title: Renal denervation therapy for the treatment of resistant hypertension: a position statement by the Canadian Hypertension Education Program.
abstract: Renal denervation is a novel catheter-based, percutaneous procedure using radiofrequency energy to ablate nerves within the renal arteries. This procedure might help to significantly lower blood pressure (BP) in patients with resistant hypertension, defined as BP > 140/90 mm Hg (> 130/80 mm Hg for those with diabetes) despite use of ≥ 3 optimally dosed antihypertensive agents, ideally including 1 diuretic agent. The Canadian Hypertension Education Program Recommendations Task Force reviewed the current evidence on safety and efficacy of this procedure. Eleven studies on renal denervation were examined and most of the evidence evaluating renal denervation was derived from the Symplicity studies. In patients with systolic BP ≥ 160 mm Hg (≥ 150 mm Hg for patients with type 2 diabetes) despite use of ≥ 3 antihypertensive agents, bilateral renal denervation was associated with significantly lower BP (-22/11 to -34/13 mm Hg) at 6 months with a low periprocedural complication rate. Few patients underwent 24-hour ambulatory BP monitoring and ambulatory BP monitoring showed more modest BP lowering (0 to -11/7 mm Hg). Although early results on short-term safety and blood pressure-lowering are encouraging, there are no long-term efficacy and safety data, or hard cardiovascular end point data. The discrepancy between office BP reductions and 24-hour ambulatory BP monitor reductions needs to be further investigated. Until more data are available, renal sympathetic denervation should be considered as a treatment option of last resort for patients with resistant hypertension who have exhausted all other available medical management options.
authors.affiliation: Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: nakhanubc@gmail.com.
authors.forename: Nadia A
authors.initials: NA
authors.lastname: Khan
authors.affiliation: Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Herman
authors.affiliation: Division of Nephrology, Department of Medicine, and Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Quinn
authors.affiliation: Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Simon W
authors.initials: SW
authors.lastname: Rabkin
authors.affiliation: Division of Nephrology, Department of Medicine, and Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.affiliation: Division of Nephrology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sheldon W
authors.initials: SW
authors.lastname: Tobe
authors.affiliation: Department of Medicine, Western University, London, Ontario, Canada.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Feldman
authors.affiliation: Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Raj S
authors.initials: RS
authors.lastname: Padwal
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D002170:Canada; D017115:Catheter Ablation / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D012077:Renal Artery / Q000294:innervation* / Q000601:surgery; D013562:Sympathectomy / Q000193:education* / Q000379:methods*; D016896:Treatment Outcome