title: Renal denervation in the management of resistant hypertension: current evidence and perspectives.
abstract: OBJECTIVE
  Catheter-based renal denervation has emerged as a novel treatment modality for resistant hypertension. This review summarizes the current evidence on this procedure in treatment of resistant hypertension, limitations of available evidence and questions to be answered.
  
  
  RESULTS
  The SYMPLICITY studies showed that renal denervation is feasible in treating resistant hypertension, but failed to provide conclusive evidence on the size and durability of the antihypertensive, renal and sympatholytic effects, as well as the long-term safety. The definition of resistant hypertension was loose in the SYMPLICITY studies and the management of resistant hypertension was suboptimal. Future studies should have a randomized design and enroll truly resistant hypertension patients by excluding secondary hypertension, white-coat hypertension and nonadherent patients. Questions to be addressed by the ongoing and future trials include the long-term efficacy and safety of this procedure, identification of responders and uncovering of the underlying mechanisms.
  
  
  CONCLUSIONS
  Only well-designed, randomized clinical trials addressing the limitations of the SYMPLICITY studies will be able to demonstrate whether renal denervation is an efficacious treatment modality in resistant hypertension and in which patients. For now, renal denervation remains an experimental procedure and should only be offered to truly resistant hypertensive patients in a research context after careful selection.
authors.affiliation: Studies Coordinating Centre, Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
authors.forename: Yu
authors.initials: Y
authors.lastname: Jin
authors.forename: Alexandre
authors.initials: A
authors.lastname: Persu
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D003714:Denervation / Q000009:adverse effects / Q000379:methods*; D004351:Drug Resistance; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000601:surgery*; D007668:Kidney / Q000294:innervation* / Q000601:surgery; D010349:Patient Compliance
chemical_list: D000959:Antihypertensive Agents