Korean Circ J.  2021 Sep;51(9):717-732. 10.4070/kcj.2021.0175.

Current Status and Future Perspectives of Renal Denervation

• Choi KH
• Choi SH

• KMID: 2519833
• DOI: http://doi.org/10.4070/kcj.2021.0175

Abstract

Catheter-based renal denervation (RDN) therapy, a new procedure that uses radiofrequency ablation to interrupt efferent and afferent renal sympathetic nerve fibers, is a complementary or alternative treatment to antihypertensive medications for optimal control of blood pressure (BP). Although several single-arm early proof-of-concept studies showed significant BP reduction, the largest sham-controlled study using the first-generation RDN device (SYMPLICITY HTN-3) failed to significantly reduce BP in patients with resistant hypertension who were taking the guideline-based combination of antihypertensive medications. Since then, new devices and techniques have been developed to improve the efficacy and safety of RDN procedures. Sham-controlled trials using second-generation RDN devices (radiofrequency- and ultrasound-based) have provided solid evidence for their BP-lowering efficacy with and without the use of concomitant antihypertensive medication. Moreover, the safety profile of RDN in several registries and clinical trials appears to be excellent. This review summarizes the current evidence for RDN and discusses its current issues, future trials, Asian perspectives, and potential roles in both hypertension and other morbidities.

Keyword

Renal denervation; Blood pressure; Resistant hypertension; Asia

Figure

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  Figure 1 BP Changes with second-generation RDN devices in recently published randomized, sham-controlled trials.Changes in 24-hour ambulatory systolic BP and office SBP in the landmark randomized, sham-controlled trials using second-generation RDN devices are presented.BP = blood pressure; DBP = diastolic blood pressure; RDN = renal denervation; SBP = systolic blood pressure.

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