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August 5, 2021
SCAI and National Kidney Foundation Roundtable Outlines Possible Role of Renal Denervation Treatment for Hypertension
August 5, 2021—The Society for Cardiovascular Angiography and Interventions (SCAI) announced the release of a proceedings document outlining the possible role of renal denervation (RDN) as a therapeutic option to complement medical therapy and lifestyle interventions for patients with uncontrolled hypertension.
According to SCAI, the document was developed after a multidisciplinary expert consensus conference composed of hypertension specialists, nephrologists, general cardiologists, and interventional cardiologists. The conference, organized by SCAI and the National Kidney Foundation (NKF) in 2021, was the first of its kind in the United States focused on RDN treatment for patients with hypertension, noted the society.
SCAI advised that several recent sham-controlled trials have shown consistent reductions in ambulatory and office blood pressure (BP) with RDN in both the presence and absence of antihypertensive medications, highlighting the potential of device-based therapies for hypertension.
As summarized by SCAI, the paper shares consensus from the multidisciplinary expert panel on issues related to BP control and associated risk, evaluation, and treatment pathways for hypertension, RDN safety, and effectiveness. It also examines how RDN may be incorporated into clinical practice.
SCAI noted that experts agree that upon approval in the United States, interventional RDN therapy has the potential to improve public health outcomes and address an epidemic of uncontrolled hypertension. Future steps will be to identify appropriate patients and build an interdisciplinary network for referrals.
David E. Kandzari, MD, Chief of the Piedmont Heart Institute in Atlanta, Georgia, and Director of Interventional Cardiology, served as chair of the document with co-chair Eric A. Secemsky, MD, Director of Vascular Intervention at Beth Israel Deaconess Medical Center in Boston, Massachusetts.
“Increasing attention to the clinical benefits of BP control and yet the persistence of uncontrolled hypertension presents the opportunity for device-based therapies such as renal denervation,” commented Dr. Kandzari in the SCAI press release. “This novel therapy offers advantages that are both distinct from the limitations of conventional antihypertensive medications but may also complement existing therapies to achieve greater BP control.”
Dr. Secemsky added, “This document lays the foundation as to how we move forward with this exciting technology. By reaching consensus on important issues, we now have a guide for how we may accomplish clinical implementation, while also raising awareness to areas we do not yet have answers for, such as reimbursement.”
The document by Dr. Kandzari et al, “Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF,” is available online in Catheterization and Cardiovascular Interventions.
The document’s discussion of which patients are ideal for referral to RDN noted that the panel unanimously agreed that patient preference has been largely unaddressed in hypertension trials and deserves important consideration.
In electronic communication with Cardiac Interventions Today, Dr. Secemsky offered the following commentary on the role of patient preference in deciding whether to offer this therapy to patients with hypertensive seeking RDN:
“RDN has the opportunity to substantially improve global hypertension control. One of the main reasons we have failed to better manage hypertension is patient adherence. In many cases, daily adherence to an optimal antihypertensive regimen can achieve target BP control. However, it is understandable that many patients struggle to take these medications as prescribed or have a preference to avoid medications.
“Patients with hypertension may require three or more daily antihypertensive medications to achieve BP control. These agents may be dosed multiple times a day and come with side effects. These medications may also be in addition to therapies they receive for other conditions.
“RDN has the promise to be a critical alternative intervention not only to help us gain better control over one of the primary risk factors for cardiovascular disease, but also to improve a patient’s quality of life.
“We have seen that patients who undergo RDN treatment experience a reduction in the number of their daily antihypertensive medications. We have also seen in registry data that the impact of RDN may last for at least 3 years. As such, the decision to undergo RDN will certainly need to take into consideration patient preferences, particularly for those patients who struggle with adherence.”
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