BlueCross BlueShield of Tennessee Medical Policy Manual

Radiofrequency Ablation of the Renal Sympathetic Nerves as a Treatment for Resistant Hypertension

DESCRIPTION

Radiofrequency ablation (RFA) of the renal sympathetic nerves is thought to decrease both the afferent sympathetic signals from the kidney to the brain and the efferent signals from the brain to the kidney. This procedure decreases sympathetic activation, decreases vasoconstriction, and decreases activation of the renin-angiotensin system. RFA of the renal sympathetic nerves has been proposed as a treatment option for patients with resistant hypertension.

The procedure is performed percutaneously with access at the femoral artery. A flexible catheter is threaded into the renal artery and controlled energy source, most commonly low-power RF energy, is delivered to the arterial walls where the renal sympathetic nerves are located. Once adequate RF energy has been delivered to ablate the sympathetic nerves, the catheter is removed.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

There are currently no radiofrequency ablation (RFA) devices approved by the FDA for ablation of the renal sympathetic nerves as a treatment for hypertension. The strongest evidence comes from sham-controlled trials, the largest of which found no significant benefits with renal denervation. The evidence is insufficient to determine the effects of the technology on health outcomes.

SOURCES 

American Heart Association, American College of Cardiology, & American Society of Hypertension. (2015). Treatment of hypertension in patients with coronary artery disease. Retrieved May 21, 2019 from https://www.acc.org/guidelines/guidelines.

BlueCross BlueShield Association. Evidence Positioning System. (9:2018). Radiofrequency ablation of the renal sympathetic nerves as a treatment for resistant hypertension (7.01.136). Retrieved May 21, 2019 from https://www.evidencepositioningsystem.com/. (48 articles and/or guidelines reviewed)

Bhatt, D., Kandzari, D., O’Neill, W., D’Agostino, R., Flack, J., Katzen, B., et al. (2014). A controlled trial of renal denervation for resistant hypertension. New England Journal of Medicine, 370, 1393-1401. (Level 1 evidence)

Elmula, F., Feng, Y., Jacobs, L., Larstorp, A., Kjeldsen, S., Persu, A., et al. (2017). Sham or no sham control: that is the question in trials of renal denervation for resistant hypertension. A systematic meta-analysis. Blood Pressure, 26 (4), 195-203. (Level 1 evidence)

Esler, M., Böhm, M., Sievert, H., Rump, C., Schmieder, R., Krum, H., et al. (2014). Catheter-based renal denervation for treatment of patients with treatment-resistant hypertension: 36 month results from the SYMPLICITY HTN-2 randomized clinical trial. European Heart Journal, 35, 1752-1759. (Level 1 evidence)

Pappaccogli, M., Covella, M., Berra, E., Fulcheri, C., Di Monaco, S., Perlo, E., et al. (2018). Effectiveness of renal denervation in resistant hypertension: a meta-analysis of 11 controlled studies. High Blood Press Cardiovascular Prevention, doi: 10.1007/s40292-018-0260-5. [Epub ahead of print]

Pourmoghaddas, M., Khosravi, A., Akhbari, M., Akbari, M., Pourbehi, M., Ziaei, F., et al. (2016). One year follow-up effect of renal sympathetic denervation in patients with resistant hypertension. ARYA Atherosclerosis, 12 (2), 109-113. Abstract retrieved August 4, 2016 from PubMed database.

Vogiatzakis, N., Tsioufis, C., Georgiopoulos, G., Thomopoulos, C., Dimitriadis, K., Kasiakogias, A., et al. (2017). Effect of renal sympathetic denervation on short-term blood pressure variability in resistant hypertension: a meta-analysis. Journal of Hypertension, Doi: 10.1097/HJH.1391. Abstract retrieved June 1, 2017 from PubMed database.

Yao, Y., Zhang, D., Qian, J., Deng, S., Huang, Y., & Huang, J. (2016). The effect of renal denervation on resistant hypertension: meta-analysis of randomized controlled clinical trials. Clinical and Experimental Hypertension, 38 (3), 278-286. Abstract retrieved June 1, 2017 from PubMed database.

ORIGINAL EFFECTIVE DATE:  4/11/2013

MOST RECENT REVIEW DATE:  6/13/2019

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