ESC and EAPCI publish guide on patient and centre selection for renal denervation

he European Society of Cardiology (ESC) and the European Association of Percutaneous Cardiovascular Internventions (EAPCI) have together developed an expert consensus document on catheter-based renal denervation [1]. The paper, published in European Heart Journal, is a guide to patient selection, centre selection, efficacy, safety, limitation and potential new indications for referring physicians, interventionalists and healthcare providers.

Patients with high blood pressure (BP)  who are resistant to treatment are at high risk of cardiovascular events, including heart attack. This is true for up to 10% of patients with high blood pressure. Catheter-based renal denervation reduces BP in patients who do not respond to conventional drug therapy.
Renal denervation involves radiofrequency ablation of the renal sympathetic nerves via a catheter. It resets renal blood pressure regulation and reduces whole body sympathetic nerve activity. Increased activity of the sympathetic nervous system is seen in conditions such as heart failure, diabetes, arrhythmia, chronic kidney disease and obstructive sleep apnea. Renal denervation is believed to be a promising treatment option to reduce high sympathetic activity.

This technique has become more widely applied in Europe, and several National Societies have issued guidance on which hypertensive patients should receive treatment. The expert consensus of ESC and EAPCI now states that renal denervation is currently indicated for blood pressure control in patients with treatment resistant hypertension (systolic BP>160 mmHg or >150 mmHg in type 2 diabetes) despite treatment with at least three antihypertensive drugs or different types in adequate doses, including one diuretic, and lifestyle modification. Secondary causes of hypertension that may be curable should be excluded. The paper furthermore prescribes that centres should be specialised in the management of hypertension.
The Symplicity HTN-1 trial showed that renal denervation had a sustained BP-lowering effect over three years [2]. Thus far no renervation is seen in these patients, but longer follow-up is needed.
Renal denervation does not substitute normal antihypertensive treatment: patients should keep taking their medications.

References

1. Mahfoud F, Lüscher TF, Andersson B, et al. Expert consensus document from the European Society of Cardiology on catheter-based renal denervation. European Heart Journal. 2013; online publish-ahead-of-print 24 April 2013.  Doi:10.1093/eurheartj/eht154
2. Krum H, Barman N, Schlaich M, Sobotka P, et al. Long-term follow-up of catheter-based renal sympathetic denervation for resistant hypertension confirms durable blood pressure reduction. J Am Coll Cardiol. 2012;59(13):E1704.