Renal Denervation for Treating Hypertension Current Scientific and Clinical Evidence

Michael A. Weber, Felix Mahfoud, Roland E. Schmieder, David E. Kandzari, Konstantinos P. Tsioufis, Raymond R. Townsend, Kazuomi Kario, Michael Bohm, Andrew S. P. Sharp, Justin E. Davies, John W. Osborn, Greg D. Fink, David E. Euler, Debbie L. Cohen, Markus P. Schlaich, Murray D. Esler

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Initial studies of catheter-based renal denervation (RDN) for uncontrolled HTN using radiofrequency ablation in the main renal arteries showed that RDN was effective in lowering office blood pressure (BP). However, the first randomized sham-controlled trial, SYMPLICITY-HTN-3, did not show significantly lower office or 24-h ambulatory systolic BP compared with sham treatment. Subsequent studies in both animals and humans demonstrated the potential importance of more distal and branch renal artery radiofrequency ablation, and a second-generation multielectrode system became available. Two recent randomized sham-controlled trials in patients not taking antihypertensive drugs (SPYRAL HTN-OFF MED) or continuing to take drugs (SPYRAL HTN-ON MED) performed RDN with the second-generation radiofrequency ablation system using an ablation protocol that included treatment of the distal renal artery as well as the branch renal arteries. These studies showed that RDN significantly reduced office and 24-h ambulatory BP compared with sham treatment. Another recent randomized sham-controlled trial in patients not receiving medications showed that RDN with catheter-based ultrasound (RADIANCE-HTN SOLO) applied in just the main renal arteries significantly lowered daytime ambulatory and office BP compared with sham treatment. These trials have renewed clinical and scientific interest in defining the appropriate role of RDN in hypertension treatment. In addition, other important issues will need to be addressed in the future such as the development of tests to determine the extent of RDN at the time of the procedure and the potential of renal nerve fibers to regain their patency at some later stage following the ablation procedure. (C) 2019 by the American College of Cardiology Foundation.

Original languageEnglish
Pages (from-to)1095-1105
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume12
Issue number12
DOIs
Publication statusPublished - 24 Jun 2019

Cite this

Weber, M. A., Mahfoud, F., Schmieder, R. E., Kandzari, D. E., Tsioufis, K. P., Townsend, R. R., ... Esler, M. D. (2019). Renal Denervation for Treating Hypertension Current Scientific and Clinical Evidence. JACC: Cardiovascular Interventions, 12(12), 1095-1105. https://doi.org/10.1016/j.jcin.2019.02.050
Weber, Michael A. ; Mahfoud, Felix ; Schmieder, Roland E. ; Kandzari, David E. ; Tsioufis, Konstantinos P. ; Townsend, Raymond R. ; Kario, Kazuomi ; Bohm, Michael ; Sharp, Andrew S. P. ; Davies, Justin E. ; Osborn, John W. ; Fink, Greg D. ; Euler, David E. ; Cohen, Debbie L. ; Schlaich, Markus P. ; Esler, Murray D. / Renal Denervation for Treating Hypertension Current Scientific and Clinical Evidence. In: JACC: Cardiovascular Interventions. 2019 ; Vol. 12, No. 12. pp. 1095-1105.
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abstract = "Initial studies of catheter-based renal denervation (RDN) for uncontrolled HTN using radiofrequency ablation in the main renal arteries showed that RDN was effective in lowering office blood pressure (BP). However, the first randomized sham-controlled trial, SYMPLICITY-HTN-3, did not show significantly lower office or 24-h ambulatory systolic BP compared with sham treatment. Subsequent studies in both animals and humans demonstrated the potential importance of more distal and branch renal artery radiofrequency ablation, and a second-generation multielectrode system became available. Two recent randomized sham-controlled trials in patients not taking antihypertensive drugs (SPYRAL HTN-OFF MED) or continuing to take drugs (SPYRAL HTN-ON MED) performed RDN with the second-generation radiofrequency ablation system using an ablation protocol that included treatment of the distal renal artery as well as the branch renal arteries. These studies showed that RDN significantly reduced office and 24-h ambulatory BP compared with sham treatment. Another recent randomized sham-controlled trial in patients not receiving medications showed that RDN with catheter-based ultrasound (RADIANCE-HTN SOLO) applied in just the main renal arteries significantly lowered daytime ambulatory and office BP compared with sham treatment. These trials have renewed clinical and scientific interest in defining the appropriate role of RDN in hypertension treatment. In addition, other important issues will need to be addressed in the future such as the development of tests to determine the extent of RDN at the time of the procedure and the potential of renal nerve fibers to regain their patency at some later stage following the ablation procedure. (C) 2019 by the American College of Cardiology Foundation.",
keywords = "ambulatory blood pressure, hypertension, radiofrequency, renal denervation, ultrasound, TREATMENT-RESISTANT HYPERTENSION, RANDOMIZED CONTROLLED-TRIAL, BLOOD-PRESSURE REDUCTION, SYMPATHETIC DENERVATION, SYMPLICITY HTN-3, ADHERENCE, SYSTEM, IMPACT, SAFETY, NERVES",
author = "Weber, {Michael A.} and Felix Mahfoud and Schmieder, {Roland E.} and Kandzari, {David E.} and Tsioufis, {Konstantinos P.} and Townsend, {Raymond R.} and Kazuomi Kario and Michael Bohm and Sharp, {Andrew S. P.} and Davies, {Justin E.} and Osborn, {John W.} and Fink, {Greg D.} and Euler, {David E.} and Cohen, {Debbie L.} and Schlaich, {Markus P.} and Esler, {Murray D.}",
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Weber, MA, Mahfoud, F, Schmieder, RE, Kandzari, DE, Tsioufis, KP, Townsend, RR, Kario, K, Bohm, M, Sharp, ASP, Davies, JE, Osborn, JW, Fink, GD, Euler, DE, Cohen, DL, Schlaich, MP & Esler, MD 2019, 'Renal Denervation for Treating Hypertension Current Scientific and Clinical Evidence' JACC: Cardiovascular Interventions, vol. 12, no. 12, pp. 1095-1105. https://doi.org/10.1016/j.jcin.2019.02.050

Renal Denervation for Treating Hypertension Current Scientific and Clinical Evidence. / Weber, Michael A.; Mahfoud, Felix; Schmieder, Roland E.; Kandzari, David E.; Tsioufis, Konstantinos P.; Townsend, Raymond R.; Kario, Kazuomi; Bohm, Michael; Sharp, Andrew S. P.; Davies, Justin E.; Osborn, John W.; Fink, Greg D.; Euler, David E.; Cohen, Debbie L.; Schlaich, Markus P.; Esler, Murray D.

In: JACC: Cardiovascular Interventions, Vol. 12, No. 12, 24.06.2019, p. 1095-1105.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Renal Denervation for Treating Hypertension Current Scientific and Clinical Evidence

AU - Weber, Michael A.

AU - Mahfoud, Felix

AU - Schmieder, Roland E.

AU - Kandzari, David E.

AU - Tsioufis, Konstantinos P.

AU - Townsend, Raymond R.

AU - Kario, Kazuomi

AU - Bohm, Michael

AU - Sharp, Andrew S. P.

AU - Davies, Justin E.

AU - Osborn, John W.

AU - Fink, Greg D.

AU - Euler, David E.

AU - Cohen, Debbie L.

AU - Schlaich, Markus P.

AU - Esler, Murray D.

PY - 2019/6/24

Y1 - 2019/6/24

N2 - Initial studies of catheter-based renal denervation (RDN) for uncontrolled HTN using radiofrequency ablation in the main renal arteries showed that RDN was effective in lowering office blood pressure (BP). However, the first randomized sham-controlled trial, SYMPLICITY-HTN-3, did not show significantly lower office or 24-h ambulatory systolic BP compared with sham treatment. Subsequent studies in both animals and humans demonstrated the potential importance of more distal and branch renal artery radiofrequency ablation, and a second-generation multielectrode system became available. Two recent randomized sham-controlled trials in patients not taking antihypertensive drugs (SPYRAL HTN-OFF MED) or continuing to take drugs (SPYRAL HTN-ON MED) performed RDN with the second-generation radiofrequency ablation system using an ablation protocol that included treatment of the distal renal artery as well as the branch renal arteries. These studies showed that RDN significantly reduced office and 24-h ambulatory BP compared with sham treatment. Another recent randomized sham-controlled trial in patients not receiving medications showed that RDN with catheter-based ultrasound (RADIANCE-HTN SOLO) applied in just the main renal arteries significantly lowered daytime ambulatory and office BP compared with sham treatment. These trials have renewed clinical and scientific interest in defining the appropriate role of RDN in hypertension treatment. In addition, other important issues will need to be addressed in the future such as the development of tests to determine the extent of RDN at the time of the procedure and the potential of renal nerve fibers to regain their patency at some later stage following the ablation procedure. (C) 2019 by the American College of Cardiology Foundation.

AB - Initial studies of catheter-based renal denervation (RDN) for uncontrolled HTN using radiofrequency ablation in the main renal arteries showed that RDN was effective in lowering office blood pressure (BP). However, the first randomized sham-controlled trial, SYMPLICITY-HTN-3, did not show significantly lower office or 24-h ambulatory systolic BP compared with sham treatment. Subsequent studies in both animals and humans demonstrated the potential importance of more distal and branch renal artery radiofrequency ablation, and a second-generation multielectrode system became available. Two recent randomized sham-controlled trials in patients not taking antihypertensive drugs (SPYRAL HTN-OFF MED) or continuing to take drugs (SPYRAL HTN-ON MED) performed RDN with the second-generation radiofrequency ablation system using an ablation protocol that included treatment of the distal renal artery as well as the branch renal arteries. These studies showed that RDN significantly reduced office and 24-h ambulatory BP compared with sham treatment. Another recent randomized sham-controlled trial in patients not receiving medications showed that RDN with catheter-based ultrasound (RADIANCE-HTN SOLO) applied in just the main renal arteries significantly lowered daytime ambulatory and office BP compared with sham treatment. These trials have renewed clinical and scientific interest in defining the appropriate role of RDN in hypertension treatment. In addition, other important issues will need to be addressed in the future such as the development of tests to determine the extent of RDN at the time of the procedure and the potential of renal nerve fibers to regain their patency at some later stage following the ablation procedure. (C) 2019 by the American College of Cardiology Foundation.

KW - ambulatory blood pressure

KW - hypertension

KW - radiofrequency

KW - renal denervation

KW - ultrasound

KW - TREATMENT-RESISTANT HYPERTENSION

KW - RANDOMIZED CONTROLLED-TRIAL

KW - BLOOD-PRESSURE REDUCTION

KW - SYMPATHETIC DENERVATION

KW - SYMPLICITY HTN-3

KW - ADHERENCE

KW - SYSTEM

KW - IMPACT

KW - SAFETY

KW - NERVES

U2 - 10.1016/j.jcin.2019.02.050

DO - 10.1016/j.jcin.2019.02.050

M3 - Review article

VL - 12

SP - 1095

EP - 1105

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

SN - 1876-7605

IS - 12

ER -

Weber MA, Mahfoud F, Schmieder RE, Kandzari DE, Tsioufis KP, Townsend RR et al. Renal Denervation for Treating Hypertension Current Scientific and Clinical Evidence. JACC: Cardiovascular Interventions. 2019 Jun 24;12(12):1095-1105. https://doi.org/10.1016/j.jcin.2019.02.050