Renal artery denervation for treating resistant hypertension

Definition of the disease, patient selection and description of the procedure

Massimo Volpe, Enrico Agabiti Rosei, Ettore Ambrosioni, Santina Cottone, Cesare Cuspidi, Claudio Borghi, Nicola De Luca, Francesco Fallo, Claudio Ferri, Giuseppe Mancia, Alberto Morganti, Maria Lorenza Muiesan, Riccardo Sarzani, Leonardo Sechi, Giuliano Tocci, Agostino Virdis

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Arterial hypertension is responsible for a significant burden of cardiovascular morbidity and mortality, worldwide. Although several rational and integrated pharmacological strategies are available, the control of high blood pressure still remains largely unsatisfactory. Failure to achieve effective blood pressure control in treated hypertensive patients may have a substantial impact on individual global cardiovascular risk, since it significantly increases the risk of developing hypertension-related macrovascular and microvascular complications.Arterial hypertension is arbitrarily defined as 'resistant' or 'refractory' when the recommended blood pressure goals (clinic blood pressure below 140/90mmHg or below 130/80mmHg in patients with type 2 diabetes mellitus or nephropathy) are not achieved in the presence of a therapeutic strategy that includes lifestyle changes and at least three classes of antihypertensive drugs, including a diuretic, at adequate doses.Recently, an innovative non-pharmacological option has become available for treating resistant hypertension. Sympathetic denervation of renal arteries is a minimally invasive procedure that is performed via percutaneous access from the femoral artery. It consists of radiofrequency ablation of the afferent and efferent nerves of the renal sympathetic nervous system, with consequent isolation of renal parenchymal and juxtaglomerular structures from abnormal stimulation of the efferent adrenergic system.The present position paper of the Italian Society of Hypertension (SIIA) offers a diagnostic and therapeutic approach for the proper identification and effective clinical management of patients with resistant hypertension, who are candidates for renal artery denervation. These indications may have important implications not only from a clinical point of view, but also from an economic point of view, since a proper identification of patients with true resistant hypertension and an accurate selection of patients suitable for the procedure of renal denervation can contribute to an improved control of blood pressure, and thus a reduced risk of cardiovascular and cerebrovascular complications in these patients.

Original languageEnglish
Pages (from-to)237-244
Number of pages8
JournalHigh Blood Pressure and Cardiovascular Prevention
Volume19
Issue number4
DOIs
Publication statusPublished - Dec 1 2012

Fingerprint

Denervation
Renal Artery
Patient Selection
Hypertension
Blood Pressure
Kidney
Sympathectomy
Sympathetic Nervous System
Femoral Artery
Diuretics
Adrenergic Agents
Type 2 Diabetes Mellitus
Antihypertensive Agents
Life Style
Economics
Pharmacology
Morbidity
Mortality
Therapeutics

Keywords

  • Hypertension, treatment
  • Resistant-hypertension, treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Internal Medicine

Cite this

Renal artery denervation for treating resistant hypertension : Definition of the disease, patient selection and description of the procedure. / Volpe, Massimo; Agabiti Rosei, Enrico; Ambrosioni, Ettore; Cottone, Santina; Cuspidi, Cesare; Borghi, Claudio; De Luca, Nicola; Fallo, Francesco; Ferri, Claudio; Mancia, Giuseppe; Morganti, Alberto; Muiesan, Maria Lorenza; Sarzani, Riccardo; Sechi, Leonardo; Tocci, Giuliano; Virdis, Agostino.

In: High Blood Pressure and Cardiovascular Prevention, Vol. 19, No. 4, 01.12.2012, p. 237-244.

Research output: Contribution to journalArticle

Volpe, M, Agabiti Rosei, E, Ambrosioni, E, Cottone, S, Cuspidi, C, Borghi, C, De Luca, N, Fallo, F, Ferri, C, Mancia, G, Morganti, A, Muiesan, ML, Sarzani, R, Sechi, L, Tocci, G & Virdis, A 2012, 'Renal artery denervation for treating resistant hypertension: Definition of the disease, patient selection and description of the procedure', High Blood Pressure and Cardiovascular Prevention, vol. 19, no. 4, pp. 237-244. https://doi.org/10.1007/BF03297636
Volpe, Massimo ; Agabiti Rosei, Enrico ; Ambrosioni, Ettore ; Cottone, Santina ; Cuspidi, Cesare ; Borghi, Claudio ; De Luca, Nicola ; Fallo, Francesco ; Ferri, Claudio ; Mancia, Giuseppe ; Morganti, Alberto ; Muiesan, Maria Lorenza ; Sarzani, Riccardo ; Sechi, Leonardo ; Tocci, Giuliano ; Virdis, Agostino. / Renal artery denervation for treating resistant hypertension : Definition of the disease, patient selection and description of the procedure. In: High Blood Pressure and Cardiovascular Prevention. 2012 ; Vol. 19, No. 4. pp. 237-244.
@article{c91d43df0cad4490b8abf0777ed709e5,
title = "Renal artery denervation for treating resistant hypertension: Definition of the disease, patient selection and description of the procedure",
abstract = "Arterial hypertension is responsible for a significant burden of cardiovascular morbidity and mortality, worldwide. Although several rational and integrated pharmacological strategies are available, the control of high blood pressure still remains largely unsatisfactory. Failure to achieve effective blood pressure control in treated hypertensive patients may have a substantial impact on individual global cardiovascular risk, since it significantly increases the risk of developing hypertension-related macrovascular and microvascular complications.Arterial hypertension is arbitrarily defined as 'resistant' or 'refractory' when the recommended blood pressure goals (clinic blood pressure below 140/90mmHg or below 130/80mmHg in patients with type 2 diabetes mellitus or nephropathy) are not achieved in the presence of a therapeutic strategy that includes lifestyle changes and at least three classes of antihypertensive drugs, including a diuretic, at adequate doses.Recently, an innovative non-pharmacological option has become available for treating resistant hypertension. Sympathetic denervation of renal arteries is a minimally invasive procedure that is performed via percutaneous access from the femoral artery. It consists of radiofrequency ablation of the afferent and efferent nerves of the renal sympathetic nervous system, with consequent isolation of renal parenchymal and juxtaglomerular structures from abnormal stimulation of the efferent adrenergic system.The present position paper of the Italian Society of Hypertension (SIIA) offers a diagnostic and therapeutic approach for the proper identification and effective clinical management of patients with resistant hypertension, who are candidates for renal artery denervation. These indications may have important implications not only from a clinical point of view, but also from an economic point of view, since a proper identification of patients with true resistant hypertension and an accurate selection of patients suitable for the procedure of renal denervation can contribute to an improved control of blood pressure, and thus a reduced risk of cardiovascular and cerebrovascular complications in these patients.",
keywords = "Hypertension, treatment, Resistant-hypertension, treatment",
author = "Massimo Volpe and {Agabiti Rosei}, Enrico and Ettore Ambrosioni and Santina Cottone and Cesare Cuspidi and Claudio Borghi and {De Luca}, Nicola and Francesco Fallo and Claudio Ferri and Giuseppe Mancia and Alberto Morganti and Muiesan, {Maria Lorenza} and Riccardo Sarzani and Leonardo Sechi and Giuliano Tocci and Agostino Virdis",
year = "2012",
month = "12",
day = "1",
doi = "10.1007/BF03297636",
language = "English",
volume = "19",
pages = "237--244",
journal = "High Blood Pressure and Cardiovascular Prevention",
issn = "1120-9879",
publisher = "Adis International Ltd",
number = "4",

}

TY - JOUR

T1 - Renal artery denervation for treating resistant hypertension

T2 - Definition of the disease, patient selection and description of the procedure

AU - Volpe, Massimo

AU - Agabiti Rosei, Enrico

AU - Ambrosioni, Ettore

AU - Cottone, Santina

AU - Cuspidi, Cesare

AU - Borghi, Claudio

AU - De Luca, Nicola

AU - Fallo, Francesco

AU - Ferri, Claudio

AU - Mancia, Giuseppe

AU - Morganti, Alberto

AU - Muiesan, Maria Lorenza

AU - Sarzani, Riccardo

AU - Sechi, Leonardo

AU - Tocci, Giuliano

AU - Virdis, Agostino

PY - 2012/12/1

Y1 - 2012/12/1

N2 - Arterial hypertension is responsible for a significant burden of cardiovascular morbidity and mortality, worldwide. Although several rational and integrated pharmacological strategies are available, the control of high blood pressure still remains largely unsatisfactory. Failure to achieve effective blood pressure control in treated hypertensive patients may have a substantial impact on individual global cardiovascular risk, since it significantly increases the risk of developing hypertension-related macrovascular and microvascular complications.Arterial hypertension is arbitrarily defined as 'resistant' or 'refractory' when the recommended blood pressure goals (clinic blood pressure below 140/90mmHg or below 130/80mmHg in patients with type 2 diabetes mellitus or nephropathy) are not achieved in the presence of a therapeutic strategy that includes lifestyle changes and at least three classes of antihypertensive drugs, including a diuretic, at adequate doses.Recently, an innovative non-pharmacological option has become available for treating resistant hypertension. Sympathetic denervation of renal arteries is a minimally invasive procedure that is performed via percutaneous access from the femoral artery. It consists of radiofrequency ablation of the afferent and efferent nerves of the renal sympathetic nervous system, with consequent isolation of renal parenchymal and juxtaglomerular structures from abnormal stimulation of the efferent adrenergic system.The present position paper of the Italian Society of Hypertension (SIIA) offers a diagnostic and therapeutic approach for the proper identification and effective clinical management of patients with resistant hypertension, who are candidates for renal artery denervation. These indications may have important implications not only from a clinical point of view, but also from an economic point of view, since a proper identification of patients with true resistant hypertension and an accurate selection of patients suitable for the procedure of renal denervation can contribute to an improved control of blood pressure, and thus a reduced risk of cardiovascular and cerebrovascular complications in these patients.

AB - Arterial hypertension is responsible for a significant burden of cardiovascular morbidity and mortality, worldwide. Although several rational and integrated pharmacological strategies are available, the control of high blood pressure still remains largely unsatisfactory. Failure to achieve effective blood pressure control in treated hypertensive patients may have a substantial impact on individual global cardiovascular risk, since it significantly increases the risk of developing hypertension-related macrovascular and microvascular complications.Arterial hypertension is arbitrarily defined as 'resistant' or 'refractory' when the recommended blood pressure goals (clinic blood pressure below 140/90mmHg or below 130/80mmHg in patients with type 2 diabetes mellitus or nephropathy) are not achieved in the presence of a therapeutic strategy that includes lifestyle changes and at least three classes of antihypertensive drugs, including a diuretic, at adequate doses.Recently, an innovative non-pharmacological option has become available for treating resistant hypertension. Sympathetic denervation of renal arteries is a minimally invasive procedure that is performed via percutaneous access from the femoral artery. It consists of radiofrequency ablation of the afferent and efferent nerves of the renal sympathetic nervous system, with consequent isolation of renal parenchymal and juxtaglomerular structures from abnormal stimulation of the efferent adrenergic system.The present position paper of the Italian Society of Hypertension (SIIA) offers a diagnostic and therapeutic approach for the proper identification and effective clinical management of patients with resistant hypertension, who are candidates for renal artery denervation. These indications may have important implications not only from a clinical point of view, but also from an economic point of view, since a proper identification of patients with true resistant hypertension and an accurate selection of patients suitable for the procedure of renal denervation can contribute to an improved control of blood pressure, and thus a reduced risk of cardiovascular and cerebrovascular complications in these patients.

KW - Hypertension, treatment

KW - Resistant-hypertension, treatment

UR - http://www.scopus.com/inward/record.url?scp=84877874143&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84877874143&partnerID=8YFLogxK

U2 - 10.1007/BF03297636

DO - 10.1007/BF03297636

M3 - Article

VL - 19

SP - 237

EP - 244

JO - High Blood Pressure and Cardiovascular Prevention

JF - High Blood Pressure and Cardiovascular Prevention

SN - 1120-9879

IS - 4

ER -