Renal Denervation for Resistant Hypertension: Where Do We Stand?
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RESISTANT HYPERTENSION (L DRAGER, SECTION EDITOR)
Renal Denervation for Resistant Hypertension: Where Do We Stand? Bo Liang 1
&
Yu-Xiu Zhao 2
&
Ning Gu 3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To review the data about the use of renal denervation (RDN), a minimally invasive surgery, for resistant hypertension (RH) and to provide practical guidance for practitioners who are establishing an RDN service. Recent Findings RDN can selectively ablate renal sympathetic nerve fibres, block the transmission of nerve impulses between central sympathetic nerve and kidney, to control blood pressure to as a novel promising non-drug treatment option for RH. At present, there are many researches on the treatment of RH by RDN, but there are some controversies. This review summarises and critically examines the evidence for RDN in the treatment of RH and identifies areas for future research. Summary With the development of RDN, the continuous innovation of RDN technology and methods, the development about better evaluating the real-time success of RDN and the improvement for identifying individuals who are most likely to benefit from RDN will ultimately determine whether RDN represents a feasible way to manage RH in the future. Keywords Hypertension . Renal denervation . Resistant hypertension . Intervention
Introduction Hypertension is an important public-health challenge worldwide [1••]. The number of adults with hypertension increased from 594 million in 1975 to 1.13 billion in 2015 [2] and is predicted to increase by about 40% to a total of 1.56 billion in 2025 [3]. Among them, resistance hypertension (RH), defined as requiring four or more antihypertensive agents to keep blood pressure (BP) below 130/80 mmHg [4••], accounted for 20~30% [5••, 6–8]. Given the importance of hypertension as a modifiable risk factor for cardiovascular disease, reducing uncontrolled hypertension should remain a population health focus [9]. However, the treatment of RH brings great difficulties to clinicians and patients. In the 1950s, Smithwick reported a surgical method of splanchnicectomy to control hypertension [10]. After splanchnicectomy, BP was obviously controlled, but because This article is part of the Topical Collection on Resistant Hypertension * Ning Gu [email protected]; [email protected] 1
Nanjing University of Chinese Medicine, Nanjing, China
2
Hospital (T.C.M.) Affiliated to Southwest Medical University, Luzhou, China
3
Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
of the extremely serious complications in the perioperation and postoperation, which seriously affected the therapeutic efficacy, this method was difficult to be accepted, and ultimately all were fruitless [11, 12]. In 2009, Schlaich et al. reported firstly that a 59-year-old male patient with RH was treated by renal sympathetic-nerve ablation [13], which opened the precedent of renal denervation (RDN) in the treatment of RH. The SYMPLICITY HTN
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