Denervation of the renal arteries in the treatment of resistant hypertension. Definition of the disease, patient selection and description of the procedure. Reference document 2012 of the Italian Society of Hypertension (SIIA) [DENERVAZIONE DELLE ARTERIE RENALI NEL TRATTAMENTO DELL'IPERTENSIONE ARTERIOSA RESISTENTE: DEFINIZIONE DELLA PATOLOGIA, SELEZIONE DEI PAZIENTI E DESCRIZIONE DELLA PROCEDURA. DOCUMENTO DI INDIRIZZO 2012 DELLA SOCIETA' ITALIANA DELL'IPERTENSIONE ARTERIOSA (SIIA)]

Hypertension is responsible for a relevant burden of cardiovascular morbidity and mortality worldwide. Al- though several appropriate and integrated pharmacological strategies are available, blood pressure control still remains largely unsatisfactory. Failure to achieve effective blood pressure control in treated hypertensive pa- tients may have a substantial impact on overall cardiovascular risk, since it significantly increases the risk of both macrovascular and microvascular complications. Hypertension is arbitrarily defined as “resistant” or “refractory” when recommended blood pressure goals (clinic blood pressure <140/90 mmHg, or <130/80 mmHg in patients with type 2 diabetes mellitus) are not achieved, despite changes in lifestyle and treatment with adequate doses of at least three antihypertensive drugs from different classes, including a diuretic. A new non-pharmacological option for the treatment of patients with resistant hypertension has recently be- come available. Renal sympathetic denervation is a minimally invasive procedure performed via femoral ac- cess that uses radiofrequency catheter ablation to disable renal sympathetic afferent and efferent nerves. It results in isolation of renal parenchymal and juxtaglomerular cells from the abnormal enhancement of renal adrenergic nerve activity. The present position paper of the Italian Society of Hypertension provides a diagnostic and therapeutic approach to the early identification and effective clinical management of patients with resistant hypertension, who maybe candidates for renal denervation. These indications may have important implications not only from a clini- cal viewpoint but also from an economic perspective. The accurate identification of patients with resistant hy- pertension and the appropriate selection of patients eligible for this procedure may help improve blood pres- sure control and reduce the risk of cardiovascular and cerebrovascular complications in these patients.