In This Section:
Hypertension Management
Renal Denervation Provides a Complementary Treatment Option
Click Here to Download the ESH Guidelines RDN Summary
There are currently 1.28 million adults with hypertension globally.1 Uncontrolled hypertension affects approximately 10% to 30% of these individuals and is associated with an increased risk of cardiovascular events, such as stroke, myocardial infarction, heart failure, and cardiovascular mortality.2 In Europe, hypertension (HTN) is defined as in-office systolic blood pressure (SBP) values ≥140 mmHg and/or diastolic blood pressure (DBP) values ≥90 mmHg. The goal of managing HTN in Europe is to lower office SBP to <140/90 mmHg, and, if treatment is well tolerated, to <130/80 mmHg. Even small reductions in blood pressure can lead to significant risk reduction. Each 10mmHg reduction in office SBP provides a 20% reduction in relative risk of major adverse cardiovascular events (MACE) and a 27% reduction in risk of stroke.3
Lowering BP through the use of antiHTN drugs has been shown to reduce the risk for CV morbidity and all-cause mortality, however, BP control rates remain poor worldwide. Renal denervation is a minimally invasive procedure that targets the nerves surrounding the renal artery. Radiofrequency (RF) renal denervation provides controlled and targeted energy which safely disrupts the overactive sympathetic signalling between the kidneys and the brain to reduce blood pressure.4
Several clinical trials have evaluated the safety and efficacy of radiofrequency renal denervation for the treatment of uncontrolled hypertension reporting safe and clinically meaningful blood pressure reduction.5,6,7 RF renal denervation has demonstrated sustained BP reductions out to 3 years in over 2,000 patients and out to 9 years in independent research.
Consensus documents from the European Society of Hypertension and a joint statement from the ESC Council on Hypertension and European Association of Percutaneous Cardiovascular Intervention (EAPCI) support RDN as an evidence-based treatment option for uncontrolled hypertensive patients.
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Section Advisor
Prof Flavio Ribichini
This section is supported by Medtronic
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Video Series
Michel Burnier, Roland E Schmieder, Cara East, et al
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Recent Videos
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Andrew SP Sharp, Atul Pathak, Felix Mahfoud, et al
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Michel Burnier, Roland E Schmieder, Cara East, et al
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Durability Evidence
Al Ghorani H, Kulenthiran S, Lauder L, et al. Clin Res Cardiol 2024; epub ahead of press.
Zeijen VJM, Theuns DA, Feyz L, et al. Clin Res Cardiol 2023;112:1766–77.
Mahfoud F, Mancia G, Schmieder RE, et al. Hypertension 2023;80:1759–70.
Vogt A, Dutzmann J, Nußbaum M, et al. Front Cardiovasc Med 2023;10:1210801.
Schmieder RE, Mahfoud F, Mancia G, et al. Eur Heart J Qual Care Clin Outcomes 2023;9:575–82.
Mahfoud F, Kandzari DE, Kario K, et al. Lancet 2022;399:1401–10.
Kario K, Mahfoud F, Kandzari DE, et al. Hypertens Res 2023;46:280–8.
Bhatt DL, Vaduganathan M, Kandzari DE, et al. Lancet 2022;400:1405–16.
Sesa-Ashton G, Nolde JM, Muente I, et al. Hypertension 2023;80:811–9.
Al Ghorani H, Kulenthiran S, Recktenwald MJM, et al. J Am Coll Cardiol 2023;81:517–9.
Zeijen VJM, Feyz L, Panday RN, et al. Clin Res Cardiol 2022;111:1256–68.
Hanssen TA, Subbotina A, Miroslawska A, et al. Scand Cardiovasc J 2022;56:174–9.
Efficacy Evidence
Sharp ASP, Kandzari DE, Townsend RR, et al. Cardiovasc Revasc Med 2024; epub ahead of press.
Townsend RR, Ferdinand KC, Kandzari DE, et al. Hypertension 2024;81:1095–105.
Kario K, Kai H, Nanto S, Yokoi H. Hypertens Res 2023;46:2044–7.
Günes-Altan M, Schmid A, Ott C, et al. Clin Kidney J 2023;17:sfad237.
Sharp ASP, Cao KN, Esler MD, et al. Eur Heart J Qual Care Clin Outcomes 2024; epub ahead of press.
Kandzari DE, Townsend RR, Kario K, et al. J Am Coll Cardiol 2023;82:1809–23.
Götzinger F, Kunz M, Lauder L, et al. Future Cardiol 2023; epub ahead of press.
Staplin N, de la Sierra A, Ruilope LM, et al. Lancet 2023;401:2041–50.
Böhm M, Kario K, Kandzari DE, et al. Lancet 2020;395:1444–51.
Kandzari DE, Böhm M, Mahfoud F, et al. Lancet 2018;391:2346–55.
Mahfoud F, Mancia G, Schmieder R, et al. J Am Coll Cardiol 2020;75:2879–88.
Kandzari DE, Weber MA, Poulos C, et al. Circ Cardiovasc Qual Outcomes 2023;16:e008997.
Mahfoud F, Mancia G, Schmieder RE, et al. J Am Coll Cardiol 2022;80:1871–80.
Schmieder RE, Mahfoud F, Mancia G, et al. Eur Heart J Qual Care Clin Outcomes 2022; epub ahead of press.
Guidelines
Mancia G, Kreutz R, Brunström M, et al. J Hypertens 2023; epub ahead of press.
Stabile E, Muiesan ML, Ribichini FL, et al. G Ital Cardiol (Rome) 2023;24:53–63.
Kandzari DE, Townsend RR, Bakris G, et al. Catheter Cardiovasc Interv 2021;98:416–26.
Schmieder RE, Mahfoud F, Mancia G, et al. J Hypertens 2021;39:1733–41.
Kandzari DE, Mahfoud F, Weber MA, et al. Circulation 2022;145:847–63.
Barbato E, Azizi M, Schmieder RE, et al. Eur Heart J 2023;44:1313–30.
Pre-clinical Evidence
Struthoff H, Lauder L, Hohl M, et al. EuroIntervention 2023;19:612–20.
Coates P, Tunev S, Trudel J, Hettrick DA. Cardiovasc Revasc Med 2022;42:171–7.
Sharp ASP, Tunev S, Schlaich M, et al. J Hypertens 2022;40:2068–75.
Sato Y, Kawakami R, Jinnouchi H, et al. JACC Cardiovasc Interv 2021;14:304–15.
Review Articles
Lauder L, Kandzari DE, Lüscher TF, Mahfoud F. EuroIntervention 2024;20:e467–78.
Lauder L, Mahfoud F, Böhm M. Annu Rev Med 2023; epub ahead of press.
Azzam O, Nejad SH, Carnagarin R, et al. Br J Pharmacol 2023; epub ahead of press.
Wagener M, Dolan E, Arnous S, et al. J Clin Med 2023;12:5634.
Lauder L, Mahfoud F, Azizi M, et al. Eur Heart J 2022; epub ahead of press.
Rey-García J, Townsend RR. Am J Kidney Dis 2022;80:527–35.
Schmieder R, Burnier M, East C, et al. Interventional Cardiology 2023;18:e06.
Fisher NDL, Mahfoud F. Eur J Prev Cardiol 2023;30:34–6.
Messerli FH, Bavishi C, Brguljan J, et al. J Hypertens 2022;40:1859–75.
Blazek O, Bakris GL. Am J Hypertens 2023;36:73–81.
Nawar K, Mohammad A, Johns EJ, Abdulla MH. J Hum Hypertens 2022;36:887–97.
Fengler K. Cardiol Ther 2022;11:385–92.
Rao A, Krishnan N. Curr Cardiol Rep 2022;24:1261–71.
Narita K, Hoshide S, Kario K. Expert Rev Cardiovasc Ther 2022;20:829–38.
Laffin LJ, Briasoulis A, Bakris GL. Hellenic J Cardiol 2023;70:75–7.
Rea F, Morabito G, Savaré L, et al. Blood Press 2022;31:245–53.
Safety Evidence
Mohammad AA, Nawar K, Binks O, Abdulla MH. J Hum Hypertens 2024;38:29–44.
Reyes KR, Rader F. Integr Blood Press Control 2023;16:59–70.
Fezzi S, Gibson W, Wagener M, et al. J Am Heart Assoc 2023;12:e030742.
Townsend RR, Walton A, Hettrick DA, et al. EuroIntervention 2020;16:89–96.
Mahfoud F, Böhm M, Schmieder R, et al. Eur Heart J 2019;40:3474–82.
Marin F, Fezzi S, Gambaro A, et al. J Nephrol 2021;34:1445–55.
Ott C, Mahfoud F, Mancia G, et al. Nephrol Dial Transplant 2022;37:304–10.
Weber MA, Schmieder RE, Kandzari DE, et al. Clin Res Cardiol 2022;111:1269–75.