Kidney Week Educational Symposia-Radiofrequency Renal Denervation: The Next Frontier for Difficult-to-Control Hypertension

Video Transcription

Video Summary

The symposium reviewed recent evidence and practical considerations for renal denervation (RDN) as a device-based therapy for hypertension. Moderator Dr. Jennifer Pollock summarized newer radiofrequency and ultrasound sham-controlled trials showing modest but significant reductions in ambulatory blood pressure, with durability reported out to three years and no major safety signals. She also highlighted patient survey data suggesting substantial interest in RDN, though individual responses vary and it remains unclear which patients benefit most.<br /><br />Dr. Ray Townsend explained renal nerve physiology: increasing sympathetic stimulation drives renin release, sodium retention, then renal vasoconstriction; RDN interrupts both efferent and afferent renal signaling. He emphasized safety as central to regulatory approval, noting the most common acute issue is procedure-related pain; serious vascular complications are uncommon. Across thousands of cases, renal artery stenosis requiring stenting is rare (~0.2%/year) and kidney function trajectories over years appear similar to medicated hypertensive populations. On efficacy, he reviewed the setback of SYMPLICITY HTN-3 (large sham BP drop and medication confounding) and how later trials improved conduct (including drug testing). Typical effects are ~10 mmHg office systolic and ~5–6 mmHg 24-hour ambulatory systolic reductions, with small additional decreases over subsequent years and durability reported up to 10 years.<br /><br />Dr. Michael Weber framed RDN’s potential public-health value amid worsening BP control, poor medication adherence, and loss of trial benefits in real-world care (e.g., SPRINT follow-up). He argued even modest sustained BP reductions can meaningfully reduce strokes, heart failure, and mortality, and RDN may help patients unable or unwilling to maintain medications. Q&A addressed effectiveness in Black patients (similar in off-med trials; on-med trials confounded by adherence), limited predictors of responders, uncertain value of repeat denervation, daytime vs 24-hour ABPM reporting, and limited but promising data in dialysis patients.

Asset Subtitle

Moderator(s): Jennifer Pollock

Presentation(s):

Introduction - Jennifer Pollock
Interpreting the Renal Denervation Literature: Mechanisms, Safety, and Effectiveness - Raymond Townsend
Practical Approaches to Renal Denervation: Establishing a Program and Optimizing Patient Selection - Michael Weber

Support is provided by an educational grant from Medtronic.

Meta Tag

Date 11/3/2023

Pathway 1 Hypertension and Cardiorenal Disorders

Session ID 464994

Session Type ES - Educational Symposium

Keywords

renal denervation

RDN

device-based hypertension therapy

radiofrequency ablation

ultrasound denervation

sham-controlled trials

ambulatory blood pressure monitoring

sympathetic nervous system physiology

renal artery stenosis safety

medication adherence and public health impact