A Review on Renal Denervation: A New Frontier in Hypertension Management

Abstract

Renal sympathetic denervation (RSDN) is a minimally invasive endovascular catheter treatment that treats resistant hypertension (high blood pressure that cannot be brought under control with medicines) by employing radiofrequency ablation or ultrasound ablation. Using radiofrequency pulses or ultrasound on the renal arteries destroys nerves in the arterial wall. As a result, there is a decrease in sympathetic afferent and efferent activity in the kidney, which lowers blood pressure. Early results from global clinical studies showing significant drops in blood pressure in individuals with treatment-resistant hypertension without sham controls were encouraging. A catheter-mounted device is advanced into the renal artery during the surgery, which entails endovascular access via the femoral artery. The renal nerves are ablated by the device using ultrasound or radiofrequency. To achieve maximum denervation, several ablations are often administered at various longitudinal and rotational positions. An implant is not required for the operation to be permanent. Serious complications are uncommon, but minor access site complications occur in about 5% of patients. Other potential complications include renal artery dissection and stenosis. RDN can reduce office systolic blood pressure by an average of 4–6 mm Hg more than control patients. It can also help reduce target organ damage.