Position paper on renal denervation for the treatment of hypertension
After the publication of the 2018 ESH/ESC Guidelines on the management of hypertension, five new sham-controlled RCTs were published which consistently demonstrated that renal denervation (RDN) is an evidence-based option to treat hypertension [1-5]. The ESH position paper provides information about the efficacy, durability and safety of RDN in patients with hypertension. In addition, knowledge gaps that still exists are listed and updated recommendations regarding the pathway for clinical use of RDN are described.
The five completed sham-controlled RCTs consistently demonstrated that RDN was effective and well tolerated in patients with hypertension, in the presence and absence of concomitant antihypertensive pharmacotherapy [1-5]. The decrease in ambulatory BP in the RDN groups ranged from -4.7 to -9.0 mmHg systolic and from -3.7 to -6.0 mmHg diastolic in the five RCTs. The decrease in office BP ranged from -9.0 to -10.8 mmHg systolic and from -5.0 to -0.5 mmHg diastolic. No peri-procedural, short-term or long-term (data available up to 3 years) safety signals have been observed. The durability of BP lowering effects of RDN have not been extensively investigated yet, although available follow-up data for up to 3 years suggests that the antihypertensive effect of RDN in humans is durable.
The authors of the position paper state that several open questions regarding RDN therapy remain. One of the major challenges is that a large variability in BP response after RDN treatment exists. Identification of predictors of BP response to RDN is therefore of importance to select patients that will benefit most from RDN therapy. The authors also stress that a structured and transparent pathway for clinical use of RDN needs to be established.