17 May 2022
Hypertension management in 2022: Latest data on renal denervation - EuroPCR 2022
On the occasion of World Hypertension Day, Felix Mahfoud speaks about the value of renal denervation, including the latest data and what we can learn about renal denervation at EuroPCR 2022.
Ali Nazmi Calik discusses with David Kandzari the current data on the catheter-based renal denervation treatment to reduce blood pressure in patients with hypertension
“It is fitting that on World Hypertension Day we begin a series of sessions on interventions to improve its management,“ says Felix Mahfoud. Hypertension is the most common cardiovascular risk factor worldwide, affecting over 1 billion people and contributing to more than 9 million premature deaths annually.1 “We know that reducing blood pressure lowers the risk of cardiovascular events and death,” he explains, “But our initial steps, such as lifestyle interventions and antihypertensive medication, are insufficient for adequate control in some patients and there is a need for additional approaches. We now have key evidence showing that renal denervation safely and effectively lowers blood pressure and I think it represents a valid adjunctive approach to enhance current strategies.”
Felix Mahfoud highlights new long-term data published recently from a sham-controlled study of radiofrequency renal denervation in which he was an investigator – the SPYRAL HTN-ON MED trial.2 At 36 months, ambulatory systolic blood pressure was reduced by 18.7 mmHg in the renal denervation group compared with a reduction of 8.6 mmHg in the control group (adjusted treatment difference −10.0 mmHg; p=0.0039), independent of concomitant antihypertensives and without safety concerns.
Felix Mahfoud’s view is that the expanding evidence base, particularly on the long-term safety and efficacy of renal denervation, may lead to an increase in the number of centres becoming interested in performing renal denervation.
At EuroPCR 2022, a series of sessions are held on the subject:
- New 3-year data from SPYRAL HTN-ON MED showing that renal denervation increases time in therapeutic range
- A patient-level pooled analysis of ultrasound renal denervation, based on results from RADIANCE-HTN SOLO and TRIO cohorts
- 3-year data on blood pressure and cardiovascular event reductions after renal denervation from the Global SYMPLICITY Registry
- A tutorial session to guide attendees through how to set up a renal denervation programme, including the organisation of both the clinical and the cathlab side of the programme and to emphasise the importance of multidisciplinary teamwork
- A tutorial to discuss the necessary pre-procedural imaging and also provide step-by-step instructions on how to perform denervation using different methods, such as radiofrequency, ultrasound and alcohol mediation.
- A case-based discussion to cover patient selection for renal denervation, specifically exploring patients with resistant hypertension, moderate hypertension and patients with comorbidities.
For me, there is no one ‘ideal patient’ for renal denervation,” concludes Felix Mahfoud, “But as the procedures continue to be refined and as hypertension prevalence increases, I think we will see more and more patients being managed this way.
References
- Solomonica A, et al. J Thorac Dis. 2018;10:707–713.
- Mahfoud F, et al. Lancet 2022;399:1401–1410.
