Renal Denervation Addressed in International Expert Consensus Statement

September 18, 2013—An international expert consensus statement on percutaneous transluminal renal denervation for the treatment of resistant hypertension has been published by Markus P. Schlaich, MD, et al online ahead of print in the Journal of the American College of Cardiology (JACC).

As summarized in JACC, the statement notes that catheter-based radiofrequency ablation technology to disrupt both efferent and afferent renal nerves has recently been introduced into clinical medicine following the demonstration of significant systolic and diastolic blood pressure reduction. Clinical trial data available thus far have primarily been obtained for patients with resistant hypertension defined as standardized systolic clinic blood pressure ≥ 160 mm Hg (or ≥ 150 mm Hg in those with type 2 diabetes) despite appropriate pharmacologic treatment with at least three antihypertensive drugs, including a diuretic.

The document continues that these criteria and blood pressure thresholds should be borne in mind when selecting patients for renal nerve ablation. Secondary forms of hypertension and pseudoresistance, such as nonadherence with medication, intolerance of medication, and “white coat hypertension” should be ruled out, and 24-hour ambulatory blood pressure monitoring is mandatory in this context.

The expert consensus statement advises that as there are theoretical concerns with regard to renal safety, selected patients should have preserved renal function with an estimated glomerular filtration rate of at least ≥ 45 mL/min/1.73 m². Optimal periprocedural management of volume status and medication regimens in specialized and experienced centers equipped with adequate infrastructure to cope with potential procedural complications will minimize the potential patient risks. Long-term safety and efficacy data are limited to 3 years of follow-up in small patient cohorts, thus efforts to monitor treated patients are crucial to assess long-term outcomes of the procedure.

Although renal nerve ablation could have beneficial effects in other conditions characterized by elevated renal sympathetic nerve activity, its potential use for such indications should currently be limited to formal research studies of its safety and efficacy, concludes the expert consensus as summarized in JACC.