[Renal-nerve ablation in patients with resistant hypertension: caution is still needed]

Abstract

The autonomic nervous system plays a major role in blood pressure regulation and pathogenesis of essential hypertension. Before the advent of orally active antihypertensive treatments, surgical sympathectomy was the only therapeutic option in severely hypertensive patients. It was effective in reducing blood pressure in half of these patients. However, this intervention was associated with high incidence of severe adverse events, including death. It was abandoned in the 1960s with the advent of effective and well tolerated antihypertensive drugs. In the 2010s, despite availability of multiple classes of antihypertensive agents, a significant proportion of patient have resistant hypertension, i.e. remain uncontrolled despite the use of optimal doses of three antihypertensive agents, including a diuretic. Catheter-based renal denervation is a new approach for the treatment of resistant hypertension developed since 2008. Clinical studies have shown that it decreases blood pressure on the short- and mid-term and has a good tolerability profile. However, the blood pressure response following this intervention has only been evaluated in a small number of highly selected patients in open-label studies and infrequent or delayed adverse events cannot be still fully excluded. Catheter-based renal denervation opens new interesting therapeutic perspectives. At this stage of development, the technique should still be evaluated before its widespread diffusion.