title: Renal sympathetic denervation in the treatment of resistant hypertension.
abstract: Arterial hypertension (HTN) is a major health problem worldwide. Treatment-resistant hypertension (trHTN) is defined as the failure to achieve target blood pressure despite the concomitant use of maximally tolerated doses of three different antihypertensive medications, including a diuretic. trHTN is associated with considerable morbidity and mortality. Renal sympathetic denervation (RDn) is available and implemented abroad as a strategy for the treatment of trHTN and is currently under clinical investigation in the United States. Selective renal sympathectomy via an endovascular approach effectively decreases renal sympathetic nerve hyperactivity leading to a decrease in blood pressure. The Symplicity catheter, currently under investigation in the United States, is a 6-French compatible system advanced under fluoroscopic guidance via percutaneous access of the common femoral artery to the distal lumen of each of the main renal arteries. Radiofrequency (RF) energy is then applied to the endoluminal surface of the renal arteries via an electrode located at the tip of the catheter. Two clinical trials (Symplicity HTN 1 and Symplicity HTN 2) have shown the efficacy of RDn with a post-procedure decline of 27/17 mmHg at 12 months and 32/12 mmHg at 6 months, respectively, with few minor adverse events. Symplicity HTN-3 study is a, multi-center, prospective, single-blind, randomized, controlled study currently under way and will provide further insights about the safety and efficacy of renal denervation in patients with trHTN.
authors.affiliation: CES University, Medellín, Colombia.
authors.forename: Catalina
authors.initials: C
authors.lastname: Sánchez-Álvarez
authors.affiliation: CES University, Medellín, Colombia.
authors.forename: Miguel
authors.initials: M
authors.lastname: González-Vélez
authors.affiliation: Yale University, Department of Medicine, Section of Cardiology, New Haven, Connecticut.
authors.forename: Erik
authors.initials: E
authors.lastname: Stilp
authors.affiliation: Yale University, Department of Medicine, Section of Cardiology, New Haven, Connecticut.
authors.forename: Charisse
authors.initials: C
authors.lastname: Ward
authors.affiliation: Yale University, Department of Medicine, Section of Cardiology, New Haven, Connecticut.
authors.forename: Carlos
authors.initials: C
authors.lastname: Mena-Hurtado
mesh_terms: D000818:Animals; D002986:Clinical Trials as Topic; D003714:Denervation; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007668:Kidney / Q000294:innervation*; D013562:Sympathectomy
keywords: cardiovascular diseases; hypertension; renal denervation; treatment resistant hypertension; uncontrolled hypertension; vascular diseases