Renal denervation in the treatment of resistant hypertension: Dead, alive or surviving?
Hypertension is one of the most common chronic clinical problems encountered by physicians. The prevalence of resistant hypertension is estimated at 9% in the US. Patients with resistant hypertension have been shown to be at higher risk for adverse cardiovascular events, hence the need for greater efforts in improving the treatment of hypertension. The renal sympathetic nerves play an important role in the development of hypertension, mediated via sodium and water retention, increased renin release and alterations in renal blood flow. The proximity of the afferent and efferent renal sympathetic nerves to the adventitia of the renal arteries suggested the feasibility of an endovascular, selective, minimally invasive approach to renal denervation; a potential treatment option for resistant hypertension. While the RAPID, Reduce-HTN, EnligHTN, DENERHTN and Symplicity HTN-1 and -2 studies showed significant benefit of renal denervation in the treatment of resistant hypertension, the results of Oslo RDN, Prague-15 and Symplicity HTN-3 were not so favorable. Future well-designed clinical trials are needed to ascertain the benefits or otherwise of renal denervation in treatment-resistant hypertension.
Department of Medicine, Methodist South Hospital, Memphis, TN, United States. Electronic address: fakhouri_md@yahoo.com.
Ahmad
A
Al-Fakhouri
Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, United States.
Nephertiti
N
Efeovbokhan
Ain Shams University School of Medicine, Cairo, Egypt.
Rami
R
Nakhla
Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, United States.
Rami N
RN
Khouzam
D006801:Humans; D007668:Kidney / Q000294:innervation*; D012077:Renal Artery / Q000294:innervation; D013562:Sympathectomy / Q000379:methods*; D013564:Sympathetic Nervous System
Desnervação renal; Hipertensão; Hipertensão arterial resistente; Hypertension; Renal denervation; Resistant hypertension; Sistema nervoso simpático; Sympathetic nervous system