Renal denervation in the antihypertensive arsenal - knowns and known unknowns

Franz H. Messerli; Chirag Bavishi; Jana Brguljan; Michel Burnier; Stephan Dobner; Fernando Elijovich; Keith C. Ferdinand; Sverre Kjeldsen; Cheryl L. Laffer; C. Venkata S Ram; Emrush Rexhaj; Luis M. Ruilope; Evgeniya V. Shalaeva; George C.M. Siontis; Jan A. Staessen; Stephen C. Textor; Wanpen Vongpatanasin; Liffert Vogt; Massimo Volpe; Jiguang Wang; Bryan Williams

doi:10.1097/HJH.0000000000003171

Renal denervation in the antihypertensive arsenal - knowns and known unknowns

Franz H. Messerli, Chirag Bavishi, Jana Brguljan, Michel Burnier, Stephan Dobner, Fernando Elijovich, Keith C. Ferdinand, Sverre Kjeldsen, Cheryl L. Laffer, C. Venkata S Ram, Emrush Rexhaj, Luis M. Ruilope, Evgeniya V. Shalaeva, George C.M. Siontis, Jan A. Staessen, Stephen C. Textor, Wanpen Vongpatanasin, Liffert Vogt, Massimo Volpe, Jiguang WangBryan Williams

Nephrology and Hypertension

Research output: Contribution to journal › Article › peer-review

Abstract

Even though it has been more than a decade since renal denervation (RDN) was first used to treat hypertension and an intense effort on researching this therapy has been made, it is still not clear how RDN fits into the antihypertensive arsenal. There is no question that RDN lowers blood pressure (BP), it does so to an extent at best corresponding to one antihypertensive drug. The procedure has an excellent safety record. However, it remains clinically impossible to predict whose BP responds to RDN and whose does not. Long-term efficacy data on BP reduction are still unconvincing despite the recent results in the SPYRAL HTN-ON MED trial; experimental studies indicate that reinnervation is occurring after RDN. Although BP is an acceptable surrogate endpoint, there is complete lack of outcome data with RDN. Clear indications for RDN are lacking although patients with resistant hypertension, those with documented increase in activity of the sympathetic system and perhaps those who desire to take fewest medication may be considered.

Original language	English (US)
Pages (from-to)	1859-1875
Number of pages	17
Journal	Journal of hypertension
Volume	40
Issue number	10
DOIs	https://doi.org/10.1097/HJH.0000000000003171
State	Published - Oct 1 2022

Keywords

antihypertensive treatment
blood pressure
hypertension
refractory hypertension
renal denervation

ASJC Scopus subject areas

Internal Medicine
Physiology
Cardiology and Cardiovascular Medicine

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10.1097/HJH.0000000000003171

Cite this

Messerli, F. H., Bavishi, C., Brguljan, J., Burnier, M., Dobner, S., Elijovich, F., Ferdinand, K. C., Kjeldsen, S., Laffer, C. L., S Ram, C. V., Rexhaj, E., Ruilope, L. M., Shalaeva, E. V., Siontis, G. C. M., Staessen, J. A., Textor, S. C., Vongpatanasin, W., Vogt, L., Volpe, M., ... Williams, B. (2022). Renal denervation in the antihypertensive arsenal - knowns and known unknowns. Journal of hypertension, 40(10), 1859-1875. https://doi.org/10.1097/HJH.0000000000003171

Messerli, FH, Bavishi, C, Brguljan, J, Burnier, M, Dobner, S, Elijovich, F, Ferdinand, KC, Kjeldsen, S, Laffer, CL, S Ram, CV, Rexhaj, E, Ruilope, LM, Shalaeva, EV, Siontis, GCM, Staessen, JA, Textor, SC, Vongpatanasin, W, Vogt, L, Volpe, M, Wang, J & Williams, B 2022, 'Renal denervation in the antihypertensive arsenal - knowns and known unknowns', Journal of hypertension, vol. 40, no. 10, pp. 1859-1875. https://doi.org/10.1097/HJH.0000000000003171

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abstract = "Even though it has been more than a decade since renal denervation (RDN) was first used to treat hypertension and an intense effort on researching this therapy has been made, it is still not clear how RDN fits into the antihypertensive arsenal. There is no question that RDN lowers blood pressure (BP), it does so to an extent at best corresponding to one antihypertensive drug. The procedure has an excellent safety record. However, it remains clinically impossible to predict whose BP responds to RDN and whose does not. Long-term efficacy data on BP reduction are still unconvincing despite the recent results in the SPYRAL HTN-ON MED trial; experimental studies indicate that reinnervation is occurring after RDN. Although BP is an acceptable surrogate endpoint, there is complete lack of outcome data with RDN. Clear indications for RDN are lacking although patients with resistant hypertension, those with documented increase in activity of the sympathetic system and perhaps those who desire to take fewest medication may be considered.",

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AU - Messerli, Franz H.

AU - Bavishi, Chirag

AU - Brguljan, Jana

AU - Burnier, Michel

AU - Dobner, Stephan

AU - Elijovich, Fernando

AU - Ferdinand, Keith C.

AU - Kjeldsen, Sverre

AU - Laffer, Cheryl L.

AU - S Ram, C. Venkata

AU - Rexhaj, Emrush

AU - Ruilope, Luis M.

AU - Shalaeva, Evgeniya V.

AU - Siontis, George C.M.

AU - Staessen, Jan A.

AU - Textor, Stephen C.

AU - Vongpatanasin, Wanpen

AU - Vogt, Liffert

AU - Volpe, Massimo

AU - Wang, Jiguang

AU - Williams, Bryan

PY - 2022/10/1

Y1 - 2022/10/1

N2 - Even though it has been more than a decade since renal denervation (RDN) was first used to treat hypertension and an intense effort on researching this therapy has been made, it is still not clear how RDN fits into the antihypertensive arsenal. There is no question that RDN lowers blood pressure (BP), it does so to an extent at best corresponding to one antihypertensive drug. The procedure has an excellent safety record. However, it remains clinically impossible to predict whose BP responds to RDN and whose does not. Long-term efficacy data on BP reduction are still unconvincing despite the recent results in the SPYRAL HTN-ON MED trial; experimental studies indicate that reinnervation is occurring after RDN. Although BP is an acceptable surrogate endpoint, there is complete lack of outcome data with RDN. Clear indications for RDN are lacking although patients with resistant hypertension, those with documented increase in activity of the sympathetic system and perhaps those who desire to take fewest medication may be considered.

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Renal denervation in the antihypertensive arsenal - knowns and known unknowns

Abstract

Keywords

ASJC Scopus subject areas

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