COMMENTARY

Renal Denervation...the Clues are in the Kidney

Robert D. Simari, MD; Rajiv Gulati, MD, PhD

Disclosures

December 13, 2013

Editorial Collaboration

Medscape &

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In This Article

Treating Hypertension in the Cath Lab

Robert D Simari MD: Greetings, I'm Rob Simari of the division of cardiovascular diseases at the Mayo Clinic. Today I'm pleased to be joined by Dr Rajiv Gulati, one of the leading interventionalists at the Mayo Clinic, to talk about a topic that has been very exciting over the past few years, and that is the topic of renovascular denervation.

Rajiv, the thought of an interventionalist treating hypertension with a catheter must be the old analogy that "to a man with a hammer, everything looks like a nail." This is a great opportunity to talk about a field that has been very exciting. Tell us how the field of renovascular denervation has developed.

Rajiv Gulati MD PhD: This is a great chance for us in the catheterization lab to rebrand ourselves as preventive cardiologists, by treating hypertension. This is a fascinating story. I won't go into too much detail because we have known for many years the importance of the sympathetic nervous system in hypertension.

Now it is becoming increasingly clear how important the kidney is as a sensor of hypertension to modulate sympathetic nervous activity. The data and the thinking come from the surgical sympathectomy done back in the 1940s and 1950s, which was the only treatment for hypertension. It worked incredibly well but was beset by problems with orthostatic hypotension and autonomic problems because of complete sympathetic nervous transaction.

Now we have the ability to nicely modulate sympathetic activity by focusing an ablation in the renal nerves to alter both sympathetic efferent outflow at the kidney level and also afferent nervous system discharge to the brain, thereby reducing chronic sympathetic overactivation.

Dr Simari: Was it technology that drove the opportunity, or was it an unmet need that drove the technology?

Dr Gulati: It was more likely the former; the recognition of the importance of the sympathetic nervous system and of sympathectomy being a brutal way of treating hypertension and then the development of ablation catheters that can focus ablation. It seems more that the technology has enabled this to be potentially a widespread technology.

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