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Clinical Articles, Lead Article

Renal denervation recommendations from ESC

The European Society of Cardiology (ESC) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) have developed an expert consensus document on catheter-based renal denervation,1 published recently in the European Heart Journal. It provides guidance on patient selection, centre selection, efficacy, safety, limitations and potential new indications for referring physicians, interventionalists and healthcare providers.

The paper states that renal denervation is currently indicated for blood pressure control in patients with treatment resistant hypertension despite treatment with at least three antihypertensive drugs of different types in adequate doses, including one diuretic, and lifestyle modification. It recommends that screening should be conducted to exclude patients with secondary causes of hypertension that are potentially curable.

Centres should be specialised in the management of hypertension, it says, with at least one hypertension expert involved in treatment and screening, and the intervention performed by interventional cardiologists or angiologists with training in percutaneous renal artery access. Centres are recommended to perform more than 25 renal artery interventions per year to ensure they have the required experience.

Felix_Mahfoud_klein

Dr Felix Mahfoud (Klinik für Innere Medizin III, Germany)

Lead author Dr Felix Mahfoud (Klinik für Innere Medizin III, Homburg/Saar, Germany), said: “The hope is that insurance companies and healthcare providers will read it and will only pay for those centres and especially for those patients who fit the criteria published in the paper. The problem right now is that there are no European criteria for determining which patients are most likely to benefit and which centres have the necessary experience.”

“We have known for decades that high sympathetic activity could be a target for treatment but until now we haven’t had a way to do it. We now have a new treatment modality which allows us to reduce sympathetic activity and I’m optimistic that we will get new indications for renal denervation,” he added.

The Symplicity HTN-1 trial showed that renal denervation had a sustained blood pressure lowering effect over three years2 but longer efficacy data is needed, said Dr Mahfoud: “We treated the first patient three years ago and so far there is no sign of renervation. Long term follow up of these patients is needed.”

Trials have not investigated the possibility of reducing pill burden, he added: “Patients have to keep taking their antihypertensive medications.”

References

1. Mahfoud F, Lüscher TF, Andersson B, et al. Expert consensus document from the European Society of Cardiology on catheter-based renal denervation. Euro Heart J 2013; online publish-ahead-of-print 24 April 2013.  http://dx.doi.org/10.1093/eurheartj/eht154

2. Krum H, Barman N, Schlaich M, Sobotka P, Esler M, Mahfoud F. Long-term follow-up of catheter-based renal sympathetic denervation for resistant hypertension confirms durable blood pressure reduction. J Am Coll Cardiol. 2012;59(13):E1704.

Published on: April 26, 2013

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