Renal denervation systems or treatment-resistant hypertension

The target population comprises patients who suffer from resistant hypertension, a con-dition that is linked to sympathetic nervous system overactivity, involving the kidneys. Patients who are eligible for the intervention can be treated with catheter-based renal denervation. The goals of the treatment are to prevent hypertensive end-organ damage and decrease cardiovascular morbidity and mortality. Treatment-resistant hypertension is a condition for which conventional/traditional treat-ments are inadequate – this condition is also described as true resistant hypertension. The traditional/standard treatment is based primarily on medical treatment and lifestyle interventions. Resistant hypertension develops when the appropriate treatments, includ-ing lifestyle measures and 3 antihypertensive drugs (1 of which is a diuretic), fail to low-er systolic blood pressure (BP) and diastolic BP values to 140 and 90 mm Hg, respectively. All drug agents should be prescribed at the optimal doses. Any secondary causes (due to other diseases, primarily renal disease) must also be ruled out. Risk factors for treatment-resistant arterial hypertension are older age, lifestyle factors (e.g. obesity or large weight gains, excessive alcohol consumption, high sodium intake), chronic intake of vasopressors or sodium-retaining substances, obstructive sleep apnoea, undetected secondary forms of hypertension and advanced and irreversible organ dam-age, particularly when it involves renal function or markedly increases the arteriolar wall–lumen ratio or reduces large artery distensibility. 

Renal denervation is a treatment for treatment-resistant hypertension that uses low-level radio frequency energy or ultrasonography to disrupt renal sympathetic nerves to reduce blood flow and thereby decrease hypertension by de-activating hyperactive nerves, with-out affecting other abdominal, pelvic or lower-extremity nerves. Most systems are catheter-based and introduce the catheter through the femoral artery, which is threaded into the renal artery lumen under fluoroscopic control. Renal denervation should be performed in a catheterisation laboratory, for cardiovascular inter-ventions and in a setting that specialises in hypertension treatment 


Tags: catheter, hypertension
Year: 2013