Aktuelle Kardiologie 2022; 11(02): 154-160
DOI: 10.1055/a-1693-2156
Kurzübersicht

Renale Denervation – Phoenix aus der Asche

Renal Denervation – Phoenix raising from the Ashes
Joachim Weil
1   Medizinische Klinik II, Sana Kliniken Lübeck GmbH, Lübeck, Deutschland (Ringgold ID: RIN39556)
› Author Affiliations

Zusammenfassung

Die arterielle Hypertonie ist eine häufige und meistens unzureichend behandelte Erkrankung, die für eine Vielzahl von kardiovaskulären Komplikationen verantwortlich ist. Aufgrund der schlechten Therapieadhärenz resultieren Lebensstiländerungen und die medikamentöse Dauertherapie häufig nicht in einer ausreichenden Blutdrucksenkung. Die renale Denervation (RDN) hat damit das Potenzial, die bisherigen Strategien zur Therapie der arteriellen Hypertonie sinnvoll zu ergänzen. Unlängst haben mehrere randomisierte, unabhängige Studien das biologische Konzept der RDN eindeutig nachgewiesen. Dabei entspricht die erreichte Blutdrucksenkung im Mittel etwa dem eines Antihypertonikums. Unabhängig von der Therapietreue des Patienten ist die Wirkung anhaltend. Weitere klinische Untersuchung werden derzeit durchgeführt, um die bisherigen Ergebnisse zu festigen und bislang ungeklärte Fragen zu beantworten.

Abstract

Hypertension is a frequent disease responsible for many cardiovascular complications. However, lifelong polypharmacy is failing as a strategy to improve hypertension control. One reason is abysmal adherence to medication and lifestyle modifications. Renal denervation therefore is an additive treatment strategy in patients with uncontrolled hypertension. Proof of principle of renal denervation for hypertension in the absence and presence of drugs has been shown in well controlled randomized clinical trials. Blood pressure reduction by RDN equates one antihypertensive drug. Independently of adherence to medication RDN induces a permanent reduction of blood pressure. Further clinical trials are underway to corroborate the current results and to answer open questions.

Was ist wichtig?

Die Behandlung der arteriellen Hypertonie bleibt unzureichend. Die renale Denervation ist eine invasive Therapiestrategie, deren biologisches Konzept in mehreren unabhängigen, kontrollierten Studien eindeutig nachgewiesen wurde. Verschiedene Techniken zur Ablation sind in der klinischen Anwendung. Alle geprüften Verfahren sind sicher und führen zu einer klinisch relevanten Blutdrucksenkung. Damit ist die renale Denervation eine Erweiterung der therapeutischen Möglichkeiten bei Patienten mit Bluthochdruck.



Publication History

Article published online:
12 April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • Literatur

  • 1 Neuhauser HK, Adler C, Rosario AS. et al. Hypertension prevalence, awareness, treatment and control in Germany 1998 and 2008–11. J Hum Hypertens 2015; 29: 247-253
  • 2 Muntner P, Hardy ST, Fine LJ. et al. Trends in Blood Pressure Control Among US Adults With Hypertension, 1999–2000 to 2017–2018. JAMA 2020; 324: 1190-1200
  • 3 Wallemacq P, Persu A. Evaluation of Adherence Should Become an Integral Part of Assessment of Patients With Apparently Treatment-Resistant Hypertension. Hypertension 2016; 68: 297-306
  • 4 Lamirault G, Artifoni M, Daniel M. et al. Resistant Hypertension: Novel Insights. Curr Hypertens Rev 2020; 16: 61-72
  • 5 DiBona GF, Esler M. Translational medicine: the antihypertensive effect of renal denervation. Am J Physiol Regul Integr Comp Physiol 2010; 298: R245-R253
  • 6 Smithwick RH, Thompson JE. Splanchnicectomy for essential hypertension; results in 1,266 cases. J Am Med Assoc 1953; 152: 1501-1504
  • 7 Converse Jr RL, Jacobsen TN, Toto RD. et al. Sympathetic overactivity in patients with chronic renal failure. N Engl J Med 1992; 327: 1912-1918
  • 8 Schlaich MP, Sobotka PA, Krum H. et al. Renal denervation as a therapeutic approach for hypertension: novel implications for an old concept. Hypertension 2009; 54: 1195-1201
  • 9 Mahfoud F, Tunev S, Ewen S. et al. Impact of Lesion Placement on Efficacy and Safety of Catheter-Based Radiofrequency Renal Denervation. J Am Coll Cardiol 2015; 66: 1766-1775
  • 10 Mahfoud F, Weber M, Schmieder RE. et al. Catheter-based alcohol-mediated renal denervation for the treatment of uncontrolled hypertension: design of two sham-controlled, randomized, blinded trials in the absence (TARGET BP OFF-MED) and presence (TARGET BP I) of antihypertensive medications. Am Heart J 2021; 239: 90-99
  • 11 Sanders MF, van Doormaal PJ, Beeftink MMA. et al. Renal artery and parenchymal changes after renal denervation: assessment by magnetic resonance angiography. Eur Radiol 2017; 27: 3934-3941
  • 12 Krum H, Schlaich MP, Sobotka PA. et al. Percutaneous renal denervation in patients with treatment-resistant hypertension: final 3-year report of the Symplicity HTN-1 study. Lancet 2014; 383: 622-629
  • 13 Esler MD, Krum H, Sobotka PA. Symplicity HTN-2 Investigators. et al. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet 2010; 376: 1903-1909
  • 14 Bhatt DL, Kandzari DE, O’Neill WW. et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med 2014; 370: 1393-1401
  • 15 Azizi M, Sapoval M, Gosse P. et al. Optimum and stepped care standardised antihypertensive treatment with or without renal denervation for resistant hypertension (DENERHTN): a multicentre, open-label, randomised controlled trial. Lancet 2015; 385: 1957-1965
  • 16 Townsend RR, Mahfoud F, Kandzari DE. et al. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet 2017; 390: 2160-2170
  • 17 Böhm M, Kario K, Kandzari DE. et al. Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial. Lancet 2020; 395: 1444-1451
  • 18 Azizi M, Schmieder RE, Mahfoud F. et al. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial. Lancet 2018; 391: 2335-2345
  • 19 Kandzari DE, Böhm M, Mahfoud F. et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet 2018; 391: 2346-2355
  • 20 Azizi M, Sanghvi K, Saxena M. et al. Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, sham-controlled trial. Lancet 2021; 397: 2476-2486
  • 21 Desch S, Okon T, Heinemann D. et al. Randomized sham-controlled trial of renal sympathetic denervation in mild resistant hypertension. Hypertension 2015; 65: 1202-1208
  • 22 Ettehad D, Emdin CA, Kiran A. et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016; 387: 957-967
  • 23 Schmieder RE, Mahfoud F, Mancia G. et al. European Society of Hypertension position paper on renal denervation 2021. J Hypertens 2021; 39: 1733-1741
  • 24 Fengler K, Reimann P, Rommel KP. et al. Comparison of Long-Term Outcomes for Responders Versus Non-Responders Following Renal Denervation in Resistant Hypertension. J Am Heart Assoc 2021; 10: e022429
  • 25 Steinberg JS, Shabanov V, Ponomarev D. et al. Effect of Renal Denervation and Catheter Ablation vs Catheter Ablation Alone on Atrial Fibrillation Recurrence Among Patients With Paroxysmal Atrial Fibrillation and Hypertension: The ERADICATE-AF Randomized Clinical Trial. JAMA 2020; 323: 248-255