Management of Renovascular Hypertension and Renal Denervation in Patients with Hypertension: An Italian Nationwide Survey

Overview

Journal High Blood Press Cardiovasc Prev

Specialty Cardiology & Vascular Diseases

Date 2024 Sep 18

PMID 39292380

Authors

Marco Pappaccogli

Lara Ponsa

Jessica Goi

Jacopo Burrello

Guido Di Dalmazi

Arrigo Francesco Giuseppe Cicero

Costantino Mancusi

Elena Coletti Moia

Guido Iaccarino

Claudio Borghi

Maria Lorenza Muiesan

Claudio Ferri

Franco Rabbia

Paolo Mulatero

Affiliations

Soon will be listed here.

Abstract

Introduction: Renovascular hypertension (RVH) remains underdiagnosed despite its significant cardiovascular and renal morbidity.

Aim: This survey investigated screening and management practices for RVH among hypertensive patients in Italian hypertension centres in a real-life setting. Secondary, we analysed the current spread of renal denervation (RDN) and the criteria used for its eligibility.

Methods: A 12 item-questionnaire was sent to hypertension centres belonging to the European Society of Hypertension and to the Italian Society of Hypertension (SIIA) in Italy. Data concerning the screening and management of RVH and of RDN were analysed according to the type of centre (excellence vs non-excellence centres), geographical area and medical specialty.

Results: Eighty-two centres participated to the survey. The number of patients diagnosed in each centre with RVH and fibromuscular dysplasia during the last five years was 3 [1;6] and 1 [0;2], respectively. Despite higher rates of RVH diagnosis in excellence centres (p = 0.017), overall numbers remained unacceptably low, when compared to expected prevalence estimates. Screening rates were inadequate, particularly among young hypertensive patients, with only 28% of the centres screening for RVH in such population. Renal duplex ultrasound was underused, with computed tomographic angiography or magnetic resonance angiography reserved for confirming a RVH diagnosis (76.8%) rather than for screening (1.9-32.7%, according to patients' characteristics). Scepticism and logistical challenges limited RDN widespread adoption.

Conclusions: These findings underscore the need for improving RVH screening strategies and for a wider use of related diagnostic tools. Enhanced awareness and adherence to guidelines are crucial to identifying renovascular hypertension and mitigating associated cardiovascular and renal risks.

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