European Society of Hypertension Position Paper Highlights Renal Denervation as an Option for Hypertension Management

September 14, 2021—The European Society of Hypertension (ESH) announced it has presented an updated position paper on renal denervation (RDN) during the 8th pre-ESH Congress Satellite Symposium, held in Athens, Greece, from September 10-11, 2021.

The paper by Professor Roland E. Schmieder, MD, et al on behalf of members of the ESH Working Group on Device-Based Treatment of Hypertension was published in Journal of Hypertension (2021;39:1733-1741).

According to ESH, the position paper confirms that RDN is considered a safe endovascular procedure without significant short-term or long-term adverse effects based on data available up to 3 years.

Recent sham-controlled randomized trials and registries have consistently demonstrated clinically favorable effects of RDN across a wide spectrum of patients with uncontrolled hypertension, in the absence and presence of prescribed antihypertensive medications, noted ESH.

“In light of the recent publication of several second-generation sham-controlled clinical trials, we thought it was important to provide an updated position paper on RDN and its role in treating uncontrolled hypertension,” commented Prof. Schmieder in the ESH press release. Prof. Schmieder is Professor of Internal Medicine, Nephrology, and Hypertension at the University Hospital Erlangen, Germany, and Chairman of the ESH Working Group on interventional treatment of hypertension.

Konstantinos Tsioufis, MD, Professor of Cardiology at the University of Athens and immediate past president of ESH, added, “RDN represents an evidence-based option to treat hypertension, in addition to lifestyle changes and blood pressure lowering drugs. RDN expands therapeutic options to address the first objective of hypertension treatment, to effectively reduce elevated blood pressure and achieve blood pressure targets. Heightened cardiovascular risk such as evident organ damage or established disease like coronary artery disease or heart failure might be pointing towards treatment priority with RDN in hypertension. Additionally, patients who are unable or unwilling to take medication might be another RDN group, especially in the first stages of the hypertensive disease.”

The ESH announcement noted that arterial hypertension constitutes the most prevalent and important risk factor for cardiovascular morbidity and mortality globally despite the availability of pharmacological treatments. In addition, approximately half of individuals with hypertension do not meet guideline-directed blood pressure goals.

Professor Reinhold Kreutz, MD, stated in the press release, “Many patients with uncontrolled hypertension struggle to adhere to lifelong drug therapy for a variety of reasons and may look to other options that complement traditional treatments. We believe this advance could help clinicians work with patients to better manage their high blood pressure.” Prof. Kreutz is Professor of Clinical Pharmacology and Hypertension at the Charité Universitaetsmedizin in Berlin, Germany, and President of ESH.

According to ESH, RDN is emerging as the most advanced and efficacious device-based interventional approach to treat uncontrolled hypertension, by significantly reducing central sympathetic outflow.

The ESH advised that at the Athens pre-ESH meeting, experts discussed various hypertensive profiles that could benefit from RDN including those unable to achieve blood pressure control despite application of guideline-recommended therapies, and those with high baseline cardiovascular risk or comorbidities or poor tolerance to medications.

“The shared decision-making process is important and it's during that process that patients could select RDN as a treatment option in addition to lifestyle changes and BP lowering drugs. In other words, RDN expands hypertension therapeutic options as an alternative and not as a competitive treatment,” concluded Prof. Schmieder in the ESH press release.