Renal sympathetic denervation in treatment of patients with resistant arterial hypertension

Abstract

Background: Hypertension represents a major health problem and is the most important cause of cardiovascular morbidity and mortality. Despite the plethora of antihypertensive drugs, hypertension remains resistant in a considerable number of patients, thus creating a requirement for alternative strategies, including interventional approaches. Recently, renal sympathetic denervation (RSD) using a very elegant, state-of-the-art technique (percutaneous, catheter-based radiofrequency ablation) has demonstrated its benefit in patients with resistant hypertension. The pathophysiology of kidney function justifies the use of RSD in the treatment of hypertension. Data from previous studies have shown that sympathectomy has efficiently decreased the blood pressure and prolonged the life expectancy of patients with hypertension, but at considerable cost. RSD is devoid of the adverse effects of sympathectomy because of its localized nature, is minimally invasive and provides short procedural and recovery times. The maximum follow-up period is only 3 years, but the beneficial effects of sympathetic denervation of the renal artery on blood pressure, diastolic function and left ventricular remodeling processes, glucose tolerance, insulin resistance and others have already been demonstrated. Conclusions: Renal sympathetic denervation is a promising method in patients with resistant hypertension, but requires additional data from longterm comparative studies to determine certainty of the safety and sustainability of the effects of this procedure compared with optimal medical treatment.