The expert position of the Polish Cardiac Society, the Polish Society of Hypertension, and the Polish Society of Nephrology on renal denervation

Renal denervation is an innovative method of treating hypertension (HT), used in clinical practicefor about a decade. The pathophysiological basis of this method derives from the role of efferentand afferent fibers of the sympathetic nervous system, entering and leaving the kidneys, in thedevelopment of HT, especially treatment-resistant HT. Initial clinical trials have suggested the highefficacy of denervation in the treatment of patients with resistant HT. However, the results of theSymplicity HTN-3 trial, which introduced a sham procedure as a control, undermined these hopes,although this trial was criticized for its methodology. Recent research, using latest-generation cathetersand more stringent protocols, confirms a significant reduction in blood pressure in patientsafter this procedure. Renal denervation should be considered in patients with HT (after excludingall hormonal causes and ischemic etiology) that is resistant to pharmacological treatment. Pseudoresistance, e.g., caused by so-called white-coat HT, should be ruled out. Every patient should complete24 hours ambulatory blood pressure monitoring. Lack of cooperation between the patientand the physician, irregular use of antihypertensive medications, and non-compliance with othertherapeutic recommendations should also be excluded. However, the condition for the successof renal denervation is the precise determination of patient eligibility and the performance of theprocedure in specialized centers with appropriate experience.