title: [Renal denervation for the treatment of resistant hypertension: definition, patient selection and description of the procedure. 2012 Position paper of the Italian Society of Hypertension].
abstract: Hypertension is responsible for a relevant burden of cardiovascular morbidity and mortality worldwide. Although several appropriate and integrated pharmacological strategies are available, blood pressure control still remains largely unsatisfactory. Failure to achieve effective blood pressure control in treated hypertensive patients may have a substantial impact on overall cardiovascular risk, since it significantly increases the risk of both macrovascular and microvascular complications. Hypertension is arbitrarily defined as "resistant" or "refractory" when recommended blood pressure goals (clinic blood pressure <140/90 mmHg, or <130/80 mmHg in patients with type 2 diabetes mellitus) are not achieved, despite changes in lifestyle and treatment with adequate doses of at least three antihypertensive drugs from different classes, including a diuretic. A new non-pharmacological option for the treatment of patients with resistant hypertension has recently become available. Renal sympathetic denervation is a minimally invasive procedure performed via femoral access that uses radiofrequency catheter ablation to disable renal sympathetic afferent and efferent nerves. It results in isolation of renal parenchymal and juxtaglomerular cells from the abnormal enhancement of renal adrenergic nerve activity. The present position paper of the Italian Society of Hypertension provides a diagnostic and therapeutic approach to the early identification and effective clinical management of patients with resistant hypertension, who may be candidates for renal denervation. These indications may have important implications not only from a clinical viewpoint but also from an economic perspective. The accurate identification of patients with resistant hypertension and the appropriate selection of patients eligible for this procedure may help improve blood pressure control and reduce the risk of cardiovascular and cerebrovascular complications in these patients.
authors.affiliation: Cattedra e Struttura Complessa di Cardiologia, Dipartimento di Medicina Clinica e Molecolare, Sapienza Universitá di Roma, Azienda Ospedaliera Sant'Andrea, Roma. massimo.volpe@uniroma1.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Volpe
authors.forename: Enrico
authors.initials: E
authors.lastname: Agabiti-Rosei
authors.forename: Ettore
authors.initials: E
authors.lastname: Ambrosioni
authors.forename: Santina
authors.initials: S
authors.lastname: Cottone
authors.forename: Cesare
authors.initials: C
authors.lastname: Cuspidi
authors.forename: Claudio
authors.initials: C
authors.lastname: Borghi
authors.forename: Nicola
authors.initials: N
authors.lastname: De Luca
authors.forename: Francesco
authors.initials: F
authors.lastname: Fallo
authors.forename: Claudio
authors.initials: C
authors.lastname: Ferri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Alberto
authors.initials: A
authors.lastname: Morganti
authors.forename: Maria Lorenza
authors.initials: ML
authors.lastname: Muiesan
authors.forename: Riccardo
authors.initials: R
authors.lastname: Sarzani
authors.forename: Leonardo
authors.initials: L
authors.lastname: Sechi
authors.forename: Giuliano
authors.initials: G
authors.lastname: Tocci
authors.forename: Agostino
authors.initials: A
authors.lastname: Virdis
mesh_terms: D003714:Denervation / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000601:surgery*; D007668:Kidney / Q000294:innervation* / Q000601:surgery*; D018579:Patient Selection