Arterial
hypertension is responsible for a significant burden of cardiovascular morbidity and mortality, worldwide. Although several rational and integrated pharmacological strategies are available, the control of
high blood pressure still remains largely unsatisfactory. Failure to achieve effective blood pressure control in treated hypertensive patients may have a substantial impact on individual global cardiovascular risk, since it significantly increases the risk of developing
hypertension-related macrovascular and microvascular complications. Arterial
hypertension is arbitrarily defined as 'resistant' or 'refractory' when the recommended blood pressure goals (clinic blood pressure below 140/90 mmHg or below 130/80 mmHg in patients with
type 2 diabetes mellitus or nephropathy) are not achieved in the presence of a therapeutic strategy that includes lifestyle changes and at least three classes of
antihypertensive drugs, including a
diuretic, at adequate doses. Recently, an innovative non-pharmacological option has become available for treating resistant
hypertension.
Sympathetic denervation of renal arteries is a minimally invasive procedure that is performed via percutaneous access from the femoral artery. It consists of
radiofrequency ablation of the afferent and efferent nerves of the renal sympathetic nervous system, with consequent isolation of renal parenchymal and juxtaglomerular structures from abnormal stimulation of the efferent
adrenergic system. The present position paper of the Italian Society of
Hypertension (SIIA) offers a diagnostic and therapeutic approach for the proper identification and effective clinical management of patients with resistant
hypertension, who are candidates for renal artery
denervation. These indications may have important implications not only from a clinical point of view, but also from an economic point of view, since a proper identification of patients with true resistant
hypertension and an accurate selection of patients suitable for the procedure of renal
denervation can contribute to an improved control of blood pressure, and thus a reduced risk of cardiovascular and cerebrovascular complications in these patients.