Sympathetic renal denervation: randomized trials and clinical practice

The objective of this study is to evaluate the efficacy and safety of renal denervation in patients with resistant hypertension and other cardiovascular diseases. The method of renal denervation is based on radiofrequencymediated destruction of renal sympathetic nerves going within the renal artery wall. Initial clinical success of renal denervation in Symplicity I and Symplicity II trials was replaced by more cautious approach after results of Symplicity III. In this study the renal denervation resulted in reduction of blood pressure after procedure but failed to prove the significant difference between main group (renal denervation) and group with imitation of denervation (sham-procedure), which was the clinical efficacy endpoint. The safety endpoint was the incidence of 30‑day complications (vascular complications at puncture site, occurrence of renal artery stenosis, progression of renal insufficiency). There was no difference in the rate of complications between denervation group and shamprocedure group. Subgroup analysis (according to patients’ clinical and demographic characteristics) demonstrated the clinical efficacy of renal denervations in patients younger than 65 years and in Caucasian patients. There are also clinical data, indicating clinical efficacy of renal denervation in the treatment of cardiovascular diseases, associated with high activity of sympathetic nervous system: chronic heart failure, sleep apnea, atrial fibrillation, ventricular arrhythmias.