Questions and comments addressed to the RHC Steering board and open to the whole community, concerning the ESH the consensus paper:
ESH Position Paper: Renal denervation – an interventional therapy of resistant hypertension – Schmieder, et al. - Journal of Hypertension 837-841
Page 839: ELIGIBILITY CRITERIA FOR RENAL DENERVATION
“Based on current evidence from available clinical studies hypertensive patients are eligible for RDN if they have (severe) treatment-resistant hypertension defined by office SBP at least 160 systolic ( ≥ 150mmHg in type 2 diabetes) despite treatment with at least three antihypertensive drugs of different types in adequate doses, including one diuretic, which is equivalent to stage 2 or 3 hypertension.”
“ Patients should have been evaluated by a hypertension specialist in very experienced hospital centres (e.g. ESH Centres of Excellence). “
Page 840: PERSPECTIVE
“ Renal denervation may have beneficial effects in other conditions characterised by excessive sympathetic activation, and is currently under assessment in several clinical investigations. Until these results are available, we should only use RDN in patients with treatment-resistant hypertension who fulfil the above criteria and after careful selection in hypertension excellence centres. RDN should be performed in experienced hypertension excellence centres by well-trained interventionalists throughout Europe.”
My questions in relation to the above is:
The definition of resistant hypertension in this paper is different to that of the French Consensus Paper: Can you comment on this?
What ‘evidence’ is there to support that “patients should have been evaluated by a hypertension specialist in very experienced hospital centres (e.g. ESH Centres of Excellence) or that “ RDN should be performed in very experienced hypertension excellence centres”?
My comment is:
In a centre not ‘accredited ‘ as an “ESH Centre of Excellence” with cardiologists and/or endocrinologists and/or nephrologists, (e.g. Clinique Pasteur, Toulouse, France), adequately educated in the management of hypertension and with a broad experience of interventional procedures as well as an established ‘regional network’ of general practitioners or general cardiologists and hospitals in the area: what would be your reasons for not selecting patients and performing RDN procedures?
What are the criteria to define a centre as “ a Hypertension Centre of Excellence”?