An Update on Catheter-Based Renal Denervation for the Treatment of Hypertension

摘要

Purpose of Review The use of catheter-based renal denervation (RD) for the treatment of hypertension showed promise in early proof-of-concept trials; however, enthusiasm to pursue clinical trials outpaced efforts to understand underlying fundamental principles. The Symplicity HTN-3 trial was a randomized, sham-controlled study that found that the effect of RD on blood pressure in patients with resistant hypertension was no different than seen in the control group. Retrospective analyses showed that the therapeutic failure more likely resulted from suboptimal first-generation technology and poor clinical trial design rather than a failure of concept. This led to the development of new catheters which deliver a more consistent ablation to renal nerves. The most recent studies which utilize these new catheters have demonstrated a consistent reduction in blood pressure, and interest in the field has been renewed. Recent Findings In the aftermath of early clinical trials, a reevaluation of the field of RD resulted in recommendations for improved study design, enhanced procedural techniques, and newly developed catheter technologies. These changes have been incorporated into contemporary studies, which have provided consistent evidence that catheter-based RD can cause a significant reduction in blood pressure in patients with hypertension. Recent developments in the field of RD have lent credence to the notion that a procedure-based approach to lower blood pressure may augment current treatment strategies for hypertension. Future research will help to better define its clinical role and utility.