Hypothesis: Catheter-based renal sympathetic denervation should be the initial therapy for essential hypertension

Abstract

Hypertension affects 30-40% of the adult population in the developed world and is a major risk factor for stroke, myocardial infarction, heart failure, and kidney failure. Though the importance of controlling hypertension is well recognized, only about 50% of patients in the United States actually attain guideline recommended blood pressure goals. Limiting factors include patient noncompliance, suboptimal application of effective medication, and true medication resistance. Renal sympathetic denervation has been used to treat resistant hypertension and appears to be safe and effective and to produce durable results. We hypothesize that renal sympathetic denervation will produce similar results across the spectrum of hypertension severity for which pharmacologic therapy is currently indicated and propose that this is an important hypothesis to be tested in suitably powered randomized trials.