Hypertension is a well-known risk factor for major cardiovascular events. Despite advances in medical
therapy, sufficient treatment of
hypertension remains unsatisfying in a substantial number of patients and is therefore one of the main challenges in modern medicine. In Germany 5-15 % of patients with
hypertension suffer from resistant
hypertension with elevated blood pressure despite the use of at least three
antihypertensive drugs. Additionally patients often suffer from side effects. In patients with resistant
hypertension the important role of the sympathetic nervous system with increased sympathetic activity is well known. In the past surgical
sympathectomy with extended removal of sympathetic ganglia was performed to reduce blood pressure in patients with
malignant hypertension. The positive effect of this highly invasive procedure on blood pressure led to the development of new strategies for the treatment of uncontrolled
hypertension. One of the novel procedures includes
catheter-based renal
sympathetic denervation. The most common system is the
radiofrequency ablation catheter (Symplicity®, Medtronic, Minneapolis, USA) which ablates the nerve fibers in the adventitia of the renal arteries by using high-frequency energy. As the results of the Symplicity trials (HTN-1 and HTN-2) showed significant reduction of systolic and diastolic blood pressure after renal
denervation there is growing interest in this novel procedure. Moreover, by reducing the sympathetic activity after renal
denervation early results indicate a positive impact on
glucose metabolism,
sleep apnea syndrome, as well as heart and
renal failure. These effects led to the development of many different devices for renal
denervation; however, trials with a higher number of patients and longer follow-up need to confirm these initially promising results and the value of newer devices. Until then renal
denervation should not be regarded as standard
therapy for arterial
hypertension or an alternative to medical
antihypertensive treatment and should be reserved for selected patients with resistant
hypertension and specialized medical centres.