Markus P Schlaich 1 , Roland E Schmieder , George Bakris , Peter J Blankestijn , Michael Böhm , Vito M Campese , Darrel P Francis , Guido Grassi , Dagmara Hering , Richard Katholi , Sverre Kjeldsen , Henry Krum , Felix Mahfoud , Giuseppe Mancia , Franz H Messerli , Krzysztof Narkiewicz , Gianfranco Parati , Krishna J Rocha-Singh , Luis M Ruilope , Lars C Rump , Domenic A Sica , Paul A Sobotka , Costas Tsioufis , Oliver Vonend , Michael A Weber , Bryan Williams , Thomas Zeller , Murray D Esler
Dec 3 2013
ABPM, AF, BP, MSNA, NE, PVI, RDN, RF, ambulatory blood pressure monitoring, atrial fibrillation, blood pressure, eGFR, estimated glomerular filtration rate, muscle sympathetic nerve activity, norepinephrine, pulmonary vein isolation, radiofrequency, renal denervation, resistant hypertension, sympathetic
Catheter-based radiofrequency ablation technology to disrupt both efferent and afferent renal nerves has recently been introduced to clinical medicine after the demonstration of significant systolic and diastolic blood pressure reductions. Clinical trial data available thus far have been obtained primarily in patients with resistant hypertension, defined as standardized systolic clinic blood pressure ≥ 160 mm Hg (or ≥ 150 mm Hg in patients with type 2 diabetes) despite appropriate pharmacologic treatment with at least 3 antihypertensive drugs, including a diuretic agent. Accordingly, these criteria and blood pressure thresholds should be borne in mind when selecting patients for renal nerve ablation. Secondary forms of hypertension and pseudoresistance, such as nonadherence to medication, intolerance of medication, and white coat hypertension, should have been ruled out, and 24-h ambulatory blood pressure monitoring is mandatory in this context. Because there are theoretical concerns with regard to renal safety, selected patients should have preserved renal function, with an estimated glomerular filtration rate ≥ 45 ml/min/1.73 m(2). Optimal periprocedural management of volume status and medication regimens at specialized and experienced centers equipped with adequate infrastructure to cope with potential procedural complications will minimize potential patient risks. Long-term safety and efficacy data are limited to 3 years of follow-up in small patient cohorts, so efforts to monitor treated patients are crucial to define the long-term performance of the procedure. Although renal nerve ablation could have beneficial effects in other conditions characterized by elevated renal sympathetic nerve activity, its potential use for such indications should currently be limited to formal research studies of its safety and efficacy.