Expert position of the Polish Cardiac Society, the Polish Society of Arterial Hypertension and the Polish Society of Nephrology on renal denervation.

Abstract

Renal denervation is an innovative method of treating hypertension, used in clinical practice for about a decade. The pathophysiological basis of this method derives from the role of efferent and afferent fibers of the sympathetic nervous system, entering and leaving the kidneys, in the development of hypertension, especially treatment-resistant hypertension. Initial clinical trials suggested the high efficacy of denervation in the treatment of patients with resistant hypertension. However, the results of the Symplicity HTN-3 trial, which introduced a sham procedure as control procedure, undermined these hopes. This trial was criticized in terms of its methodology Recent research, using latest generation catheters and more stringent protocols, confirms a significant reduction in blood pressure in patients after surgery. Renal denervation should be considered in patients with hypertension (after excluding all hormonal causes and ischemic etiology), which is resistant to pharmacological treatment. Pseudo resistance, e.g., caused by the so-called white-coat hypertension, should be ruled out. Every patient should have their blood pressure monitored 24 hours a day. Lack of cooperation between the patient and the physician, and non-systematic taking of antihypertensive medications and non-compliance with other therapeutic recommendations should also be excluded. However, the condition for the success of renal denervation is the precise determination of patient eligibility and the performance of the procedure in specialized centers with appropriate experience.