- Patient Selection and Practical Implementation of Renal Denervation in Patients with Treatment-resistant Hypertension
Patient Selection and Practical Implementation of Renal Denervation in Patients with Treatment-resistant Hypertension
- CV Renal Metabolic
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Course Expiry Date:
An estimated 1.13 billion people worldwide have hypertension and is a major cause of premature death worldwide.1
Resistant hypertension is defined as blood pressure (BP) that exceeds 140/90 mm Hg despite the concomitant use of maximally tolerated doses of antihypertensive drugs from more than three drug classes.2,3 In a meta-analysis of data from 3.2 million patients, the prevalence of true-resistant or apparent treatment-resistant hypertension combined was 25%.4 Even within the context of clinical trials that provide medications, rigorous follow-up, and often multidisciplinary treatment, around 25–30% of patients do not achieve adequate BP control.5,6 The greater the number of medications a patient is on, the lower the adherence.7
Experts from the European Society of Hypertension (ESH) have stated that, with individualised treatment, catheter-based renal denervation (RDN) is supported by biological proof for lowering BP that is clinically meaningful and associated with no major adverse events reported in clinical trials.8
While RDN was initially only considered as a last resort for patients with treatment-resistant severe hypertension, data from recent clinical trials indicate that the intervention may gain importance when treating patients with uncomplicated hypertension.9
RDN for treating hypertension is an emerging clinical procedure and improved catheter design, procedure technique and medication use have confirmed its feasibility. Identifying predictors that could ensure that RDN is effective for all patients treated is important.
Recent sham-controlled pilot studies using the new and improved multi-electrode SYMPLICITY Spyral catheter design, SPYRAL HTN-OFF MED and SPYRAL HTN-ON MED, have reaffirmed the biological proof of principle that RDN can result in a significant BP-lowering effect versus sham controls for subjects with resistant hypertension in the absence or presence of antihypertensive medications, respectively.10,11,12
Understanding the appropriate patient profile and when to refer is also pertinent. In this regard, patient preference will be an important factor in a shared decision-making process.
With safety and efficacy of RDN established, education is now needed to define how RDN could fit into future clinical practice.
This case-based course brings together opinion leaders engaged in RDN to review the evidence, discuss trial data, and practical aspects around patient selection and management.
- The World Health Organisation (2019) Hypertension. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension (Accessed February 2020).
- Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA 2003;289:2560–72.
- Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013;34:2159–219.
- Noubiap JJ, Nansseu JR, Nyaga UF, et al. Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients. Heart 2019;105:98–105.
- Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008;117:e510–26.
- Persell SD. Prevalence of resistant hypertension in the United States, 2003-2008. Hypertension2011;57:1076–80
- Hutchins R, Viera AJ, Sheridan SL, Pignone MP. Quantifying the utility of taking pills for cardiovascular prevention. Circ Cardiovasc Qual Outcomes 2015;8:155–63
- Schmieder RE, Mahfoud F, Azizi M, et al. European Society of Hypertension position paper on renal denervation 2018. J Hypertens 2018;36):2042–8
- Jung S, Schmieder RE. The resurrection of renal denervation. E-Journal Cardiol Pract 2019;17:17
- Townsend RR, Mahfoud F, Kandzari DE, et al. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet 2017;390:2160–70.
- Sardar P, Bhatt DL, Kirtane AJ, et al. Sham-controlled randomized trials of catheter-based renal denervation in patients with hypertension. J Am Coll Cardiol 2019;73:1633–42.
- Böhm M, Townsend RR, Kario K, et al. Rationale and design of two randomized sham-controlled trials of catheter-based renal denervation in subjects with uncontrolled hypertension in the absence (SPYRAL HTN-OFF MED Pivotal) and presence (SPYRAL HTN-ON MED Expansion) of antihypertensive medications: a novel approach using Bayesian design [published online ahead of print, 2020 Feb 7]. Clin Res Cardiol2020;10.1007/s00392-020-01595-z
This activity has been supported by an unrestricted educational grant from Medtronic.
This programme is accredited by the European Board for Accreditation in Cardiology (EBAC) for 1 hour of external CME credit(s). Each participant should claim only those hours of credit that have actually been spent in the educational activity. EBAC works according to the quality standards of the European Accreditation Council for Continuing Medical Education (EACCME), which is an institution of the European Union of Medical Specialists (UEMS). In compliance with EBAC/ EACCME guidelines, all speakers/chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event are declared to the audience prior to the CME activities.
Radcliffe-CME requires contributors to our CME programmes to disclose any relevant financial relationships that have occurred within the past 12 months that could create a conflict of interest. These will be identified in the faculty section if applicable.
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Instruction to Participants
There is no fee for taking part in this online learning activity.
Activities are designed to be completed within 60 minutes and must be completed by the registered user. Physicians should only claim credits for time spent on the activity. To successfully earn credit, participants must complete the activity in full in the indicated time frame.
To complete the course and claim certification participants must:
1. Read the course outline information supplied and complete pre-test questions if supplied prior to starting the activity. Users must read and study the activity in its entirety before completing the post-test questions.
2. Your results will be automatically saved and if a pass score is achieved (where applicable), you may be eligible to claim credit for the activity and receive a certificate of completion.
- Specialists treating hypertension
Upon completion of this activity, participants will be able to:
- Describe the evidence to support the use of renal denervation as a treatment modality in patients with resistant hypertension
- Understand renal denervation and how effective it is as a treatment option
- Identify patients with resistant hypertension suitable for renal denervation
|1||Patients with poor adherence||Andrew SP Sharp (University Hospital of Wales, Cardiff, UK) Atul Pathak (Clinique Pasteur, Toulouse, FR) Roland E Schmieder (University Hospital Erlangen, DE) Stefano Taddei (University of Pisa, IT)|
|2||Patients with hypertension with high cardiovascular risk||Andrew SP Sharp (University Hospital of Wales, Cardiff, UK) Atul Pathak (Clinique Pasteur, Toulouse, FR) Roland E Schmieder (University Hospital Erlangen, DE) Stefano Taddei (University of Pisa, IT)|
|3||Uncontrolled hypertension despite medication||Andrew SP Sharp (University Hospital of Wales, Cardiff, UK) Atul Pathak (Clinique Pasteur, Toulouse, FR) Roland E Schmieder (University Hospital Erlangen, DE) Stefano Taddei (University of Pisa, IT)|
Patients with poor adherence
Patients with hypertension with high cardiovascular risk
Uncontrolled hypertension despite medication
The event ‘Patient Selection and Practical Implementation of Renal Denervation in Patients with Treatment-resistant Hypertension’ is accredited by the European Board for Accreditation in Cardiology (EBAC) for 1 hour of external CME credits.
Each participant should claim only those hours of credit that have actually been spent in the educational activity. EBAC works according to the quality standards of the European Accreditation Council for Continuing Medical Education (EACCME), which is an institution of the European Union of Medical Specialists (UEMS).
Through an agreement between the European Board for Accreditation in Cardiology and the American Medical Association, physicians may convert EBAC External CME credits to AMA PRA Category 1 Credits™. Information on the process to convert EBAC credit to AMA credit can be found on the AMA website.
- Assess the current global burden of resistant hypertension
- Carry out appropriate assessments to identify resistant hypertension
- Identify patients most likely to benefit from RDN
- Recall the practical considerations for adopting RDN into routine practice
- Recall the latest data on RDN from recent clinical trials