Novel approaches to the treatment of patients with resistant hypertension: renal sympathetic denervation

Abstract

Background: Hypertension continues to be a major burden of public health concern despite the recent advances and proven benefit of pharmacological therapy. A certain subset of patients has hypertension resistant to maximal medical therapy and appropriate lifestyle measures. Resistant hypertension continues to pose a major challenge to clinicians worldwide and has serious implications for patients who are at increased risk of cardiovascular morbidity and mortality with this diagnosis. Pharmacological therapy for resistant hypertension follows guidelines-based regimens, although there is surprisingly scant evidence for beneficial outcomes using additional drug treatment after three antihypertensives have failed to achieve target blood pressure. Through modulation of renin secretion, glomerular filtration rate and renal absorption of sodium, the sympathetic innervation of the kidneys plays an important role in the pathogenesis of hypertension. A novel catheter-based technique for renal sympathetic denervation (RSDN) as a new therapeutic avenue has great promise for the treatment of resistant hypertension. Renal denervation has the unique advantage of offering the denervation at the renal level, thus mitigating the systemic side effects. Various trials evaluated the role of renal denervation in the management of resistant hypertension and have found promising results. More studies are underway to evaluate the role of renal denervation in patients presenting with resistant hypertension in different scenarios. Conclusions: This review included the physiology of the renal sympathetic nervous system and the renal nerve anatomy. Furthermore, the RSDN procedure, technology systems, and RSDN clinical trials as well as findings besides antihypertensive effects were discussed. Findings on safety and efficacy seem to suggest that renal sympathetic denervation could be of therapeutic benefit in refractory hypertensive patients. Despite the fast pace of development in RSDN therapies, only initial and very limited clinical data are available. Large gaps in knowledge concerning the long-term effects and consequences of RSDN still exist, and solid, randomized data are warranted.