Blood pressure and renal denervation with ultrasound: another step forward

Among cardiovascular risk factors, arterial hypertension has the highest prevalence and is poorly controlled.1 The sympathetic nervous system targeting the kidney via efferent and afferent nerves, thereby contributing to hypertension and potentially other cardiovascular conditions,2 can be modulated...

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Bibliographic Details
Published in:The Lancet (British edition) 2021-06, Vol.397 (10293), p.2441-2443
Main Authors: Böhm, Michael, Lauder, Lucas
Format: Article
Language:English
Subjects:
Ablation
Antihypertensives
Blood Pressure
Cardiovascular diseases
Catheters
Clinical trials
Congestive heart failure
Denervation
Fibrillation
Health risks
Heart failure
Humans
Hypertension
Kidney - diagnostic imaging
Kidney diseases
Kidneys
Medical instruments
Nerves
Patient compliance
Patients
Pressure effects
Pressure reduction
Radio frequency
Renal function
Risk analysis
Risk factors
Sensory neurons
Sympathectomy
Sympathetic nervous system
Ultrasonic imaging
Ultrasound
World population
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Summary:Among cardiovascular risk factors, arterial hypertension has the highest prevalence and is poorly controlled.1 The sympathetic nervous system targeting the kidney via efferent and afferent nerves, thereby contributing to hypertension and potentially other cardiovascular conditions,2 can be modulated with different denervation technologies.3 Rigorously controlled clinical trials without4–6 and with7 antihypertensive medications have shown a significant reduction in blood pressure with high-frequency energy. Renal denervation, irrespective of whether radiofrequency-based or ultrasound-based catheter systems were used, has been shown to reduce blood pressure and achieve guideline-recommended blood pressure in several sham-controlled trials in patients on and off antihypertensive medications.5–9 To our knowledge, RADIANCE-HTN TRIO is the first trial showing the blood pressure-lowering efficacy of ultrasound-based renal denervation in patients with resistant hypertension. [...]in a real-world population with renal impairment and comorbidities, the blood pressure-lowering effects were durable over 3 years,11 beyond the timeframe of controlled studies.5–9 Importantly, the patient's preference should be taken into consideration to improve adherence to treatment and blood pressure control. The most exciting potential benefit of renal denervation is in reducing hypertension complications associated with an increased sympathetic activation, such as heart failure (NCT02085668), atrial fibrillation (NCT02064764 and NCT02115100), and chronic kidney disease (NCT04264403), which, in concert with blood pressure reduction, could provide substantial clinical benefits.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(21)00989-2