Concept, techniques, and clinical effectiveness of renal denervation in hypertension

Summary

Elevated blood pressure (BP) is the most prevalent modifiable risk factor for cardiovascular disease. Pharmacological BP lowering reduces the risk of cardiovascular disease events and all-cause mortality. Despite the availability of numerous safe and effective medications, the global rates of BP control remain unacceptably low. Several factors contribute to this issue, including limited awareness of hypertension among patients and clinicians, insufficient diagnosis, and poor adherence to lifestyle recommendations and antihypertensive medications. Various interventional therapies have been developed and investigated for the treatment of hypertension—most of these targeting the autonomous nervous system. Among these, most evidence is available for catheter-based renal denervation (RDN). Recent second-generation, sham-controlled trials involving patients with a wide range of hypertension—with and without antihypertensive medications—have demonstrated both the safety and BP-lowering efficacy of radiofrequency and ultrasound RDN. These results have led to the incorporation of RDN into the European and American hypertension management guidelines.

Introduction

Elevated blood pressure (BP) remains the most prevalent modifiable risk factor for cardiovascular morbidity and mortality worldwide. 1