Subscribe to RSS
DOI: 10.1055/s-0033-1363598
Renale Denervation bei Patienten mit therapieresistenter Hypertonie – Aktuelle Entwicklungen
Renal denervation in patients with true-resistant arterial hypertension – New developmentPublication History
Publication Date:
09 December 2013 (online)
![](https://www.thieme-connect.de/media/klinikarzt/201311/lookinside/thumbnails/10.1055-s-0033-1363598-1.jpg)
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.
-
Literatur
- 1 Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet 2008; 371: 1513-1518
- 2 Lowel H, Meisinger C, Heier M et al. Epidemiology of hypertension in Germany. Selected results of population-representative cross-sectional studies. Dtsch Med Wochenschr 2006; 131: 2586-2591
- 3 Sarafidis PA. Epidemiology of resistant hypertension. J Clin Hypertens (Greenwich) 2011; 13: 523-528
- 4 DiBona GF, Esler M. Translational medicine: the antihypertensive effect of renal denervation. Am J Physiol Regul Integr Comp Physiol 2010; 298: 245-253
- 5 Smithwick RH, Thompson JE. Splanchnicectomy for essential hypertension; results in 1,266 cases. J Am Med Assoc 1953; 152: 1501-1504
- 6 Schlaich MP, Sobotka PA, Krum H, Lambert E, Esler MD. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med 2009; 361: 932-934
- 7 Krum H, Schlaich M, Whitbourn R. Catheter-based renal sympatheticc denervation for resistant hypertension: a multicentre safety and proof-of-princciple cohort study. Lancet 2009; 373: 1275-1281
- 8 Investigators Symplicity HTN-1. Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months. Hypertension 2011; 57: 911-917
- 9 Krum H, Schlaich M, Sobotka P. Long-term follow-up of catheter-based renal denervation for resistant hypertension confirms durable blood pressure reduction. J Am Coll Cardiol 2012; 60 (Suppl. 01)
- 10 Esler MD, Krum H, Sobotka PA et al. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet 2010; 376: 1903-1909
- 11 Esler MD, Krum H, Schlaich M. Renal sympathetic denervation for treatment of drug-resistant hypertension. One-Year results from the Symplicity HTN-2 randomized, controlled trial. Circulation 2012; 126: 2976-2982
- 12 Mahfoud F, Ukena C, Schmieder RE et al. Ambulatory blood pressure changes after renal sympathetic denervation in patients with resistent hypertension. Circulation 2013; 128: 132-140
- 13 Rippy MK, Zarins D, Barman NC et al. Catheter-based renal sympathetic denervation: chronic preclinical evidence for renal artery safety. Clin Res Cardiol 2011; 100: 1095-1101
- 14 Vonend O, Antoch G, Rump LC, Blondin D. Secondary rise in blood pressure after renal denervation. Lancet 2012; 25: 778-778
- 15 Dörr O, Liebetrau C, Möllmann H et al. Renal sympathetic denervation does not aggravate functional or structural renal damage. J Am Coll Cardiol 2013; 61: 479-480
- 16 Mortensen K, Franzen K, Himmel F et al. Catheter-based renal sympathetic denervation improves central hemodynamics and arterial stiffness: a pilot study. J Clin Hypertens (Greenwich) 2012; 14: 861-870
- 17 Brandt MC, Mahfoud F, Reda S et al. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol 2012; 59: 901-909
- 18 Mahfoud F, Cremers B, Janker J et al. Renal hemodynamics and renal function after catheter-based renal sympathetic denervation in patients with resistant hypertension. Hypertension 2012; 60: 419-424
- 19 Fadl Elmula FE, Hoffmann P, Fossum E et al. Renal Sympathetic Denervation in Patients With Treatment-Resistant Hypertension After Witnessed Intake of Medication Before Qualifying Ambulatory Blood Pressure. Hypertension 2013 Jul 8. [Epub ahead of print]
- 20 Pessina AC, Bisogni V, Fassina A, Rossi GP. Munchausen syndrome: a novel cause of drug-resistant hypertension. J Hypertens 2013 Apr 23. [Epub ahead of print]
- 21 Kandzari DE, Bhatt DL, Sobotka PA et al. Catheter-based renal denervation for resistant hypertension: rationale and design of the SYMPLICITY HTN-3 Trial. Clin Cardiol 2012; 35: 528-535
- 22 Schmieder RE, Redon J, Grassi G et al. ESH position paper -renal denervation- an interventional therapy of resistant hypertension. J Hypertens 2012; 30: 837-841