Renal Denervation

Abstract

Resistant hypertension, defined as failure to reach blood pressure (BP) goals despite treatment with ≥3 antihypertensive agents, one of which is a diuretic, bears a significant risk of cardiovascular complications. Strong evidence exists, implicating the overactivation of the sympathetic nervous system (SNS) in the pathogenesis of resistant hypertension through complex neurohormonal interactions. Renal denervation is a novel attractive option to achieve adequate blockade of the sympathetic system, with subsequent BP reductions in patients with resistant hypertension. Data have shown promising results regarding the efficacy of the procedure, maintaining a favorable safety profile. As such, the paradigm of resistant hypertension has expanded in other conditions involving a hyperadrenergic state such as the metabolic syndrome, heart failure, arrhythmias, sleep apnea, and renal failure. This review focuses on the pathophysiological rationale of modifying SNS tone and the evidence of the benefits of such intervention beyond BP control.

Long-term benefit of renal denervation on blood pressure control in a patient with hemorrhagic stroke

“…Bilateral renal denervation (RDN) is a promising option of anti-hypertensive therapy in some hypertensive patients, such as those with resistant hypertension. 3–6 Apart from the effects on BP, RDN is suggested to exert beneficial cardiovascular and cerebral effects. 7,8 We describe a case of sustained long-term reduction of BP in a patient having received RDN because of resistant hypertension leading to hemorrhagic stroke.…”