Eligibility for Renal Denervation
Authors: Persu Alexandre , Jin Yu , Baelen Marie , Vink Eva , Verloop Willemien L. , Schmidt Bernhard , Blicher Marie K. , Severino Francesca , Wuerzner Grégoire , Taylor Alison , Pechère-Bertschi Antoinette , Jokhaji Fadi , Fadl Elmula Fadl Elmula M. , Rosa Jan , Czarnecka Danuta , Ehret Georg , Kahan Thomas , Renkin Jean , Widimský Jiří , Jacobs Lotte , Spiering Wilko , Burnier Michel , Mark Patrick B. , Menne Jan , Olsen Michael H. , Blankestijn Peter J. , Kjeldsen Sverre , Bots Michiel L. , Staessen Jan A. , Baelen Marie , Gerber Bernhard , Horman Sandrine , Kefer Joëlle , Lengelé Jean-Philippe , le Polain de Waroux Jean-Benoit , Renkin Jean , Scavée Christophe , Severino Francesca , Vanoverschelde Jean-Louis , Ehret Georg , Péchère-Bertschi Antoinette , Berry Collin , Brady Adrian , Delles Christian , Dominiczak Anna , Freel Marie , Jardine Alan , Moss Jon , Muir Scot , Mark Patrick , Padmanabhan Sandosh , Roditi Giles , Bauersachs Johann , Brinkmann Julia , Haller Hermann , Heusser Karsten , Jordan Jens , Klein Gunnar , Menne Jan , Schmidt Bernhard , Tank Jens , Czarnecka D. , Jastrzębski Marek , Styczkiewicz Katarzyna , Burnier Michel , Wuerzner Grégoire , Asayama Kei , Gu Yumei , Hashimoto Asuza , Jacobs Lotte , Jin Yu , Kuznetsova Tatiana , Liu Yanping , Thijs Lutgarde , Staessen Jan A. , Blicher Maria , Beck-Nielse Henning , Flemming Høilund-Carlsen Poul , Olsen M. , Brekke Magne , Engeseth Kristian , Fadl Elmula Fadl Elmula M. , Fossum Eigil , Gjønnæss Eivind , Hjørnholm Ulla , Hoffmann Pavel , Høieggen Aud , Kjær Vibeke , Kjeldsen Sverre E. , Larstorp Anne C.K. , Meyerdierks Oliver , Os Ingrid , Rostrup Morten , Stenehjem Aud , Rosa Jan , Petrak Ondrej , Zelinka Tomas , Strauch Branislav , Curila Karol , Tousek Petr , Widimský Jiří , Widimský Petr , Jokhaji Fadi , Lander Riker , Kahan Thomas , Spaak Jonas , Blankestijn Peter J. , Bots Michiel L. , Doevendans Pieter A. , Rookmaaker Maarten B. , Spiering Wilko , Verloop Willemien L. , Vink Eva E. , Voskuil Michiel , Vonken Evert-jan 
Published: March 2014

Based on the SYMPLICITY studies and CE (Conformité Européenne) certification, renal denervation is currently applied as a novel treatment of resistant hypertension in Europe. However, information on the proportion of patients with resistant hypertension qualifying for renal denervation after a thorough work-up and treatment adjustment remains scarce. The aim of this study was to investigate the proportion of patients eligible for renal denervation and the reasons for noneligibility at 11 expert centers participating in the European Network COordinating Research on renal Denervation in treatment-resistant hypertension (ENCOReD). The analysis included 731 patients. Age averaged 61.6 years, office blood pressure at screening was 177/96 mm Hg, and the number of blood pressure–lowering drugs taken was 4.1. Specialists referred 75.6% of patients. The proportion of patients eligible for renal denervation according to the SYMPLICITY HTN-2 criteria and each center’s criteria was 42.5% (95% confidence interval, 38.0%–47.0%) and 39.7% (36.2%–43.2%), respectively. The main reasons of noneligibility were normalization of blood pressure after treatment adjustment (46.9%), unsuitable renal arterial anatomy (17.0%), and previously undetected secondary causes of hypertension (11.1%). In conclusion, after careful screening and treatment adjustment at hypertension expert centers, only ≈40% of patients referred for renal denervation, mostly by specialists, were eligible for the procedure. The most frequent cause of ineligibility (approximately half of cases) was blood pressure normalization after treatment adjustment by a hypertension specialist. Our findings highlight that hypertension centers with a record in clinical experience and research should remain the gatekeepers before renal denervation is considered.