Date of Graduation

8-10-2013

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

Abstract

Background: Hypertension is a major contributor to cerebrovascular and heart disease. Of the patients who are medically managed but not meeting blood pressure goals, there is a subset of patients who have resistant hypertension, a condition requiring more aggressive technology and treatment to assist in the reduction of their blood pressure. The sympathetic innervation of the kidneys plays an intricate role in these patients and is becoming the target for future treatment alternatives. Will the use of renal radiofrequency ablation (RFA) be an effective therapeutic option for patients with resistant hypertension?

Methods: An exhaustive search of available and applicable literature was conducted using Medline-OVID, Evidence Based Medicine Reviews Multifile, CINAHL, and Google Scholar by using the key words: resistant hypertension, kidney, renal denervation, sympathectomy and radiofrequency ablation. Relevant articles were assessed for quality using GRADE and are found in the Table section of this paper. A search on the NIH clinical trials website revealed few completed trials, but showed multiple trials that are in process or recruiting for further investigation of the efficacy of renal radiofrequency ablation for the treatment of resistant hypertension.

Results: Two studies met inclusion criteria and are discussed in this systematic review. A randomized controlled study with 106 participants demonstrated a statistically significant reduction in blood pressure following renal denervation. A proof-of-principle cohort study with 50 participants demonstrated a statistically significant and sustained reduction in blood pressure for those who received renal radiofrequency ablation therapy.

Conclusion: Renal radiofrequency ablation has been shown to reduce blood pressure in patients with resistant hypertension with no evidence of serious complications. RFA has also been shown to be a cost effective therapeutic alternative when comparing the long-term cost of treating hypertension to the upfront cost of the procedure. Due to the existing low quality of available studies, more thorough research is needed to confirm long-term efficacy of RFA as a treatment option for patients with resistant hypertension.

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