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Jan 4, 2013

Renal sympathetic denervation (RSD) for resistant hypertension


Resistant hypertension is defined as persistent elevation of BP above goal despite concurrent use of 3 antihypertensive agents. Each drug from different class with one being diuretic. Hypertension controlled with four or more drug is also considered resistant hypertension.

Kidneys are richly supplied by sympathetic nerves, brain impulse induce vasoconstriction by release of rennin

In 1938 Thoracolumbar splanchnicectomy was introduced as a treatment for hypertension, a particularly invasive surgical procedure involving resection of splanchnic innervation to the kidneys. Those treated surgically versus those declined for surgery and treated medically, 5-year mortality rates were 19% and 54%, respectively.
Adavantesia of arteries of kidney contain both efferent and afferent by damaging these nerves brain and kidney crosstalk be prevention

Three modalities of RSD are
1.     Radiofrequency ablation (RFA)
2.     Ultrasonic ablation
3.     Tissue-directed pharmacological ablation

Simplicity 1 and Simplicity HTN -2 trail demonstrated benefit of RSD in resistant hypertension. And no risk of renal artery stenosis as well no sympatric reinnervation. Two year follow-up has shown no loss of control of blood pressure

Following RSD office BP reduction is more than home measurement probably because of excess sympathetic flow in office.