Introduction on Catheter-based Renal Sympathetic Denervation - Long-term Symplicity™ Renal Denervation Clinical Evidence, New Data and Future Perspectives

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Introduction on Catheter-based Renal Sympathetic Denervation - Long-term Symplicity™ Renal Denervation Clinical Evidence, New Data and Future Perspectives

Hypertension is one of the most important public health problems of the 21st century, with a global prevalence of around 30 %.1 In 2010, it accounted for 7.5 million deaths worldwide, representing 12.8 % of the global total.2 Furthermore, its prevalence is projected to rise to 1.5 billion hypertensive patients in 2025.3 Despite the availability of numerous safe and effective antihypertensive medications, the proportion of hypertensive patients achieving recommended blood pressure (BP) targets is only around 50 %.4 Resistant hypertension is generally dened as BP that remains high (>140/90 millimetres of mercury [mmHg]) despite the concomitant use of antihypertensive drugs from more than three drug classes, including a diuretic.5 Estimates of its prevalence vary widely, but data from observational studies and clinical trials suggest that 8-30% of treated hypertension patients have resistant hypertension.Given that cardiovascular mortality doubles with each 20/10 mmHg increase in BP,7 resistant hypertension represents a serious global health challenge.

New approaches to the treatment of patients with resistant hypertension are an important clinical need. Percutaneous catheterbased transluminal renal ablation (renal denervation [RDN]) is emerging as a novel treatment approach for resistant hypertension. Renal nerve activation contributes to the pathogenesis of hypertension as a result of renal vasoconstriction; renal blood ow and glomerular ltration rate (GFR) decrease; increased sodium reabsorption and renin release.8,9 RDN, involving a multiple application of radiofrequency (RF) energy using a catheter, has been shown to provide an effective and safe means of reducing sympathetic outow to and from the kidneys without adversely affecting other functions of the kidney.10 It is a minimally invasive procedure, characterised by short recovery times and the absence of signicant systemic side effects.11 The treatment has resulted in signicant and sustained BP reductions over 36 months in the majority of patients with resistant hypertension12-14 and has been associated with improvements in health-related quality of life.15 A recent study also suggested that RDN is a cost-effective strategy for resistant hypertension.16

Several devices have been approved for RDN, the most established of which is the Symplicity™ renal denervation system (Medtronic, Inc). The Symplicity Flex™ catheter is specically designed for the renal anatomy, being non-occlusive and 6 French guiding catheter compatible. The Symplicity G2™ generator utilises specic algorithms that ensure optimal delivery of RF energy to the renal artery. The procedure requires application of RF energy to 4-6 locations within each of the renal arteries to effect renal nerve interruption. The technique is straightforward to perform - treatment of renal arteries without angiographic stenosis with the Symplicity Flex catheter requires two minutes duration per treatment for a total bilateral denervation time of 8-12 minutes. Its use is supported by extensive worldwide experience, including a clinical evaluation programme. This review will present the clinical evidence in support of RDN, as well as considering future perspectives on the technique.

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