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    Interventional procedure overview of percutaneous transluminal renal sympathetic denervation for resistant hypertension

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    Existing assessments of this procedure

    In 2019, the Joint UK Societies (JUKS) published the consensus statement on RDN (Lobo 2019). JUKS concluded that "there are insufficient data at present to suggest that RDN should be considered routine standard of care in the management of hypertension in adults and that additional clinical trials data are required".

    In 2021, the European Society of Hypertension (ESH) published a position paper on RDN (Schmieder 2021). ESH gave the following position statements:

    • On the basis of consistent results of several sham-controlled clinical trials, renal denervation represents an evidence-based option to treat hypertension, in addition to lifestyle changes and blood pressure lowering drugs.

    • Renal denervation therefore expands therapeutic options to address the first objective of hypertension treatment, that is to effectively reduce an elevated blood pressure and achieve blood pressure targets.

    • Renal denervation is considered a safe endovascular procedure without significant short-term or long-term adverse effects based on data available up to 3 years.

    • Renal denervation is an alternative or additive, not a competitive treatment strategy.

    • A structured pathway for clinical use of RDN in daily practice is recommended.

    • Patients' perspective and preference as well as patients' stage of hypertensive disease including comorbidities should lead to an individualized treatment strategy in a shared decision-making process, that carefully includes the various options of treatment, including renal denervation.

    In 2018, the Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) published the ESC/ESH guidelines for the management of arterial hypertension (Williams 2018). The Task Force recommended that "use of device-based therapies is not recommended for the routine treatment of hypertension, unless in the context of clinical studies and RCTs, until further evidence regarding their safety and efficacy becomes available" (Grade III recommendation). This recommendation differs from the 2013 guidelines, in which it was recommended that "in case of ineffectiveness of drug treatment, invasive procedures such as renal denervation and baroreceptor stimulation may be considered" (Grade IIa recommendation).

    In 2016, the French Society of Hypertension, an affiliate of the French Society of Cardiology, published the expert consensus statement in the management of resistant hypertension (Denolle 2016). They recommended that "because renal denervation is still undergoing assessment for the treatment of hypertension, it is suggested this technique should only be proposed by a multidisciplinary team in a specialist hypertension clinic." (Class 1, Level C, Grade +++).