Renal denervation for the management of hypertension. Joint position statement from the SEH-LELHA and the ACI-SEC

Rodríguez-Leor, Oriol; Jaén-Águila, Fernando; Segura, J.; Núñez‐Gil, Iván J.; García‐Touchard, Arturo; Rubio, E. Múñez; Troya, Maribel; Diego-Mediavilla, Juan; Cequier, Ángel; Moreno, Raúl; Martell, Nieves; Beltrán, Paola; y, Eduardo Molina; García-Donaire, José Antonio

doi:10.24875/recice.m21000235

Cited by 4 publications

(7 citation statements)

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“… 26 , 27 In summary, therefore, pre-RDN blood pressure level may be a reliable indicator for a successful RDN ( Figure 1 ). However, position statements on renal denervation from medical societies including the European Society for Hypertension (ESH), 1 Joint UK societies, 28 and the SEH-LELHA 29 (Spanish Society of Hypertension-Spanish League for Combating High Blood Pressure) do not provide any guidance on the best pre-RDN blood pressure level for patient selection, highlighting the knowledge gap in this area.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, renal denervation is being supported for patients with persistent BP > 140/90 mmHg despite drug treatment by the ESH, 1 the Asia Renal Denervation Consortium 37 and SEH-LELHA. 29 …”

Section: Introductionmentioning

confidence: 99%

“…Some guidelines, however, do note that arteries with abnormal renal anatomy (for example, diameters <3mm or >8mm) or with significant disease or flow-limiting obstructions should be avoided, as should patients with previous renal angioplasty indwelling ureteral stents and aortic grafts. 29 , 56 The presence of accessory renal arteries is therefore a potential confounder of the therapeutic effect of RDN but not necessarily a factor that would exclude patient selection ( Figure 1 ).…”

Section: Introductionmentioning

confidence: 99%

“…Another group of patients that should be considered potential candidates for renal denervation are those with hypertension-mediated organ damage (HMOD), due to the likelihood of their receiving significant clinical benefit from the intervention, 29 with meta-analysis supporting an independent effect of renal denervation on HMOD. 73 …”

Section: Introductionmentioning

confidence: 99%

“…While considering which groups of hypertensive patients are likely good candidates for renal denervation, it is important to note those who are not or for whom there is insufficient data to make an informed clinical decision. For example, patients in whom a blood pressure reduction is considered hazardous such as those with haemodynamically significant valvular heart disease are contraindicated for renal denervation, 29 while patients who have primary pulmonary hypertension, are pregnant, nursing or planning to become pregnant or patients with type 1 diabetes mellitus are typically excluded from clinical trials 74 and so are not currently deemed suitable candidates for the procedure.…”

Section: Introductionmentioning

confidence: 99%

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Patient Selection for Renal Denervation in Hypertensive Patients: What Makes a Good Candidate?

Li¹,

Phillips²

2022

VHRM

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Renal denervation (RDN) as a therapeutic intervention in patients with hypertension has been intensively studied for over a decade, yet a critical question remains unanswered: what kind of patients are the ideal target population for RDN to achieve its maximum clinical benefit? We herein provide a review of current literature to answer questions related to patient selection to identify populations that will benefit most from RDN, drawing first from human studies but also important clues derived from preclinical animal models. Different aspects that may influence the selection of patients such as the cause of hypertension, the severity of hypertension, concurrent pharmaceutical treatment, renal function, and renal artery anatomy are discussed. Based on current evidence, patients who have severe primary hypertension, regardless of medication or degree of renal dysfunction, who have an accessible accessory renal artery, can achieve a desirable response if a thorough ablation is achieved. In preclinical models, as in humans, RDN shows variable impact, with evidence indicating it does not work in specific conditions such as reduced renal mass, salt-sensitive hypertension, and autosomal recessive polycystic kidney disease. The thresholds, however, for indicators are such that it is still not possible to reliably predict which patients could benefit from the technique. Confirmation of predictive factors and identification of biomarkers are needed before RDN can be integrated in clinical practice on clear and reliable grounds.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Patient Selection for Renal Denervation in Hypertensive Patients: What Makes a Good Candidate?

Li¹,

Phillips²

2022

VHRM

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The role of autonomic imbalance in the pathogenesis of hypertension and the therapeutic effectiveness of renal denervation (literature review)

Skomkina,

Mordovin,

Falkovskaya

et al. 2024

SJCEM

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Arterial hypertension (AH) remains a global problem of modern healthcare, since, despite advances in clinical pharmacology and the use of modern antihypertensive drugs, it continues to be a major risk factor for cardiovascular complications. This necessitates a more in-depth study of the pathogenetic mechanisms of this disease and the development of new pathogenetically based methods of its treatment. Every year more and more studies are published, the results of which indicate the significant role of autonomic imbalance in the pathogenesis of the disease. The article presents the main modern data concerning the study of this problem. A detailed analysis of works devoted to the role of sympathetic hyperactivation in a sustained increase in blood pressure (BP) and the development of pharmacotherapy-resistant forms of hypertension (RAH) was carried out. Particular attention is paid to the influence of modern endovascular methods on changes in the severity of immunoinflammatory processes, through the activation of which the hypertensive effects of increased activity of the sympathetic nervous system are realized. Possible mechanisms of the therapeutic effectiveness of renal denervation and prospects for further clinical application of the method are described.

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Renal denervation for resistant hypertension and heart failure with a reduced ejection fraction

Cañameras¹,

Rodríguez-Leor²,

Riera³

et al. 2023

Ann Clin Hypertens

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Hypertension is a risk factor for the development of heart failure and has a negative impact on the survival of these patients. Although patients with these two conditions usually take different antihypertensive medications, some patients do not achieve adequate blood pressure control and their hypertension becomes resistant or refractory. In this scenario, percutaneous renal denervation has emerged in recent years as an alternative to achieve blood pressure control goals. We present the case of a 53-year-old woman with a medical history of essential hypertension, hypercholesterolemia, unipolar depression, and diabetes, who was diagnosed with dilated cardiomyopathy with reduced left ventricular ejection fraction (33%). Despite the initiation of multiple antihypertensive medications and placement of a cardiac resynchronization therapy pacemaker, the patient remained hypertensive with a left ventricular ejection fraction of 40%. At that time, percutaneous renal denervation was performed without complications, and one year after the procedure, the patient had improved better blood pressure control and the left ventricular ejection fraction increased to 51%. This case illustrates one of the clinical scenarios in which it has been suggested that renal denervation may be more beneficial, as in the situation of patients with refractory hypertension and heart failure.

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Renal denervation for the management of hypertension. Joint position statement from the SEH-LELHA and the ACI-SEC

Cited by 4 publications

References 0 publications

Patient Selection for Renal Denervation in Hypertensive Patients: What Makes a Good Candidate?

Patient Selection for Renal Denervation in Hypertensive Patients: What Makes a Good Candidate?

The role of autonomic imbalance in the pathogenesis of hypertension and the therapeutic effectiveness of renal denervation (literature review)

Renal denervation for resistant hypertension and heart failure with a reduced ejection fraction

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