1
|
Lobo MD, de Belder MA, Cleveland T, Collier D, Dasgupta I, Deanfield J, Kapil V, Knight C, Matson M, Moss J, Paton JFR, Poulter N, Simpson I, Williams B, Caulfield MJ. Joint UK societies' 2014 consensus statement on renal denervation for resistant hypertension. Heart 2014; 101:10-6. [PMID: 25431461 PMCID: PMC4283620 DOI: 10.1136/heartjnl-2014-307029] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Resistant hypertension continues to pose a major challenge to clinicians worldwide and has serious implications for patients who are at increased risk of cardiovascular morbidity and mortality with this diagnosis. Pharmacological therapy for resistant hypertension follows guidelines-based regimens although there is surprisingly scant evidence for beneficial outcomes using additional drug treatment after three antihypertensives have failed to achieve target blood pressure. Recently there has been considerable interest in the use of endoluminal renal denervation as an interventional technique to achieve renal nerve ablation and lower blood pressure. Although initial clinical trials of renal denervation in patients with resistant hypertension demonstrated encouraging office blood pressure reduction, a large randomised control trial (Symplicity HTN-3) with a sham-control limb, failed to meet its primary efficacy end point. The trial however was subject to a number of flaws which must be taken into consideration in interpreting the final results. Moreover a substantial body of evidence from non-randomised smaller trials does suggest that renal denervation may have an important role in the management of hypertension and other disease states characterised by overactivation of the sympathetic nervous system. The Joint UK Societies does not recommend the use of renal denervation for treatment of resistant hypertension in routine clinical practice but remains committed to supporting research activity in this field. A number of research strategies are identified and much that can be improved upon to ensure better design and conduct of future randomised studies.
Collapse
Affiliation(s)
- Melvin D Lobo
- On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | - Mark A de Belder
- The British Cardiovascular Society The British Cardiovascular Intervention Society Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK
| | - Trevor Cleveland
- The British Society for Interventional Radiology Sheffield Vascular Institute, Sheffield Teaching Hospitals NHSFT, Northern General Hospital, Sheffield, UK
| | - David Collier
- On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Indranil Dasgupta
- The Renal Association Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK
| | - John Deanfield
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK The National Institute for Cardiovascular Outcomes Research, University College London, London, UK
| | - Vikas Kapil
- On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | - Charles Knight
- Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK The British Cardiovascular Society
| | - Matthew Matson
- The British Society for Interventional Radiology Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Jonathan Moss
- The British Society for Interventional Radiology Interventional Radiology Unit, Gartnavel General Hospital, Glasgow, UK
| | - Julian F R Paton
- On behalf of the British Hypertension Society School of Physiology & Pharmacology, Bristol Cardiovascular Medical Sciences Building, University of Bristol, Bristol, UK
| | - Neil Poulter
- On behalf of the British Hypertension Society International Centre for Circulatory Health, Imperial College, London, UK
| | - Iain Simpson
- The British Cardiovascular Society Wessex Regional Cardiac Unit, University Hospital Southampton, UK
| | - Bryan Williams
- On behalf of the British Hypertension Society Institute of Cardiovascular Sciences, University College London, London, UK
| | - Mark J Caulfield
- On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | | | | | | | | |
Collapse
|