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Joint UK societies’ 2014 consensus statement on renal denervation for resistant hypertension
  1. Melvin D Lobo1,2,3,
  2. Mark A de Belder4,5,6,
  3. Trevor Cleveland7,8,
  4. David Collier1,2,
  5. Indranil Dasgupta9,10,
  6. John Deanfield6,11,
  7. Vikas Kapil1,2,3,
  8. Charles Knight3,4,
  9. Matthew Matson7,2,
  10. Jonathan Moss7,12,
  11. Julian F R Paton1,13,
  12. Neil Poulter1,14,
  13. Iain Simpson4,15,
  14. Bryan Williams1,16,
  15. Mark J Caulfield1,2,3
  1. 1On behalf of the British Hypertension Society
  2. 2Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK
  3. 3Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK
  4. 4The British Cardiovascular Society
  5. 5The British Cardiovascular Intervention Society
  6. 6Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK
  7. 7The British Society for Interventional Radiology
  8. 8Sheffield Vascular Institute, Sheffield Teaching Hospitals NHSFT, Northern General Hospital, Sheffield, UK
  9. 9The Renal Association
  10. 10Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK
  11. 11The National Institute for Cardiovascular Outcomes Research, University College London, London, UK
  12. 12Interventional Radiology Unit, Gartnavel General Hospital, Glasgow, UK
  13. 13School of Physiology & Pharmacology, Bristol Cardiovascular Medical Sciences Building, University of Bristol, Bristol, UK
  14. 14International Centre for Circulatory Health, Imperial College, London, UK
  15. 15Wessex Regional Cardiac Unit, University Hospital Southampton, UK
  16. 16Institute of Cardiovascular Sciences, University College London, London, UK
  1. Correspondence to Dr Melvin D Lobo, Centre for Clinical Pharmacology, William Harvey Heart Centre, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; m.d.lobo{at}qmul.ac.uk

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.

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