Renal sympathetic denervation: indications, contemporary devices and future directions

摘要

Hypertension has a considerable worldwide burden and is a major risk factor for cardiovascular disease. Despite the use of lifestyle measures and medical therapy, a large proportion of patients remain treatment 'resistant' and fail to have adequate control of blood pressure. This may adversely affect both future cardiovascular events and mortality. Catheter-based renal denervation is a promising contemporary evolution of a historical treatment for hypertension and aims to achieve a reduction in renal sympathetic activation. This has been shown previously to be important in both resistant hypertension and in other disease states including heart failure. This review will focus on contemporary evidence supporting the utility of renal denervation, review current and emerging devices, consider potential future treatment indications, and discuss unresolved issues that need to be addressed before renal denervation can be embraced as mainstream therapy.