Can Afferent Nerve Ablation Cure Essential Hypertension?
Jeffrey Westcott, Robert Bersin, James Zidar, William O’Neill
Background: Hypertension remains an enormous issue worldwide, and because of its impact on cardiovascular events and mortality, is a major public health issue. Because of its impact on cardiovascular events and mortality, small sustained changes in blood pressure (10 mm systolic, 5 mm diastolic) can have an incredible impact, a 40% lower risk of stroke-related death, and a 30% lower risk of death from other vascular causes. Unfortunately, 30% of patients go untreated, and 35% are treated and uncontrolled, and approximately 10% of patients are uncontrolled despite the administration of 3 or more anti-hypertensive drugs. It is this subset of medically refractory hypertension that the clinical trials of renal artery denervation have focused.
Gaps in current knowledge: The clinical trials of renal denervation have demonstrated a significant reduction in systolic blood pressure in the medically refractory population. The trials have not yet established the long-term durability of this benefit, nor have they established the long-term safety, not just in terms of the patency of the treated renal artery and the functionality of the treated kidney, but also in scenarios where a blood pressure response is desirable or needed, but potentially may no longer available, such as in sepsis, hemorrhage, trauma, shock, etc. It is also not established whether the measured drop in systolic blood pressure with the denervation procedure results in the same clinical benefit to the patient as an equivalent drop achieved with anti-hypertensive medications, as many anti-hypertensive medications have benefits independent of their blood pressure lowering actions, such as the effects of beta blockers on cardiac arrhythmias or the effects of ACE inhibitors on endothelial function.
Summary and recommendations: A large scale randomized trial of best medical therapy versus renal denervation with long term follow-up of more than two years will be needed in the resistant hypertensive population to determine whether the blood pressure lowering effect of renal denervation is durable and affords the same or greater clinical benefit in terms of reduction of major cardiovascular and cerebrovascular events and mortality as best medical therapy. Additional trials will be needed to see if this benefit can also be extended to less resistant hypertensive populations.
Speaker: Jeffrey Westcott
Moderator: Robert Bersin
Panelists: Jim Zidar and William O’Neill
Robert Bersin: The next new technology is in what I would call a breakthrough area, an area where no previous interventional treatments have been available, and I would like to welcome my partner Jeff Westcott back up to the podium to talk about afferent nerve ablation in the renal arteries.
Jeffrey Westcott: Thanks Bob, I am rookie so be kind to me. I really did take seriously the IAGS rule about limiting the number of our slides, but this is an impossible topic to talk about in three slides. I think I figured out how to do it. This is the first disruptive technology, maybe other than BVS, that we have talked about today. Hypertension is a public health issue. The sequelae of hypertension is a public health issue and I think this therapy has the potential of being a real homerun. If you take a look at the number of companies that are involved in this I think it makes sense………
link to more discussion: http://www.invasivecardiology.com/blog/renal-denervation-treatment-hypertension