Renal nerve ablation after SYMPLICITY HTN-3: confused at the higher level?

Abstract

In spite of all the medical progress, hypertension remains a highly prevalent chronic disease worldwide, contributing importantly to cardiovascular morbidity and mortality in Europe¹ and around the globe. Indeed, it has been estimated that in the not too distant future up to 50% of the adult population will develop high blood pressure according to currently used definitions.² Since Franklin D. Roosevelt died of a cerebral haemorrhage in 1945 due to uncontrolled high blood pressure with values up to 300/190 mmHg, the management of hypertension has made impressive progress. Indeed, while at that time only Kempner's rice diet was available, after the war diuretics, reserpine, guanethidine, and later beta-blockers, spironolactone, calcium antagonists, and angiotensin-converting enzyme (ACE) inhibitors became available. Today, with the advent of angiotensin receptor blockers, renin inhibitors, eplerenone, and beta-blockers, the pharmacological armamentarium to treat high blood pressure has become quite vast, and most patients can be controlled with 1–3 antihypertensive drugs to levels of ≤140/90 mmHg.³