Renal sympathetic nerve ablation for the management of resistant hypertension: an update.

Thorp, Alicia A; Larsen, Robyn N; Schlaich, Markus P

PURPOSE OF REVIEW The aim is to provide clinicians with a concise update on renal sympathetic nerve ablation in the management of resistant hypertension. The review will specifically discuss the latest clinical trial findings, technological advancements in ablation modalities and expert guidelines for patient eligibility. Novel therapeutic applications beyond blood pressure (BP) control will also be discussed. RECENT FINDINGS Follow-up data from the Symplicity Clinical Trials Program provides further evidence for the safety of the procedure and substantiates a sustained reduction in BP in most patients with resistant hypertension. Recently published expert consensus statements recommend that only patients with resistant hypertension should undergo the procedure at this stage. Several alternative treatment modalities for renal denervation have been developed to improve efficacy, procedure time and safety. Initial findings suggest comparable BP reductions amongst technical approaches. Several pilot studies, although predominantly uncontrolled, indicate additional benefits of renal sympathetic nerve ablation on regression of hypertensive end-organ damage, heart failure, cardiac arrhythmias and other disturbances commonly associated with resistant hypertension. SUMMARY Catheter-based renal nerve ablation is emerging as a well tolerated, effective and cost-effective treatment to control BP in patients with resistant hypertension. Further studies are required to determine the long-term impact of this novel therapeutic option.