Expert consensus document from the European Society of Cardiology on catheter-based renal denervation
Abstract
Hypertension is highly prevalent and one of the most frequent chronic diseases worldwide.1 It has been suggested that over the next two decades up to 50% of the adult population will be diagnosed with hypertension, according to the standard guideline definitions. Despite the availability of many safe and effective antihypertensive drugs, control rates to target blood pressure remain low.
Approximately 5-10% of all patients with high blood pressure are resistant to drug treatment defined as blood pressure >140/90 mmHg, >130-139/80-85 mmHg in diabetes mellitus or >130/80 mmHg in chronic kidney disease in the presence of three or more antihypertensives of different classes, including a diuretic, at maximal or the highest tolerated dose. Resistant hypertension is associated with an increased risk of cardiovascular events.
Current non-invasive therapeutic strategies are mainly based on lifestyle interventions and pharmacological treatment, including mineralocorticoid receptor antagonists. Up until recently treatment options for patients with resistant hypertension were limited.
Nowadays catheter-based renal denervation offers a new approach targeting the renal sympathetic nerves. Indeed, the technique has been shown to reduce sympathetic nerve activity,5 norepinephrine spillover6 as well as blood pressure7-9 in patients with resistant hypertension.
Several national10-13 and international14 consensus documents from different societies have recently been published, with different degrees of involvement of interventionalists. This expert consensus document summarizes the view of an expert panel of the European Society of Cardiology and the European Association of Percutaneous Cardiovascular Interventions to provide guidance regarding appropriate patient selection, efficacy, safety, limitations, and potential new indications of renal denervation for referring physicians, interventionalists, and healthcare providers.