title: Eligibility for percutaneous renal denervation: the importance of a systematic screening.
abstract: OBJECTIVE
  Percutaneous renal denervation (pRDN) is a new and promising therapy for resistant hypertension. Among patients suspected of having resistant hypertension, the actual presence of this condition needs to be well established; pseudoresistant hypertension and significant white-coat effect (WCE) should be excluded. This analysis presents the results of a standardized screening programme for patients referred for pRDN.
  
  
  METHODS
  All patients referred to our centre for pRDN underwent a standardized stepwise screening and were subsequently discussed in a multidisciplinary team. The screening included a 24-h ambulatory blood pressure measurement (ABPM), collection of plasma, urine and saliva, and finally imaging of the renal arteries.
  
  
  RESULTS
  From August 2010 till October 2012, 181 patients were referred for pRDN. Mean blood pressure (BP) was 182/100 mmHg, and median use was three antihypertensives. Ultimately, 121 patients (67%) were excluded from pRDN. Main reasons for exclusion were BP-related. Twenty-three patients (19%) had an office SBP less than 160 mmHg and 26 patients (22%) showed a WCE. Fourteen patients (12%) had a so far undetected underlying cause of hypertension, the majority being primary aldosteronism (n = 11). Nine patients had an ineligible renal anatomy.
  
  
  CONCLUSIONS
  A high percentage of patients were excluded from treatment with pRDN due to secondary causes of hypertension, WCE or a BP below the currently advised thresholds. Treatment of these excluded patients would lead to inappropriate use of pRDN, leading most likely to little benefit for the patients and a burden to healthcare. Therefore, it is recommended to use a standardized screening before treatment with pRDN.
authors.affiliation: Department of Vascular Medicine, University Medical Center Utrecht The Netherlands.
authors.forename: Willemien L
authors.initials: WL
authors.lastname: Verloop
authors.forename: Eva E
authors.initials: EE
authors.lastname: Vink
authors.forename: Michiel
authors.initials: M
authors.lastname: Voskuil
authors.forename: Evert-Jan
authors.initials: EJ
authors.lastname: Vonken
authors.forename: Maarten B
authors.initials: MB
authors.lastname: Rookmaaker
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.forename: Wilko
authors.initials: W
authors.lastname: Spiering
mesh_terms: D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D015331:Cohort Studies; D003714:Denervation; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis; D006973:Hypertension / Q000175:diagnosis* / Q000628:therapy*; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008403:Mass Screening; D055118:Medication Adherence; D008875:Middle Aged; D018579:Patient Selection; D013997:Time Factors; D059466:White Coat Hypertension / Q000175:diagnosis*