title: Review of the state of renal nerve ablation for patients with severe and resistant hypertension.
abstract: Through modulation of renin secretion, glomerular filtration rate, and renal absorption of sodium, the sympathetic innervation of the kidneys plays an important role in the pathogenesis of hypertension. Renal nerve ablation technology is being developed for treatment of drug-treatment-resistant hypertension worldwide. Preliminary research with the use of radiofrequency-based renal denervation systems have demonstrated encouraging results with significant reduction of blood pressure in patients inadequately controlled despite nearly maximal drug therapy regimens. From work done thus far, the renal denervation procedure has not been associated with serious adverse effects. Long-term efficacy and safety still needs to be established for renal nerve ablation. This review focuses on the impact of the renal sympathetic system on blood pressure regulation, the clinical rationale for renal nerve ablation in severe and drug-treatment-resistant hypertension, and current evidence from the more advanced renal denervation devices.
authors: Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT.
authors: Vinay
authors: V
authors: Gulati
authors: Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT. Electronic address: wwhite@nso1.uchc.edu.
authors: William B
authors: WB
authors: White
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D017115:Catheter Ablation; D004351:Drug Resistance; D006801:Humans; D006977:Hypertension, Renal / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000294:innervation* / Q000503:physiopathology; D013562:Sympathectomy / Q000379:methods*
keywords: Resistant hypertension; renal nerve ablation; sympathetic nervous system
references: Hypertension. 1988 Jan;11(1):3-20
references: 2828236
references: Hypertension. 2011 Oct;58(4):559-65
references: 21844482
references: Transplantation. 1988 Aug;46(2):234-7
references: 2900564
references: Eur Heart J. 2013 Jul;34(28):2149-57
references: 23620497
references: J Am Med Assoc. 1949 Jun 18;140(7):592-602
references: 18131738
references: J Clin Hypertens (Greenwich). 2012 Sep;14(9):654-5
references: 22947367
references: Acta Physiol Scand. 1989 Apr;135(4):487-92
references: 2525311
references: Clin Res Cardiol. 2012 Jan;101(1):63-7
references: 21960416
references: Lancet. 2010 Dec 4;376(9756):1903-9
references: 21093036
references: N Engl J Med. 1992 Dec 31;327(27):1912-8
references: 1454086
references: Am J Hypertens. 2000 Jun;13(6 Pt 2):99S-105S
references: 10921528
references: Diabetologia. 2005 Jul;48(7):1359-65
references: 15933859
references: Physiol Rev. 1991 Jul;71(3):659-82
references: 1647536
references: Int J Cardiol. 2013 Sep 10;167(6):2846-51
references: 22917547
references: EuroIntervention. 2012 Jan;7(9):1077-80
references: 21959556
references: Am J Physiol. 1991 Feb;260(2 Pt 2):R298-305
references: 1996717
references: Circulation. 2011 May 10;123(18):1940-6
references: 21518978
references: Circulation. 2011 Jan 18;123(2):209-15
references: 21242507
references: J Am Soc Nephrol. 2012 Jul;23(7):1250-7
references: 22595301
references: Hypertension. 2012 Jul;60(1):172-8
references: 22585944
references: J Hypertens. 2011 May;29(5):991-6
references: 21358414
references: Clin Cardiol. 2012 Sep;35(9):528-35
references: 22573363
references: Ann Surg. 1941 Oct;114(4):753-75
references: 17857907
references: J Am Coll Cardiol. 2012 Mar 6;59(10):901-9
references: 22381425
references: J Neurosci. 1983 Apr;3(4):714-24
references: 6131947
references: Hypertension. 2004 Jan;43(1):10-7
references: 14638619
references: Circulation. 2008 Jun 24;117(25):e510-26
references: 18574054
references: Eur Heart J. 2005 May;26(9):906-13
references: 15764611
references: Am J Physiol. 1985 Oct;249(4 Pt 2):F507-17
references: 4051004
references: Circulation. 2002 Oct 8;106(15):1974-9
references: 12370222
references: J Am Coll Cardiol. 2012 Sep 25;60(13):1163-70
references: 22958958
references: Eur Heart J. 2012 May;33(9):1058-66
references: 22507981
references: N Engl J Med. 1999 Apr 29;340(17):1321-8
references: 10219067
references: Circulation. 2013 Jul 9;128(2):132-40
references: 23780578
references: Int J Cardiol. 2013 Jan 20;162(3):189-92
references: 23031283
references: J Am Coll Cardiol. 2011 Sep 6;58(11):1176-82
references: 21884958
references: Lancet. 2009 Apr 11;373(9671):1275-81
references: 19332353
references: Hypertension. 2012 Aug;60(2):419-24
references: 22733462
references: J Am Med Assoc. 1956 Mar 24;160(12):1023-6
references: 13295059
references: Lancet. 1998 Feb 14;351(9101):478-84
references: 9482439
references: Circulation. 2011 Aug 30;124(9):1046-58
references: 21824920
references: J Am Coll Cardiol. 2012 Nov 6;60(19):1956-65
references: 23062529
references: Curr Cardiol Rep. 2012 Jun;14(3):285-92
references: 22392370
references: Heart Vessels. 2002 Jan;16(2):51-6
references: 11833842
references: Ann Surg. 1949 Jun;129(6):850-71
references: 17859363
references: EuroIntervention. 2013 May 20;9(1):70-4
references: 23685297
references: Lancet. 1948 Jul 10;2(6515):65
references: 18870109
references: Curr Hypertens Rep. 2002 Apr;4(2):136-42
references: 11884269
references: Hypertension. 2011 Jun;57(6):1076-80
references: 21502568
references: Can J Physiol Pharmacol. 1992 May;70(5):735-49
references: 1423018
references: J Hypertens. 1991 Nov;9(11):983-6
references: 1661769
references: Physiol Rev. 1997 Jan;77(1):75-197
references: 9016301