Renal arteries denervation with second generation systems: a remedy for resistant hypertension?

Abstract

Initial studies on renal denervation (RDN) for the treatment of non-controlled arterial hypertension (HTN) through radiofrequency ablation of renal arteries demonstrated that RDN is an effective therapeutic strategy to reduce arterial blood pressure (BP). Nonetheless, the first randomized study, SYMPLICITY-HTN-3, failed to demonstrate a clear benefit for RND over the control group. Technologic evolution, with the introduction of new second generation multi-electrode devices, allowed deep energy delivery along the full circumference of the vessel. Two recent randomized studies involving patients assuming (SPYRAL HTN-ON MED) or not (SPYRAL HTN-OFF MED) antihypertensive pharmacologic treatment, demonstrated the efficacy and safety of RDN using second generation systems for radiofrequency ablation. Another recent randomized study demonstrated that RDN with ultrasounds (RADIANCE-HTN SOLO) of the main renal arteries led to a significant BP reduction compared to the control group. These studies have once again raised the interest of the scientific community towards attempting to define the appropriate role of RDN in the treatment of hypertension. Nonetheless, larger and longer clinical trials will be necessary to draw further conclusions.

Intravascular Renal Denervation Reduces Ambulatory and Office Blood Pressure in Patients with Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Trials

“…This meta-analysis provides evidence that catheterbased intravascular RDN using second-generation catheters reduces 24-h ambulatory and office BP. Second-generation catheters utilize the multielectrode system that allows simultaneous multisite ablation [24] and allows deep energy delivery along the full circumference of the vessel [25]. The efficiency and speed may be the major characteristics of second-generation catheters as com- pared with first-generation catheters [26].…”

Predicting Renal Denervation Response in Resistant High Blood Pressure by Arterial Stiffness Assessment: A Systematic Review

“…Using first-generation RDN systems could represent a potential explanation for SIMPLICITY HTN-3 trial neutral results. New-generation RDN systems appear to be consistently efficient and safe for blood pressure reduction [ 11 , 12 ]. A recent meta-analysis of nine randomized sham-controlled trials reported contrasting yet noteworthy results [ 13 ].…”

Renal arteries denervation: from the treatment of resistant hypertension to the treatment of atrial fibrillation

“… 1 Initial randomized studies such as Symplicity HTN-1 and the Symplicity HTN-2 had shown promising results of renal denervation in reducing blood pressure levels; 2 , 3 however, in 2014 the Symplicity HTN-3 study, a randomized study comparing RDNs to the placebo group, had shown insignificant differences between the groups of patients studied. 4 , 5 The reasons for these results were many, among them the sample of patients numerically insufficient from a statistical point of view, the inadequate selection of patients, the inexperience of the operators, and the use of first-generation devices. More recent randomized trials were carried out with second-generation devices: the DENERHTN trial, the Spyral HTN-OFF MED trial, the Spyral HTN-ON MED trial and the RARDIANCE-HTN SOLO trial showing how renal denervation resulted in a significant reduction in arterial blood pressure in the outpatient setting.…”