Renale Denervation bei Patienten mit therapieresistenter Hypertonie – Aktuelle Entwicklungen

Mit der renalen Sympathikusdenervation steht seit 2009 ein neues interventionelles minimal-invasives Verfahren zur Behandlung von therapieresistenten Hypertonikern zur Verfügung. Die bisherigen Follow-up-Untersuchungen bis 3 Jahre nach Intervention zeigen anhaltende relevante Blutdrucksenkungen, positive Auswirkungen auf hypertensive Zielorganschäden sind ebenso zwischenzeitlich beschrieben. Bei hoher prozeduraler Sicherheit sind die Langzeitauswirkungen der Ablation auf die Nierengefäße noch nicht hinreichend geklärt. Ebenso besteht weiterhin Optimierungsbedarf hinsichtlich der Auswahl der am besten für dieses Verfahren geeigneten Patienten, hier müssen insbesondere sekundäre Hypertonieformen bzw. Patienten mit Pseudoresistenz vor Intervention identifiziert werden, um unnötige Interventionen zu vermeiden.

Renal denervation (RD) by minimal-invasive catheter ablation seems to enhance our therapeutic armamentarium to treat patients with true-resistant arterial hypertension. Long-term follow up data up to 36 months after intervention demonstrate persistent and relevant blood pressure reductions as well as beneficial effects on target organ damage in patients treated with RD. Despite a favorable procedural safety profile in the acute setting our knowledge concerning long-term consequences of initially applied intimal lesions on the integrity of renal arteries remains limited and warrants further investigation. Which patient groups benefit most from this procedure is also a matter of ongoing debate. In this regard it seems prudent to avoid unnecessary renal denervation in patients with otherwise treatable secondary hypertension forms respectively in patients with pseudo-resistant hypertension.

Key words

Arterial hypertension - sympathetic nervous system - kidney - therapy

• Literatur

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