20 Sep 2024
Editorial: Hypertension and Renal Denervation
Hypertension - the silver bullet of medicine
Hypertension is the number one cause of years of life lost, and, perhaps more importantly, years of healthy living lost. It causes at least half of all heart attacks and strokes and is the major driver of heart failure.
As cardiologists, much of our working life is spent dealing with the downstream consequences of hypertension and in this Special Report, Sofie Brouwers will expand on why hypertension should perhaps be considered the most important disease of our professional lifetimes.
An ongoing challenge for the medical community
The recently published guidelines on hypertension from the European Society of Cardiology, released in August 2024, bring into sharp focus the challenge we face as a medical community in controlling this most important of diseases. Hypertension remains defined at an Office BP threshold of 140/90 and, historically, most countries in the world have struggled to get blood pressure below this level in over 55% of patients identified with elevated blood pressure. The new ESC guidelines now recommend a blood pressure target for treatment of 120-129/70-79mmHg in most patients. We are currently achieving these levels of BP control levels in under 30% of patients.
Lifestyle, drugs and now devices
The mainstay of treatment for hypertension has, for decades, been lifestyle interventions (such as weight loss and salt reduction) and drugs (such as ACE inhibitors, or calcium channel blockers). More recently, devices, in particular those that denervate the renal sympathetic nerves, have been proven to lower blood pressure in multiple sham-controlled clinical trials, leading to their approval for clinical use by the 2023 European Society of Hypertension clinical guidelines, the US Food and Drug Administration, and now the European Society of Cardiology guidelines on hypertension in 2024. In two video interviews, Valerie Duchatelle will explain how she established a renal denervation (RDN) service in Switzerland, and then Felix Mahfoud will explain how to safely integrate renal denervation into current treatment practice.
Safe practice
The practicalities of how to perform a renal denervation are key to safe practice and Joachim Weil will explain how to use the radiofrequency Spyral device and the ultrasound-based Paradise device to treat patients, followed by Atul Pathak, who will look to the future and give his expert opinion on how renal denervation will integrate into clinical practice over the next five years.
Blood pressure control: the 'silver bullet' of cardiovascular care
Reducing systolic blood pressure by just 10 points would be expected to reduce the risk of heart failure by 28% and stroke by 27%. This is a linear relationship, meaning a 20-point reduction in systolic BP would be expected to reduce those risks by more than half. During an epidemic of cardiovascular disease, blood pressure control (by whatever means) really could prove to be the ‘silver bullet’ of cardiovascular care, dramatically reducing the incidence of these terrible diseases. In this programme, we describe how to safely integrate the latest additional guideline-recommended treatment option for some hypertensive patients - renal denervation.
