2019 consensus statement of the Taiwan hypertension society and the Taiwan society of cardiology on renal denervation for the management of arterial hypertension

Tzung Dau Wang, Ying Hsiang Lee, Shih Sheng Chang, Ying Chang Tung, Chih Fan Yeh, Yen Hung Lin, Chien Ting Pan, Chien Yi Hsu, Chun Yao Huang, Cho Kai Wu, Pei Hsun Sung, Liang Ting Chiang, Yu Chen Wang, Wei Chung Tsai, Ting Tse Lin, Chia Pin Lin, Wen Jone Chen, Juey Jen Hwang

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Sympathetic overactivity, an essential mechanism of hypertension, in driving sustained hypertension derives mostly from its effects on renal function. Percutaneous renal denervation (RDN) is designed to disrupt renal afferent and efferent sympathetic nerves to achieve sustained blood pressure (BP) reduction. Since 2017 onward, all three proof-of-concept, sham-controlled RDN trials demonstrated that RDN achieved consistent and clinically meaningful BP reductions [approximately 10 mmHg in office systolic BP (SBP) and 6-9 mmHg in 24-hour SBP] compared to sham operation in patients with mild to moderate or uncontrolled hypertension. There were no serious adverse events. The registry data in Taiwan showed similar 24-hour BP reductions at 12 months following RDN. The Task Force considers RDN as a legitimate alternative antihypertensive strategy and recommends 1) RDN should be performed in the context of registry and clinical studies (Class I, Level C) and 2) RDN should not be performed routinely, without detailed evaluation of various causes of secondary hypertension and renal artery anatomy (Class III, Level C). RDN could be performed in patients who fulfill either of the following BP criteria: 1) office BP ≥ 150/90 mmHg and daytime ambulatory SBP ≥ 135 mmHg or diastolic BP (DBP) ≥ 85 mmHg, irrespective of use of antihypertensive agents (Class IIa, Level B), or 2) 24-hour ambulatory SBP ≥ 140 mmHg and DBP ≥ 80 mmHg, irrespective of use of antihypertensive agents (Class IIa, Level B), with eligible renal artery anatomy and estimated glomerular filtration rate ≥ 45 mL/min/1.73 m2. Five subgroups of hypertensive patients are deemed preferred candidates for RDN and dubbed “RDN i2": Resistant hypertension, patients with hypertension-mediated organ Damage, Non-adherent to antihypertensivemedications, intolerant to antihypertensivemedications, and patients with secondary (2ndary) causes being treated for ≥ 3months but BP still uncontrolled. The Task Force recommends assessment of three aspects, dubbed “RAS” (R for renal, A for ambulatory, S for secondary), beforehand to ascertain whether RDN could be performed appropriately: 1) Renal artery anatomy eligibility assessed by computed tomography or magnetic resonance renal angiography if not contraindicated, 2) genuine uncontrolled BP confirmed by 24-hour Ambulatory BP monitoring, and 3) Secondary hypertension identified and properly treated. After the procedure, 24-hour ambulatory BP monitoring, together with the dose and dosing interval of all BP-lowering drugs, should be obtained 6 months following RDN. Computed tomography or magnetic resonance renal angiography should be obtained 12 months following RDN, given that renal artery stenosis might not be clinically evident.

Original languageEnglish
Pages (from-to)199-230
Number of pages32
JournalActa Cardiologica Sinica
Volume35
Issue number3
DOIs
Publication statusPublished - May 1 2019

Fingerprint

Denervation
Cardiology
Taiwan
Hypertension
Kidney
Blood Pressure
Renal Artery
Antihypertensive Agents
Anatomy
Ambulatory Blood Pressure Monitoring
Magnetic Resonance Angiography
Advisory Committees
Registries
Tomography
Renal Artery Obstruction
Glomerular Filtration Rate

Keywords

  • Blood pressure
  • Catheter ablation
  • Hypertension
  • Nerve
  • Renal artery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

2019 consensus statement of the Taiwan hypertension society and the Taiwan society of cardiology on renal denervation for the management of arterial hypertension. / Wang, Tzung Dau; Lee, Ying Hsiang; Chang, Shih Sheng; Tung, Ying Chang; Yeh, Chih Fan; Lin, Yen Hung; Pan, Chien Ting; Hsu, Chien Yi; Huang, Chun Yao; Wu, Cho Kai; Sung, Pei Hsun; Chiang, Liang Ting; Wang, Yu Chen; Tsai, Wei Chung; Lin, Ting Tse; Lin, Chia Pin; Chen, Wen Jone; Hwang, Juey Jen.

In: Acta Cardiologica Sinica, Vol. 35, No. 3, 01.05.2019, p. 199-230.

Research output: Contribution to journalArticle

Wang, TD, Lee, YH, Chang, SS, Tung, YC, Yeh, CF, Lin, YH, Pan, CT, Hsu, CY, Huang, CY, Wu, CK, Sung, PH, Chiang, LT, Wang, YC, Tsai, WC, Lin, TT, Lin, CP, Chen, WJ & Hwang, JJ 2019, '2019 consensus statement of the Taiwan hypertension society and the Taiwan society of cardiology on renal denervation for the management of arterial hypertension', Acta Cardiologica Sinica, vol. 35, no. 3, pp. 199-230. https://doi.org/10.6515/ACS.201905_35(3).20190415A
Wang, Tzung Dau ; Lee, Ying Hsiang ; Chang, Shih Sheng ; Tung, Ying Chang ; Yeh, Chih Fan ; Lin, Yen Hung ; Pan, Chien Ting ; Hsu, Chien Yi ; Huang, Chun Yao ; Wu, Cho Kai ; Sung, Pei Hsun ; Chiang, Liang Ting ; Wang, Yu Chen ; Tsai, Wei Chung ; Lin, Ting Tse ; Lin, Chia Pin ; Chen, Wen Jone ; Hwang, Juey Jen. / 2019 consensus statement of the Taiwan hypertension society and the Taiwan society of cardiology on renal denervation for the management of arterial hypertension. In: Acta Cardiologica Sinica. 2019 ; Vol. 35, No. 3. pp. 199-230.
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T1 - 2019 consensus statement of the Taiwan hypertension society and the Taiwan society of cardiology on renal denervation for the management of arterial hypertension

AU - Wang, Tzung Dau

AU - Lee, Ying Hsiang

AU - Chang, Shih Sheng

AU - Tung, Ying Chang

AU - Yeh, Chih Fan

AU - Lin, Yen Hung

AU - Pan, Chien Ting

AU - Hsu, Chien Yi

AU - Huang, Chun Yao

AU - Wu, Cho Kai

AU - Sung, Pei Hsun

AU - Chiang, Liang Ting

AU - Wang, Yu Chen

AU - Tsai, Wei Chung

AU - Lin, Ting Tse

AU - Lin, Chia Pin

AU - Chen, Wen Jone

AU - Hwang, Juey Jen

PY - 2019/5/1

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N2 - Sympathetic overactivity, an essential mechanism of hypertension, in driving sustained hypertension derives mostly from its effects on renal function. Percutaneous renal denervation (RDN) is designed to disrupt renal afferent and efferent sympathetic nerves to achieve sustained blood pressure (BP) reduction. Since 2017 onward, all three proof-of-concept, sham-controlled RDN trials demonstrated that RDN achieved consistent and clinically meaningful BP reductions [approximately 10 mmHg in office systolic BP (SBP) and 6-9 mmHg in 24-hour SBP] compared to sham operation in patients with mild to moderate or uncontrolled hypertension. There were no serious adverse events. The registry data in Taiwan showed similar 24-hour BP reductions at 12 months following RDN. The Task Force considers RDN as a legitimate alternative antihypertensive strategy and recommends 1) RDN should be performed in the context of registry and clinical studies (Class I, Level C) and 2) RDN should not be performed routinely, without detailed evaluation of various causes of secondary hypertension and renal artery anatomy (Class III, Level C). RDN could be performed in patients who fulfill either of the following BP criteria: 1) office BP ≥ 150/90 mmHg and daytime ambulatory SBP ≥ 135 mmHg or diastolic BP (DBP) ≥ 85 mmHg, irrespective of use of antihypertensive agents (Class IIa, Level B), or 2) 24-hour ambulatory SBP ≥ 140 mmHg and DBP ≥ 80 mmHg, irrespective of use of antihypertensive agents (Class IIa, Level B), with eligible renal artery anatomy and estimated glomerular filtration rate ≥ 45 mL/min/1.73 m2. Five subgroups of hypertensive patients are deemed preferred candidates for RDN and dubbed “RDN i2": Resistant hypertension, patients with hypertension-mediated organ Damage, Non-adherent to antihypertensivemedications, intolerant to antihypertensivemedications, and patients with secondary (2ndary) causes being treated for ≥ 3months but BP still uncontrolled. The Task Force recommends assessment of three aspects, dubbed “RAS” (R for renal, A for ambulatory, S for secondary), beforehand to ascertain whether RDN could be performed appropriately: 1) Renal artery anatomy eligibility assessed by computed tomography or magnetic resonance renal angiography if not contraindicated, 2) genuine uncontrolled BP confirmed by 24-hour Ambulatory BP monitoring, and 3) Secondary hypertension identified and properly treated. After the procedure, 24-hour ambulatory BP monitoring, together with the dose and dosing interval of all BP-lowering drugs, should be obtained 6 months following RDN. Computed tomography or magnetic resonance renal angiography should be obtained 12 months following RDN, given that renal artery stenosis might not be clinically evident.

AB - Sympathetic overactivity, an essential mechanism of hypertension, in driving sustained hypertension derives mostly from its effects on renal function. Percutaneous renal denervation (RDN) is designed to disrupt renal afferent and efferent sympathetic nerves to achieve sustained blood pressure (BP) reduction. Since 2017 onward, all three proof-of-concept, sham-controlled RDN trials demonstrated that RDN achieved consistent and clinically meaningful BP reductions [approximately 10 mmHg in office systolic BP (SBP) and 6-9 mmHg in 24-hour SBP] compared to sham operation in patients with mild to moderate or uncontrolled hypertension. There were no serious adverse events. The registry data in Taiwan showed similar 24-hour BP reductions at 12 months following RDN. The Task Force considers RDN as a legitimate alternative antihypertensive strategy and recommends 1) RDN should be performed in the context of registry and clinical studies (Class I, Level C) and 2) RDN should not be performed routinely, without detailed evaluation of various causes of secondary hypertension and renal artery anatomy (Class III, Level C). RDN could be performed in patients who fulfill either of the following BP criteria: 1) office BP ≥ 150/90 mmHg and daytime ambulatory SBP ≥ 135 mmHg or diastolic BP (DBP) ≥ 85 mmHg, irrespective of use of antihypertensive agents (Class IIa, Level B), or 2) 24-hour ambulatory SBP ≥ 140 mmHg and DBP ≥ 80 mmHg, irrespective of use of antihypertensive agents (Class IIa, Level B), with eligible renal artery anatomy and estimated glomerular filtration rate ≥ 45 mL/min/1.73 m2. Five subgroups of hypertensive patients are deemed preferred candidates for RDN and dubbed “RDN i2": Resistant hypertension, patients with hypertension-mediated organ Damage, Non-adherent to antihypertensivemedications, intolerant to antihypertensivemedications, and patients with secondary (2ndary) causes being treated for ≥ 3months but BP still uncontrolled. The Task Force recommends assessment of three aspects, dubbed “RAS” (R for renal, A for ambulatory, S for secondary), beforehand to ascertain whether RDN could be performed appropriately: 1) Renal artery anatomy eligibility assessed by computed tomography or magnetic resonance renal angiography if not contraindicated, 2) genuine uncontrolled BP confirmed by 24-hour Ambulatory BP monitoring, and 3) Secondary hypertension identified and properly treated. After the procedure, 24-hour ambulatory BP monitoring, together with the dose and dosing interval of all BP-lowering drugs, should be obtained 6 months following RDN. Computed tomography or magnetic resonance renal angiography should be obtained 12 months following RDN, given that renal artery stenosis might not be clinically evident.

KW - Blood pressure

KW - Catheter ablation

KW - Hypertension

KW - Nerve

KW - Renal artery

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