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European Society of Hypertension position paper on renal denervation 2018

Schmieder, Roland E.a; Mahfoud, Felixb; Azizi, Michelc,d; Pathak, Atule; Dimitriadis, Kyriakosf; Kroon, Abraham A.g; Ott, Christiana,h; Scalise, Filippoi; Mancia, Giuseppej; Tsioufis, Costask on behalf of Members of the ESH Working Group on Interventional Treatment of Hypertension

doi: 10.1097/HJH.0000000000001858

This ESH update was deemed necessary with the publication of new results of sham-controlled randomized blinded prospective trials with renal denervation (RDN). Proof of concept studies and first randomized trials (some were sham-controlled) displayed discrepant results about the efficacy of RDN. Three sham-controlled randomized trials of the 2.0 generation yielded now similarity in the average blood pressure decrease following RDN. Reduction of ambulatory blood pressure was approximately 5 to 7 mmHg and of office blood pressure 10 mmHg. Such a decrease in blood pressure by pharmacologic therapy has been found to be associated with lower incidence of cardiovascular events in particular with respect to heart failure and stroke by roughly 25%. Nevertheless, some questions about renal denervation are unanswered. The heterogeneity of the blood pressure-lowering response point to the clinical need to identify predictors for efficacy, and questions on long-term safety could not have been answered due to the short duration of the sham-controlled randomized clinical trials.

aUniversity Hospital Erlangen, Department of Nephrology and Hypertension, Erlangen

bDepartment of Internal Medicine, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany

cParis-Descartes University

dAssistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris

eClinique Pasteur, Hypertension, Risk Factors and Heart Failure Unit, Clinical Research Center, Toulouse, France

fHippokration General Hospital, Hypertension Unit, Athens, Greece

gMaastricht University Medical Center (Department of Internal Medicine) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands

hParacelsus Medical University, Department of Nephrology and Hypertension, Nürnberg, Germany

iPoliclinico di Monza, Interventional Cardiology, Monza

jUniversity of Milano-Bicocca, Milan, Italy

kNational and Kapodistrian University of Athens, 1st Cardiology Clinic, Hippocratio Hospital, Athens, Greece

Correspondence to Roland E. Schmieder, MD, Head of the Clinical Research Center, Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. Tel: +49 9131 85 36245; fax: +49 9131 85 36215; e-mail:,

Received 13 June, 2018

Accepted 14 June, 2018

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