title: Eligibility for renal denervation: experience at 11 European expert centers.
abstract: Based on the SYMPLICITY studies and CE (Conformité Européenne) certification, renal denervation is currently applied as a novel treatment of resistant hypertension in Europe. However, information on the proportion of patients with resistant hypertension qualifying for renal denervation after a thorough work-up and treatment adjustment remains scarce. The aim of this study was to investigate the proportion of patients eligible for renal denervation and the reasons for noneligibility at 11 expert centers participating in the European Network COordinating Research on renal Denervation in treatment-resistant hypertension (ENCOReD). The analysis included 731 patients. Age averaged 61.6 years, office blood pressure at screening was 177/96 mm Hg, and the number of blood pressure-lowering drugs taken was 4.1. Specialists referred 75.6% of patients. The proportion of patients eligible for renal denervation according to the SYMPLICITY HTN-2 criteria and each center's criteria was 42.5% (95% confidence interval, 38.0%-47.0%) and 39.7% (36.2%-43.2%), respectively. The main reasons of noneligibility were normalization of blood pressure after treatment adjustment (46.9%), unsuitable renal arterial anatomy (17.0%), and previously undetected secondary causes of hypertension (11.1%). In conclusion, after careful screening and treatment adjustment at hypertension expert centers, only ≈40% of patients referred for renal denervation, mostly by specialists, were eligible for the procedure. The most frequent cause of ineligibility (approximately half of cases) was blood pressure normalization after treatment adjustment by a hypertension specialist. Our findings highlight that hypertension centers with a record in clinical experience and research should remain the gatekeepers before renal denervation is considered.
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Kapucijnenvoer 35, Box 7001, BE-3000 Leuven, Belgium. jan.staessen@med.kuleuven.be.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Persu
authors.forename: Yu
authors.initials: Y
authors.lastname: Jin
authors.forename: Marie
authors.initials: M
authors.lastname: Baelen
authors.forename: Eva
authors.initials: E
authors.lastname: Vink
authors.forename: Willemien L
authors.initials: WL
authors.lastname: Verloop
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schmidt
authors.forename: Marie K
authors.initials: MK
authors.lastname: Blicher
authors.forename: Francesca
authors.initials: F
authors.lastname: Severino
authors.forename: Grégoire
authors.initials: G
authors.lastname: Wuerzner
authors.forename: Alison
authors.initials: A
authors.lastname: Taylor
authors.forename: Antoinette
authors.initials: A
authors.lastname: Pechère-Bertschi
authors.forename: Fadi
authors.initials: F
authors.lastname: Jokhaji
authors.forename: Fadl Elmula M
authors.initials: FE
authors.lastname: Fadl Elmula
authors.forename: Jan
authors.initials: J
authors.lastname: Rosa
authors.forename: Danuta
authors.initials: D
authors.lastname: Czarnecka
authors.forename: Georg
authors.initials: G
authors.lastname: Ehret
authors.forename: Thomas
authors.initials: T
authors.lastname: Kahan
authors.forename: Jean
authors.initials: J
authors.lastname: Renkin
authors.forename: Jiři
authors.initials: J
authors.lastname: Widimsky
authors.forename: Lotte
authors.initials: L
authors.lastname: Jacobs
authors.forename: Wilko
authors.initials: W
authors.lastname: Spiering
authors.forename: Michel
authors.initials: M
authors.lastname: Burnier
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Mark
authors.forename: Jan
authors.initials: J
authors.lastname: Menne
authors.forename: Michael H
authors.initials: MH
authors.lastname: Olsen
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.forename: Sverre
authors.initials: S
authors.lastname: Kjeldsen
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
mesh_terms: D000368:Aged; D005060:Europe; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000294:innervation*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013562:Sympathectomy / Q000379:methods*
keywords: Antihypertensive Agents; Hypertension Resistant to Conventional Therapy; Sympathetic Denervation