Renal denervation in 2019

Abstract

In the 21st century, hypertension remains a major health threat to the adult population worldwide, despite the phenomenal progress in the development of antihypertensive pharmacotherapy. Currently, the rate of pharmacological control of hypertension barely exceeds 50%. Indeed, pharmacotherapy is fundamentally limited by pharmacological/pharmacokinetic tolerance (adaptation) to the drugs as well as by non-compliance of patients with treatment regimens due to depletion of their psychophysiological function of self-control. Renal denervation (RDN) is a new non-drug treatment of hypertension. Renal denervation consists of a mini-electrosurgery on the renal sympathetic system where a catheter ablation is used to create a permanent block of conduction through the renal nerves. This procedure, in accordance with the function of the renal adrenergic receptors, increases glomerular filtration, reduces tubular water reabsorption, and inhibits glomerular secretion of renin. After the over-disputed failure of the early version of RDN using the first-generation single-electrode catheter system in the SYMPLICITY HTN-3 study, therapy was virtually reinvented with a new three-dimensional multi-electrode design and an anatomically optimized procedure. The new device design ensures deployment of the electrodes in a pre-defined fully circumferential pattern. Moreover, this design provides a radial contact that presses the electrodes against the arterial wall thereby maximizing the efficiency of radiofrequency (RF) tissue heating. Another major improvement of RDN therapy is the anatomical optimization of the procedure by extending the treatment into the segmental branches of the renal artery where the renal nerves concentrate the most around renal vessels. This article presents an analysis of the current state-of-the-development and future perspectives of RDN therapy.