Renal denervation for treatment of drug-resistant hypertension
Abstract
At the seven-year anniversary of the first catheter-based renal denervation procedure for resistant hypertension, it is timely to reflect on the past, present, and future of the development and clinical application of this treatment. Unresolved procedural and technical questions are central: How much renal denervation is optimal? How can this level of denervation be achieved? What test for denervation can be applied in renal denervation trials? Will renal denervation show a "class effect," with the different energy forms now used for renal nerve ablation producing equivalent blood pressure lowering? When I have assessed renal denervation efficacy, using measurements of the spillover of norepinephrine from the renal sympathetic nerves to plasma, the only test validated to this point, denervation was found to be incomplete and non-uniform between patients. It is probable that the degree of denervation has commonly been suboptimal in renal denervation trials; this criticism applying with special force to the Symplicity HTN-3 trial, where the proceduralists, although expert interventional cardiologists, had no prior experience with the renal denervation technique. Recently presented results from the Symplicity HTN-3 trial confirm that renal denervation was not achieved effectively or consistently. Given this, and other difficulties in the execution of the trial relating to drug adherence, an idea mooted is that the US pivotal trial of the future may be in younger, untreated patients.
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Renal norepinephrine spillover is trebled in resistant hypertension.
“and trebled in resistant hypertension.100”
From Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? (2018) · cites this paper as [100]
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- Authors
- Esler, M.
- Affiliations
- Baker Heart and Diabetes Institute (AU)
- Corresponding author
- Esler, Murray
- ORCID
- Esler, Murray
- Venue
- Trends in Cardiovascular Medicine
- Publisher
- Elsevier BV
- Published
- 2015-02
- Volume
- 25
- Issue
- 2
- Pages
- 107-115
- ISSN
- 1050-1738 (ISSN-L)
- OpenAlex
- W2080826845
- Cited by
- 55
- References
- 52
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 1 · 2020: 4 · 2019: 1 · 2018: 5 · 2017: 14 · 2016: 10 · 2015: 8 · 2014: 5
- FWCI
- 1.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Trends in Cardiovascular Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- renal denervation, resistant hypertension, renal sympathetic nerves, norepinephrine spillover, Symplicity HTN-3 trial, catheter ablation, energy forms, blood pressure reduction, medication adherence, trial design
- MeSH terms
- Drug Resistance, Humans, Hypertension, Renal, Kidney, Sympathectomy
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