Our editors talked with Dr. Marco Wainstein, an active member of SOLACI Web Editorial Board
SOLACI WEB: Which is the rationale for renal denervation?
Marco Wainstein, MD: The rationale for renal denervation is based on the modification of the sympathetic innervation of the renal arteries affecting both afferent and efferent nerves. Ultimately, renal denervation would lead to a favorable effect on sodium elimination and on the renin-angiotensin system among other effects.
S. W. : What about patient selection, which is the ideal candidate?
M. W. : Presently, renal denervation is indicated for hypertensive patients with essential hypertension who are refractory to the combination of 2 or 3 different antihypertensive medications.
S. W. : Marco, could you tell us, which is current available evidence supporting this procedure?
M. W. : The concept of renal artery sympathetic ablation was developed some decades ago through surgical denervation. This idea was left aside until recently due to its high morbidity associated to the surgical procedure. Transcatheter renal denervation was first tested in animal experimental models and then translated into human feasibility studies. After the success of these preliminary clinical studies, transcatheter renal ablation has gained visibility after the publication of the Simplicity 2 trial. This randomized clinical trial where renal denervation successfully lowered both systolic and diastolic blood pressure in patients with refractory hypertension when compared to medical treatment alone. More recently, alternative devices have been tested with variable results.
S. W. : How do you envision the future applications in Latin America?
M. W. : I believe this treatment modality will be widely adopted and have a great impact in the management of hypertensive patients. Such adoption not only will occur in our region, but also around the world. Hypertension is certainly among the leading causes of cardiovascular morbidity and mortality and its prevalence is increasing. Unfortunately, a considerable amount of patients is still unresponsive to different combination of drugs.
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