Case Presentation

Renal denervation for resistant hypertension and heart failure with a reduced ejection fraction

Carles Cañameras Fugasot, Oriol Rodríguez-Leor, Josep Riera Sadurní, Edgar Fadeuilhe, Javier Paul Martínez, Marina Urrutia Jou, Jordi Bover and Maribel Troya-Saborido*

Published: 16 March, 2023 | Volume 7 - Issue 1 | Pages: 001-003

Hypertension is a risk factor for the development of heart failure and has a negative impact on the survival of these patients. Although patients with these two conditions usually take different antihypertensive medications, some patients do not achieve adequate blood pressure control and their hypertension becomes resistant or refractory. In this scenario, percutaneous renal denervation has emerged in recent years as an alternative to achieve blood pressure control goals. We present the case of a 53-year-old woman with a medical history of essential hypertension, hypercholesterolemia, unipolar depression, and diabetes, who was diagnosed with dilated cardiomyopathy with reduced left ventricular ejection fraction (33%). Despite the initiation of multiple antihypertensive medications and placement of a cardiac resynchronization therapy pacemaker, the patient remained hypertensive with a left ventricular ejection fraction of 40%. At that time, percutaneous renal denervation was performed without complications, and one year after the procedure, the patient had improved better blood pressure control and the left ventricular ejection fraction increased to 51%. This case illustrates one of the clinical scenarios in which it has been suggested that renal denervation may be more beneficial, as in the situation of patients with refractory hypertension and heart failure.

Read Full Article HTML DOI: 10.29328/journal.ach.1001033 Cite this Article Read Full Article PDF


  1. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, Ramirez A, Schlaich M, Stergiou GS, Tomaszewski M, Wainford RD, Williams B, Schutte AE. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020 Jun;75(6):1334-1357. doi: 10.1161/HYPERTENSIONAHA.120.15026. Epub 2020 May 6. PMID: 32370572.
  2. Kasiakogias A, Rosei EA, Camafort M, Ehret G, Faconti L, Ferreira JP, Brguljan J, Januszewicz A, Kahan T, Manolis A, Tsioufis K, Weber T, von Lueder TG, Smiseth OA, Wachtell K, Kjeldsen SE, Zannad F, Mancia G, Kreutz R. Hypertension and heart failure with preserved ejection fraction: position paper by the European Society of Hypertension. J Hypertens. 2021 Aug 1;39(8):1522-1545. doi: 10.1097/HJH.0000000000002910. PMID: 34102660.
  3. Beckett N, Peters R, Leonetti G, Duggan J, Fagard R, Thijs L, Narkiewicz K, McCormack T, Banya W, Fletcher A, Bulpitt C; HYVET Study Group. Subgroup and per-protocol analyses from the Hypertension in the Very Elderly Trial. J Hypertens. 2014 Jul;32(7):1478-87; discussion 1487. doi: 10.1097/HJH.0000000000000195. PMID: 24984177.
  4. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; Authors/Task Force Members:. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018 Oct;36(10):1953-2041. doi: 10.1097/HJH.0000000000001940. Erratum in: J Hypertens. 2019 Jan;37(1):226. PMID: 30234752.
  5. Rodríguez-Leor O. Renal denervation for the management of hypertension. Joint position statement from the SHE-LELHA and the ACI-SEC. REC Interv Cardiol. 2022; 4:39-46.
  6. Schlaich MP, Schmieder RE, Bakris G, Blankestijn PJ, Böhm M, Campese VM, Francis DP, Grassi G, Hering D, Katholi R, Kjeldsen S, Krum H, Mahfoud F, Mancia G, Messerli FH, Narkiewicz K, Parati G, Rocha-Singh KJ, Ruilope LM, Rump LC, Sica DA, Sobotka PA, Tsioufis C, Vonend O, Weber MA, Williams B, Zeller T, Esler MD. International expert consensus statement: Percutaneous transluminal renal denervation for the treatment of resistant hypertension. J Am Coll Cardiol. 2013 Dec 3;62(22):2031-45. doi: 10.1016/j.jacc.2013.08.1616. Epub 2013 Sep 18. PMID: 24021387.
  7. Symplicity HTN-2 Investigators; Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Böhm M. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet. 2010 Dec 4;376(9756):1903-9. doi: 10.1016/S0140-6736(10)62039-9. Epub 2010 Nov 17. PMID: 21093036.
  8. Barbato E, Azizi M, Schmieder RE, Lauder L, Böhm M, Brouwers S, Bruno RM, Dudek D, Kahan T, Kandzari DE, Lüscher TF, Parati G, Pathak A, Ribichini FL, Schlaich MP, Sharp ASP, Sudano I, Volpe M, Tsioufis C, Wijns W, Mahfoud F. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2023 Feb 15:ehad054. doi: 10.1093/eurheartj/ehad054. Epub ahead of print. PMID: 36790101.


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