Eligibility for percutaneous renal denervation: the importance of a systematic screening

J Hypertens. 2013 Aug;31(8):1662-8. doi: 10.1097/HJH.0b013e328362152e.


Objective: Percutaneous renal denervation (pRDN) is a new and promising therapy for resistant hypertension. Among patients suspected of having resistant hypertension, the actual presence of this condition needs to be well established; pseudoresistant hypertension and significant white-coat effect (WCE) should be excluded. This analysis presents the results of a standardized screening programme for patients referred for pRDN.

Methods: All patients referred to our centre for pRDN underwent a standardized stepwise screening and were subsequently discussed in a multidisciplinary team. The screening included a 24-h ambulatory blood pressure measurement (ABPM), collection of plasma, urine and saliva, and finally imaging of the renal arteries.

Results: From August 2010 till October 2012, 181 patients were referred for pRDN. Mean blood pressure (BP) was 182/100 mmHg, and median use was three antihypertensives. Ultimately, 121 patients (67%) were excluded from pRDN. Main reasons for exclusion were BP-related. Twenty-three patients (19%) had an office SBP less than 160 mmHg and 26 patients (22%) showed a WCE. Fourteen patients (12%) had a so far undetected underlying cause of hypertension, the majority being primary aldosteronism (n = 11). Nine patients had an ineligible renal anatomy.

Conclusion: A high percentage of patients were excluded from treatment with pRDN due to secondary causes of hypertension, WCE or a BP below the currently advised thresholds. Treatment of these excluded patients would lead to inappropriate use of pRDN, leading most likely to little benefit for the patients and a burden to healthcare. Therefore, it is recommended to use a standardized screening before treatment with pRDN.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood Pressure
  • Blood Pressure Monitoring, Ambulatory
  • Cohort Studies
  • Denervation*
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Hyperaldosteronism / diagnosis
  • Hypertension / diagnosis*
  • Hypertension / therapy*
  • Kidney / physiopathology*
  • Male
  • Mass Screening
  • Medication Adherence
  • Middle Aged
  • Patient Selection*
  • Time Factors
  • White Coat Hypertension / diagnosis*