1.1 Current evidence on percutaneous transluminal radiofrequency sympathetic denervation of the renal artery for resistant hypertension is from limited numbers of patients, but there is evidence of efficacy in the short and medium term. There is inadequate evidence on efficacy in the long term; this is particularly important for a procedure aimed at treating resistant hypertension. The limited evidence suggests a low incidence of serious periprocedural complications, but there is inadequate evidence on long-term safety. Therefore this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.
1.2 Clinicians wishing to undertake percutaneous transluminal radiofrequency sympathetic denervation of the renal artery for resistant hypertension should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy, and provide them with clear written information. In addition, the use of NICE's information for patients (Understanding NICE guidance) is recommended.
1.3 Patient selection should be carried out by a multidisciplinary team including a physician with expertise in hypertension and a specialist in endovascular interventions, giving consideration to the number of antihypertensive drugs that have failed to control the patient's blood pressure and the anatomical suitability of their renal arteries. The procedure should only be done by specialists who are experienced in endovascular interventions and with facilities for emergency stenting in case this is required.
1.4 NICE encourages further research on this procedure. Patient selection criteria should be described clearly and reported outcome measures should include adverse events and the long-term effect of the procedure on blood pressure.
1.5 NICE also encourages data collection and publication of outcomes on all patients having this procedure. Clinicians should submit data on all patients having this procedure to the national register when it becomes available.