Renale Denervation: Ist sie reif für die breite Anwendung?

Zusammenfassung

Zielsetzung und Methode: Die renale Denervation ist eine neuartige, minimal-invasive, Katheter-basierte Behandlungsoption zur Behandlung der therapierefraktären Hypertonie. Die Indikationen und Kontraindikationen wurden interdisziplinär erarbeitet und festgestellt.

Ergebnisse: Derzeit ist die Indikation limitiert auf Patienten, die trotz einer optimalen medikamentösen Therapie mit ≥ 3 unterschiedlichen Antihypertensiva einen systolischen Blutdruck von ≥ 160 mm Hg (bzw. ≥ 150 mm Hg bei Diabetes Typ 2) aufweisen. Hierbei ist auf eine optimale Medikamentenkombination mit synergistischen Wirkmechanismen zu achten. Nach renaler Denervation konnte unter Berücksichtigung dieser Kriterien innerhalb von Studien eine Blutdrucksenkung von durchschnittlich 32/14 mm Hg erreicht werden. Bei Patienten mit einer eingeschränkten Nierenfunktion (GFR < 45 ml/min) sollte eine renale Denervation derzeit nicht durchgeführt werden.

Schlussfolgerung: In Zukunft müssen Langzeitsicherheit und -effektivität der renalen Denervation untersucht werden. Ferner muss in weiteren Studien geklärt werden, ob die renale Denervation auch bei anderen, hypertonieassoziierten Erkrankungen (z. B. renoparenchymatöse Hypertonie, Hypertonie bei eingeschränkter Nierenfunktion, obstruktives Schlafapnoe-Syndrom) mit ausreichender Wirksamkeit und Patientensicherheit durchgeführt werden kann. Auch die Anwendung als Alternative zu einer antihypertensiven Medikation z. B. bei Medikamentenunverträglichkeit muss noch überprüft und kann derzeit nicht befürwortet werden, sollte aber Gegenstand weiterer Untersuchungen sein.

Abstract

Objective and Methods: Renal denervation is a novel, minimally invasive, catheter-based treatment option for the treatment of refractory hypertension. Indications and contraindications for renal denervation have been developed interdisciplinary.

Results: Currently, indication for renal denervation is limited to patients with a systolic blood pressure of ≥ 160 mmHg (or ≥ 150 mmHg in diabetes type 2) despite optimal medical therapy with ≥ 3 different antihypertensive drugs. Special attention should be paid to prescribe an optimum combination of anti-hypertensive drugs with synergistic mechanisms. In this specific patient population, an average blood pressure reduction of 32/14 mmHg was observed after renal denervation. In patients with chronic kidney disease (GFR < 45 ml/min) renal denervation should currently not be performed outside controlled studies.

Conclusion: Future studies are necessary to evaluate long-term effects and safety of renal denervation, and if renal denervation can be performed with sufficient safety and efficacy in patients with hypertension associated diseases (e.g. renoparenchymal hypertension, hypertension in patients with chronic kidney disease, obstructive sleep apnea syndrome). The use of renal denervation as an alternative therapy (e.g. in patients with drug intolerance) requires further investigation and cannot be supported currently.

Schlüsselwörter

renale Denervation - Hypertonie

Keywords

renal denervation - hypertension

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