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Review
Update on advanced interventional neuromodulatory approaches to lower blood pressure
  1. Marcio Galindo Kiuchi1,
  2. Revathy Carnagarin1,
  3. Carl Schultz2,
  4. Sharad Shetty3,
  5. Natalie C Ward1,
  6. Carlos Eduardo Santos4,
  7. Markus P Schlaich1,2,5
  1. 1 Dobney Hypertension Centre, Medical School, The University of Western Australia, Perth, Western Australia, Australia
  2. 2 Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
  3. 3 Department of Cardiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  4. 4 Cardiology, Hospital Esperança Olinda, Olinda, Penambuco, Brazil
  5. 5 Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
  1. Correspondence to Professor Markus P Schlaich, Dobney Hypertension Centre, Medical School, The University of Western Australia, Perth, WA 6000, Australia; markus.schlaich{at}uwa.edu.au

Abstract

Herein, we review interventional peripheral neuromodulatory approaches to reduce blood pressure (BP), specifically focusing on catheter-based renal denervation (RDN), as well as the latest data from recent clinical trials underpinning its clinical use. Given the apparent failure of established lifestyle measures and pharmacologic BP-lowering approaches to improve hypertension (HTN) control rates, the past decade has seen remarkable scientific efforts to explore the utility of interventional strategies for BP management. Experimental studies and human clinical trials have demonstrated the crucial role of the sympathetic nervous system in the development and mainenance of HTN - consequently, most recent interventional technologies aimed primarily at modulating neural pathways. Advanced approaches that were rigorously tested in human studies include RDN, endovascular baroreflex amplification, baroreflex activation therapy and cardiac neuromodulation stimulation.

Amongst these, RDN is by far the most established technology. With recent robust evidence from clinical trials and real-world data showing the safety and efficacy of both ultrasound and radiofrequency-based approaches, a recent clinical consensus statement of the European Society of Cardiology Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions concludes that RDN represents an ancillary therapeutic option in patients with uncontrolled resistant HTN confirmed by ambulatory blood pressure measurement and in spite of attention to lifestyle changes and optimised pharmacological treatment. Furthermore, RDN could alos be considered for patienst unlikley to adhere to or tolerate long-term antihypertensive drug treatment. Very recent data indicate long-term safety and efficacy up to 10 years. Appropriate implementation of RDN into clinical practice is now warranted.

For all other interventions additional data from adequately designed human studies are required to establish their safety and clinical utility for potential future use in routine practice.

  • catheter ablation
  • outcome assessment, healthcare
  • hypertension

https://doi.org/10.1136/heartjnl-2022-321499

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    Footnotes

    • Twitter @markus schlaich

    • Contributors MGK and MS researched data and wrote the initial draft of the manuscript. All other authors provided intellectual input, researched relevant data and provided critical review of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MGK has received consulting fees and/or travel and research support from Medtronic. RC is supported by the Australian National Heart Foundation post doc fellowship. CES and SS have been involved in renal denervation studies supported by Medtronic. SS has received consulting fees and/or travel and research support from Medtronic. MS has received consulting fees, and/or travel and research support from Medtronic, Abbott, Novartis, Servier, Pfizer and Boehringer-Ingelheim.

    • Provenance and peer review Commissioned; externally peer reviewed.