergo renal denervation? Lancet. May 23, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29803587 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31126-7/fulltext - ↑ 7.0 7.1 Lou N Renal Denervation: No Rush for BP-Lowering Benefit = RADIANCE-HTN SOLO data suggest a little more time for med optimization does no harm. MedPage Today June 26, 2020 https://www.medpagetoday.com/meetingcoverage/europcr/87309
- ↑ 8.0 8.1 Sesa-Ashton G, Nolde JM, Muente I, et al. Long-term blood pressure reductions following catheter-based renal denervation: A systematic review and meta-analysis. Hypertension 2024 Mar 20; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38506059 https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.123.22314
- ↑ 9.0 9.1 9.2 Cluett JL, Blazek O, Brown AL et al. Renal denervation for the treatment of hypertension: A scientific statement from the American Heart Association. Hypertension 2024 Oct; 81:e135 PMID: https://www.ncbi.nlm.nih.gov/pubmed/39101202 Free article. Review. https://www.ahajournals.org/doi/10.1161/HYP.0000000000000240