Page 3 - hypertension_newsletter (5)

REFLECTIONS rtensio n
Hypertension Global Newsletter #2 Hype
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European Society of Hypertension position paper on renal denervation 2021.
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Schmieder RE, et al. J Hypertension. 2021;39(9):1733-1741.

The ESH position paper with updated recommendations Position Statement
reflects results from recent pivotal sham-controlled RCTs,
which provided important information on the efficacy and safety On the basis of consistent results of several sham-controlled
of endovascular device-based renal denervation (RDN) for clinical trials, RDN represents an evidence-based option to
hypertension treatment. RDN has emerged as an advanced treat hypertension, in addition to lifestyle changes and BP
and promising device-based technology and has been shown lowering drugs.
to be effective in reducing or interrupting the sympathetic
signals to the kidneys, thereby decreasing whole body RDN therefore expands therapeutic options to address the
sympathetic activity. These RCTs demonstrate that RDN lowers first objective of hypertension treatment, that is to effectively
ambulatory and office BP in patients with mild-to-moderate reduce an elevated BP and achieve BP targets.
as well as more severe hypertension, both with and without
concomitant antihypertensive medication. RDN is considered a safe endovascular procedure without
significant short-term or long-term adverse effects based on
data available up to three years.

Before endovascular device-based RDN can be incorporated RDN is an alternative or additive, not a competitive,

into clinical practice, a structured implementation approach treatment strategy.

should be in place to inform on the selection of appropriate A structured pathway for clinical use of RDN in daily practice
patients and how to guarantee the best outcome from the is recommended.
intervention. Regulatory approval is a prerequisite to interact

subsequently with reimbursement authorities. In addition, a Patients’ perspective and preference as well as patients’

structured and transparent way of qualifying centres to perform stage of hypertensive disease including comorbidities should

RDN should be established. lead to an individualized treatment strategy in a shared

decision-making process, that carefully includes the various

Some current gaps in knowledge on RDN include robust options of treatment, including RDN.

predictors of BP response to RDN, direct comparison of

different ablation technologies, long-term durability of BP lowering and safety beyond three years, and considerations and further

studies in hypertensive patients with comorbidities such as CKD, atrial fibrillation, and heart failure, as well as cost-effectiveness. In

addition, patients’ perspective, therapeutic preference, and quality of life need to be explored in the future.

RDN is an innovative option in antihypertensive treatment, which may be an option for patients based on patient preference, side
effects from pharmacotherapy, and admitted nonadherence to pharmacotherapy.

“The shared decision-making process is important and it’s during that process that patients could select RDN as a treatment
option in addition to lifestyle changes and BP lowering drugs. In other words, RDN expands hypertension therapeutic options as
an alternative and not as a competitive treatment,”

Professor Schmieder
Quote taken from https://www.eshonline.org/spotlights/guidelines-position-statements/

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