Renal denervation for resistant hypertension

Abstract

Hypertension is a common condition with an estimated 1 billion individuals affected worldwide. The resistant hypertension cohort tends to have a longer duration of hypertension, greater end-organ damage, and a greater mortality rate than non-resistant hypertensive patients. This chapters review one of novel nonpharmacologic therapies, renal denervation. An important factor underlying several forms of hypertension is an elevated level of sympathetic nerve activity. A dose-response relationship has been demonstrated, in that those individuals with higher blood pressure also display evidence of greater sympathetic activation. More recently, the value of surgical denervation has been realized in a sub-selected group of patients within renal transplant medicine. Continuous monitoring of heart rate, blood pressure, and oxygen saturation is mandatory after administration of analgesics and sedatives. Blood pressure and heart rate response to renal sympathetic nerve stimulation before and after denervation are a potential method to assess efficacy of the ablation procedure.