2022 Renal denervation therapy for the treatment of hypertension: a statement from the Thai Hypertension Society

Abstract

Hypertension remains a significant risk factor for major cardiovascular events worldwide. Poor adherence to treatment is extremely common in clinical practice, leading to uncontrolled hypertension. However, some patients with resistant hypertension still have uncontrolled blood pressure despite good medical compliance. A specific group of patients also develop adverse reactions to many blood pressure-lowering medications. These scenarios indicate that innovative strategies to lower blood pressure in challenging cases of hypertension are needed. The blood pressure-lowering efficacy of catheter-based renal denervation therapy to decrease sympathetic tone has been confirmed in many publications in recent years. Apart from both the invasiveness and the expensiveness of this technology, appropriate case selection to undergo this procedure is still developing. The utilization of renal denervation therapy for hypertension treatment in Thailand has lasted for 10 years with a good response in most cases. Currently, only certain interventionists at a few medical schools in Thailand can perform this procedure. However, more physicians are now interested in applying this technology to their patients. The Thai Hypertension Society Committee has reviewed updated information to provide principles for the appropriate utilization of renal denervation therapy. The blood pressure-lowering mechanism, efficacy, suitable patient selection, pre- and postprocedural assessment and procedural safety of renal denervation are included in this statement.

Technical aspects should also be fully considered in order to obtain better effectiveness of RDN

“…Then, risks may be pointed out that too many ablations may lead to increase complications. In other words, repeat ablation could cause perforation or stenosis, as described by Weranuj et al [2]. However, as far as I know, there is no such report.…”

“…There is always a learning curve in the development of physicians' skills. This report presented by Weranuj et al [2]. emphasized that RDN should be performed by a welltrained and experienced operator who should understand the indications, contra-indications, and its procedure in detail.…”

“…RDN is the first catheter-based therapy used clinically for sympathetic nerve modulation. Although multiple single-center openlabel studies have reported its beneficial effect, not all clinical trials, have shown the expected outcomes to lower the blood pressure as the author [2] reported.…”

Renal sympathetic denervation improves pressure-natriuresis relationship in cardiorenal syndrome: insight from studies with Ren-2 transgenic hypertensive rats with volume overload induced using aorto-caval fistula

“…There is vast evidence of the importance of the SNS in the regulation of renal function and blood pressure (BP) [20,21] and its role in the progression of HF [20][21][22] and particularly in the development of the cardiorenal syndrome [2,[4][5][6]. RDN was originally introduced for the treatment of resistant hypertension and is now regarded a safe and effective procedure bringing long-term BP-lowering [23][24][25], therefore new clinical indications for its application beyond hypertension are considered [25][26][27]. Recent studies have suggested that RDN may be a promising tool in the treatment of HF and the cardiorenal syndrome [4,5,[27][28][29].…”

Ten-year follow-up of very-high risk hypertensive patients undergoing renal sympathetic denervation

“…Previous studies, regardless of the ablation modality, confirming both the BP (BP)-lowering efficacy and safety of RDN in a broad range of patients with hypertension, including resistant hypertension [ 1 – 4 ]. Expert consensus in multiple countries and regions has proposed that RDN can be used as an adjunct treatment option for uncontrolled and resistant hypertension despite best efforts at lifestyle and pharmacologic interventions [ 5 , 6 ]. RDN may also be used in patients who are unable to tolerate antihypertensive medications in the long-term [ 7 ].…”