Renal Denervation

The term “ultima ratio ” has multiple, though related, meanings. The motto “ultima ratio regum, ” cast on the cannons of the French army of King Louis XIV, meant that war is the last argument of kings, that is, the one to be used after all diplomatic arguments have failed. Along similar lines, we propose that, given the current evidence, renal denervation should be used as a last resort, after state-of-the-art drug treatment optimized at expert centers failed to control blood pressure. Hypertension affects an estimated 20 % to 30 % of theworld’s adult population.1 Despite the availability of numerous safe and effective pharmacological therapies, in-cluding single-pill combinations of 2 to 3 drugs, the percent-age of patients achieving adequate blood pressure control meeting guideline targets remains low.1,2 Resistant hyperten-sion is a blood pressure that remains above goal in spite of the concomitant use of antihypertensive medications from 3 drug classes.3 Patients who require 4 drug classes to have their blood pressure controlled are also considered to have resistant hypertension. Preferably, the regimen should include a diuretic, and all of the doses should be optimal.3,4 Treatment-Resistant Hypertension The online-only Data Supplement provides an overview of the epidemiology of treatment-resistant hypertension and the role of the sympathetic nervous system in maintaining un-controlled hypertension.