Abstract
Renal denervation is not a cure for hypertension. Although more recent sham-controlled
trials were positive, a significant minority of patients in each trial were unresponsive.
The optimal patient or patients need to be defined. Combined systolic/diastolic hypertension
appears more responsive than isolated systolic hypertension. It remains uncertain
whether patients with comorbidities associated with higher adrenergic tone should
be targeted, including obesity, diabetes, sleep apnea, and chronic kidney disease.
No biomarker can adequately predict response. A key to a successful response is the
adequacy of denervation, which currently cannot be assessed in real time. It is uncertain
what is the optimal denervation methodology i.e., radiofrequency, ultrasound, or ethanol
injection. Radiofrequency requires targeting the distal main renal artery plus major
branches and accessory arteries. Although denervation appears to be safe, conclusive
data on quality-of-life, improved target organ damage, and/or reduced cardiovascular
events/mortality are required before denervation can be generally recommended.
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Article info
Publication history
Accepted:
May 3,
2023
Received:
May 3,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc.
