title: Renal artery denervation for treating resistant hypertension : definition of the disease, patient selection and description of the procedure.
abstract: Arterial hypertension is responsible for a significant burden of cardiovascular morbidity and mortality, worldwide. Although several rational and integrated pharmacological strategies are available, the control of high blood pressure still remains largely unsatisfactory. Failure to achieve effective blood pressure control in treated hypertensive patients may have a substantial impact on individual global cardiovascular risk, since it significantly increases the risk of developing hypertension-related macrovascular and microvascular complications. Arterial hypertension is arbitrarily defined as 'resistant' or 'refractory' when the recommended blood pressure goals (clinic blood pressure below 140/90 mmHg or below 130/80 mmHg in patients with type 2 diabetes mellitus or nephropathy) are not achieved in the presence of a therapeutic strategy that includes lifestyle changes and at least three classes of antihypertensive drugs, including a diuretic, at adequate doses. Recently, an innovative non-pharmacological option has become available for treating resistant hypertension. Sympathetic denervation of renal arteries is a minimally invasive procedure that is performed via percutaneous access from the femoral artery. It consists of radiofrequency ablation of the afferent and efferent nerves of the renal sympathetic nervous system, with consequent isolation of renal parenchymal and juxtaglomerular structures from abnormal stimulation of the efferent adrenergic system. The present position paper of the Italian Society of Hypertension (SIIA) offers a diagnostic and therapeutic approach for the proper identification and effective clinical management of patients with resistant hypertension, who are candidates for renal artery denervation. These indications may have important implications not only from a clinical point of view, but also from an economic point of view, since a proper identification of patients with true resistant hypertension and an accurate selection of patients suitable for the procedure of renal denervation can contribute to an improved control of blood pressure, and thus a reduced risk of cardiovascular and cerebrovascular complications in these patients.
authors: Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant' Andrea Hospital, and IRCCS Neuromed, Rome, Via di Grottarossa 1035-39, 00189, Pozzilli, Isernia, Rome, Italy. massimo.volpe@uniroma1.it
authors: Massimo
authors: M
authors: Volpe
authors: Enrico Agabiti
authors: EA
authors: Rosei
authors: Ettore
authors: E
authors: Ambrosioni
authors: Santina
authors: S
authors: Cottone
authors: Cesare
authors: C
authors: Cuspidi
authors: Claudio
authors: C
authors: Borghi
authors: Nicola
authors: N
authors: De Luca
authors: Francesco
authors: F
authors: Fallo
authors: Claudio
authors: C
authors: Ferri
authors: Giuseppe
authors: G
authors: Mancia
authors: Alberto
authors: A
authors: Morganti
authors: Maria Lorenza
authors: ML
authors: Muiesan
authors: Riccardo
authors: R
authors: Sarzani
authors: Leonardo
authors: L
authors: Sechi
authors: Giuliano
authors: G
authors: Tocci
authors: Agostino
authors: A
authors: Virdis
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D062186:Arterial Pressure / Q000187:drug effects; D017115:Catheter Ablation / Q000009:adverse effects / Q000592:standards; D004351:Drug Resistance; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D012077:Renal Artery / Q000294:innervation*; D018570:Risk Assessment; D012307:Risk Factors; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents