title: Joint UK societies' 2014 consensus statement on renal denervation for resistant hypertension.
abstract: Resistant hypertension continues to pose a major challenge to clinicians worldwide and has serious implications for patients who are at increased risk of cardiovascular morbidity and mortality with this diagnosis. Pharmacological therapy for resistant hypertension follows guidelines-based regimens although there is surprisingly scant evidence for beneficial outcomes using additional drug treatment after three antihypertensives have failed to achieve target blood pressure. Recently there has been considerable interest in the use of endoluminal renal denervation as an interventional technique to achieve renal nerve ablation and lower blood pressure. Although initial clinical trials of renal denervation in patients with resistant hypertension demonstrated encouraging office blood pressure reduction, a large randomised control trial (Symplicity HTN-3) with a sham-control limb, failed to meet its primary efficacy end point. The trial however was subject to a number of flaws which must be taken into consideration in interpreting the final results. Moreover a substantial body of evidence from non-randomised smaller trials does suggest that renal denervation may have an important role in the management of hypertension and other disease states characterised by overactivation of the sympathetic nervous system. The Joint UK Societies does not recommend the use of renal denervation for treatment of resistant hypertension in routine clinical practice but remains committed to supporting research activity in this field. A number of research strategies are identified and much that can be improved upon to ensure better design and conduct of future randomised studies.
authors.affiliation: On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK.
authors.forename: Melvin D
authors.initials: MD
authors.lastname: Lobo
authors.affiliation: The British Cardiovascular Society The British Cardiovascular Intervention Society Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK.
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.affiliation: The British Society for Interventional Radiology Sheffield Vascular Institute, Sheffield Teaching Hospitals NHSFT, Northern General Hospital, Sheffield, UK.
authors.forename: Trevor
authors.initials: T
authors.lastname: Cleveland
authors.affiliation: On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Collier
authors.affiliation: The Renal Association Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK.
authors.forename: Indranil
authors.initials: I
authors.lastname: Dasgupta
authors.affiliation: Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK The National Institute for Cardiovascular Outcomes Research, University College London, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
authors.affiliation: On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK.
authors.forename: Vikas
authors.initials: V
authors.lastname: Kapil
authors.affiliation: Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK The British Cardiovascular Society.
authors.forename: Charles
authors.initials: C
authors.lastname: Knight
authors.affiliation: The British Society for Interventional Radiology Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Matson
authors.affiliation: The British Society for Interventional Radiology Interventional Radiology Unit, Gartnavel General Hospital, Glasgow, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Moss
authors.affiliation: On behalf of the British Hypertension Society School of Physiology & Pharmacology, Bristol Cardiovascular Medical Sciences Building, University of Bristol, Bristol, UK.
authors.forename: Julian F R
authors.initials: JF
authors.lastname: Paton
authors.affiliation: On behalf of the British Hypertension Society International Centre for Circulatory Health, Imperial College, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Poulter
authors.affiliation: The British Cardiovascular Society Wessex Regional Cardiac Unit, University Hospital Southampton, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Simpson
authors.affiliation: On behalf of the British Hypertension Society Institute of Cardiovascular Sciences, University College London, London, UK.
authors.forename: Bryan
authors.initials: B
authors.lastname: Williams
authors.affiliation: On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Caulfield
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002309:Cardiology / Q000592:standards*; D002986:Clinical Trials as Topic / Q000592:standards; D004351:Drug Resistance; D019317:Evidence-Based Medicine / Q000592:standards; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000294:innervation*; D013562:Sympathectomy / Q000379:methods / Q000592:standards*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents