Concept, techniques and clinical effectiveness of renal nerve ablation in hypertension

Summary

Arterial hypertension represents a significant global health burden. Despite lifestyle modification and the availability of effective antihypertensive drugs, blood pressure control remains suboptimal worldwide. Several factors account for that problem, among them non-compliance of physicians and patients, untreated secondary forms of hypertension and true treatment-resistant hypertension (i.e. blood pressure > 140/90 mmHg in spite of 3 antihypertensive drugs including a diuretic).

Both experimental and clinical studies have emphasised the important role of sympathetic nervous system activation in the development and progression of arterial hypertension. Catheter-based renal denervation is a new therapeutic option to reduce renal sympathetic nerve traffic in experimental and human hypertension. The data so far obtained in patients with drug-resistant hypertension have demonstrated that this procedure may reduce blood pressure effectively and safely, if renal nerve ablation has been performed properly.

Targeting the renal sympathetic nerves could also be an attractive future strategy for other diseases, where the activation of the sympathetic nervous system plays an important pathophysiological role such as in sleep apnoea syndrome, heart failure, chronic kidney disease or polycystic ovary syndrome.

Importance of hypertension

HISTORICAL PERSPECTIVE

High blood pressure (systemic arterial hypertension) was only recognised as a clinical entity in the 20th century. In...