ESC recommends patients and centres for renal denervation

April 25, 2013

Up to 10 per cent of patients with high blood pressure are resistant to treatment, which puts them at increased risk of cardiovascular events, including heart attacks. Clinical trials show that catheter-based renal denervation reduces blood pressure in patients who do not respond to conventional drug therapy.

Use of the technique is increasing in Europe and worldwide and several national societies have published guidance on which patients with hypertension should receive treatment. The European Society of Cardiology (ESC) and the European Association of Percutaneous (EAPCI) decided it was time for a European view and have developed an expert consensus document on catheter-based renal denervation.

The paper provides guidance on patient selection, centre selection, efficacy, safety, limitations and potential new indications for referring physicians, interventionalists and healthcare providers. It is published today in European Heart Journal, online ahead of print.1 [must confirm]

First author Dr Felix Mahfoud (Germany), said: "The hope is that insurance companies and healthcare providers will read it and will only pay for those centres and especially for those patients who fit the criteria published in the paper. The problem right now is that there are no European criteria for determining which patients are most likely to benefit and which centres have the necessary experience."

The technique involves radiofrequency ablation of the renal via a catheter. It resets renal and reduces whole body .

Increased activity of the occurs in other conditions including , diabetes, arrhythmias, and obstructive , and pilot studies indicate that renal denervation may be an effective therapy.

Dr Mahfoud said: "We have known for decades that high sympathetic activity could be a target for treatment but until now we haven't had a way to do it. We now have a new treatment modality which allows us to reduce sympathetic activity and I'm optimistic that we will get new indications for renal denervation."

The paper states that renal denervation is currently indicated for blood pressure control in patients with treatment resistant hypertension (defined as systolic blood pressure >160mmHg or >150mmhg in type 2 diabetes) despite treatment with at least three antihypertensive drugs of different types in adequate doses, including one diuretic, and lifestyle modification. Screening should be conducted to exclude patients with secondary causes of hypertension that are potentially curable.

Centres should be specialised in the management of hypertension. At least one hypertension expert should be involved in treatment and screening and the intervention should be performed by interventional cardiologists or angiologists with training in percutaneous renal artery access. Centres should perform more than 25 renal artery interventions per year to ensure they have the required experience.

The Symplicity HTN-1 trial showed that renal denervation had a sustained blood pressure lowering effect over three years2 but longer efficacy data is needed. Dr Mahfoud said: "We treated the first patient three years ago and so far there is no sign of renervation. Long term follow up of these patients is needed."

Trials have not investigated the possibility of reducing pill burden. Dr Mahfoud said: "Patients have to keep taking their antihypertensive medications."

Explore further: Renal denervation achieves significant and sustained blood pressure reduction

More information: 1 Mahfoud F, Lüscher TF, Andersson B, Baumgartner I, Cifkova R, DiMario C, Doevendans P, Fagard R, Fajadet J, Komajda M, LeFèvre T, Lotan C, Sievert H, Volpe M, Widmisky P, Wijns W, Williams B, Windecker S, Witkowski A, Zeller T, Böhm M. Expert consensus document from the European Society of Cardiology on catheter-based renal denervation. European Heart Journal. 2013; online publish-ahead-of-print 24 April 2013. doi:10.1093/eurheartj/eht154

2 Krum H, Barman N, Schlaich M, Sobotka P, Esler M, Mahfoud F. Long-term follow-up of catheter-based renal sympathetic denervation for resistant hypertension confirms durable blood pressure reduction. J Am Coll Cardiol. 2012;59(13):E1704.

Related Stories

Renal denervation achieves significant and sustained blood pressure reduction

August 27, 2012
Renal denervation leads to significant and sustained blood pressure reduction for up to 18 months in patients with treatment resistant hypertension, according to research presented at ESC Congress 2012. The new clinical data ...

Study tests new therapy for treatment-resistant hypertension

June 28, 2012
(Medical Xpress) -- Treatment-resistant hypertension affects nearly 6 million Americans and another 94 million people worldwide and is associated with increased cardiovascular risk, including stroke and heart attack, as well ...

Renal denervation gives better outcomes than drugs in advanced heart failure

August 27, 2012
Renal denervation leads to better outcomes than standard drug treatment in patients with advanced heart failure, according to research presented at ESC Congress 2012. The results of the Olomouc I pilot study were presented ...

Renal denervation treats resistant hypertension in real world patient populations

August 27, 2012
Renal denervation successfully treats patients with resistant hypertension in real world patient populations, according to a study presented at ESC Congress 2012. The findings were presented by Dr Darren Mylotte from France.

NY-Presbyterian Hospital announces participation in trial for hard-to-treat hypertension

October 25, 2012
Patients with hypertension whose blood pressure cannot be brought down to safe levels despite taking three or more medications may have some relief coming their way. An innovative, first-of-its-kind clinical trial for a device ...

Renal denervation improves blood pressure and arterial stiffness

August 27, 2012
Renal denervation improves blood pressure and arterial stiffness in patients with therapy resistant hypertension, according to research presented at ESC Congress 2012 by Mr Klaas Franzen from the University Hospital of Schleswig-Holstein. ...

Recommended for you

Newborns with trisomy 13 or 18 benefit from heart surgery, study finds

October 18, 2017
Heart surgery significantly decreases in-hospital mortality among infants with either of two genetic disorders that cause severe physical and intellectual disabilities, according to a new study by a researcher at the Stanford ...

High blood pressure linked to common heart valve disorder

October 17, 2017
For the first time, a strong link has been established between high blood pressure and the most common heart valve disorder in high-income countries, by new research from The George Institute for Global Health at the University ...

Saving hearts after heart attacks: Overexpression of a gene enhances repair of dead muscle

October 17, 2017
University of Alabama at Birmingham biomedical engineers report a significant advance in efforts to repair a damaged heart after a heart attack, using grafted heart-muscle cells to create a repair patch. The key was overexpressing ...

Blood cancer gene could be key to preventing heart failure

October 16, 2017
A new study, published today in Circulation, shows that the gene Runx1 increases in damaged heart muscle after a heart attack. An international collaboration led by researchers from the University of Glasgow, found that mice ...

Mitochondrial DNA could predict risk for sudden cardiac death, heart disease

October 11, 2017
Johns Hopkins researchers report that the level, or "copy number," of mitochondrial DNA—genetic information stored not in a cell's nucleus but in the body's energy-creating mitochondria—is a novel and distinct biomarker ...

Tai chi holds promise as cardiac rehab exercise

October 11, 2017
The slow and gentle movements of Tai Chi hold promise as an alternative exercise option for patients who decline traditional cardiac rehabilitation, according to preliminary research in Journal of the American Heart Association, ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.