Source: China Food and Drug Net

 In recent years, the prevalence of hypertension has been increasing year by year. Renal artery sympathetic nerve radiofrequency ablation (RDN) is an effective treatment for hypertension and is expected to become the preferred option and a powerful supplement to drug combination therapy by virtue of the advantages of higher safety and better antihypertensive effect. Meanwhile, the clinical application of RDN devices is in strong demand, and the potential market space is vast.

RDN has many advantages

 Human blood pressure is controlled by signals from multiple systems in the body (such as the nervous system, circulatory system, endocrine system, etc.). If the office systolic blood pressure is not less than 140 mmHg or the office diastolic blood pressure is not less than 90 mmHg after several repeated measurements, the person is considered to be suffering from hypertension. The higher the body's blood pressure, the more difficult it is for the heart to pump blood. If left unchecked, hypertension may cause cardiovascular disease and may also lead to kidney failure, blindness, and cognitive impairment.

 Hypertension can be categorized into three subtypes: controlled hypertension, uncontrolled hypertension, and persistent hypertension. According to Frost & Sullivan, for patients with controlled hypertension, it is relatively easy to control their blood pressure at a normal level by making lifestyle changes or taking medications; for patients with recalcitrant hypertension, it is difficult to maintain their blood pressure at a normal level despite taking at least three different types of antihypertensive medications at the maximum tolerated dosage; and the severity of uncontrolled hypertension is in between that of controlled hypertension and recalcitrant hypertension.

 The main treatment modalities for hypertension are medication, lifestyle intervention and interventional therapy. Lifestyle interventions include weight control, limiting salt and alcohol intake, increasing physical activity, and reducing mental stress. However, it is difficult to treat more severe hypertension (e.g., uncontrolled hypertension and refractory hypertension) through lifestyle changes alone.

 Drugs for hypertension treatment mainly include angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, beta-blockers, calcium channel blockers, diuretics, alpha-blockers, and central antihypertensive drugs. However, it is difficult to treat recalcitrant hypertension with medications alone. For uncontrolled hypertension, patients need to take a large amount of medication for a long time and need regular review, and the compliance of patients is poor. In addition, antihypertensive drugs have certain side effects, such as thiazide diuretics can cause or aggravate diabetes mellitus, beta blockers can cause asthma and worsening of heart failure.

 Currently, RDN is one of the interventional therapies for hypertension with extensive research and sufficient clinical evidence. The kidney has a central role in the long-term regulation of blood pressure, and increased excitability of renal sympathetic nerves is an important neural mechanism causing hypertension, which can increase blood pressure through both efferent and afferent fibers.The antihypertensive effect of RDN is closely related to the effects of renal sympathetic efferent fibers and afferent fibers, which can be removed by removing renal sympathetic efferent fibers and afferent fibers, and block signal transduction between the brain and renal sympathetic nerves to reduce hypertension. By removing the efferent and afferent fibers, it can block the signal transmission between the brain and renal sympathetic nerves and reduce the overactive renal sympathetic nerve excitability of hypertensive patients, thus achieving the effect of lowering blood pressure.

 Compared with drug therapy, lifestyle intervention and other means, RDN has various advantages in the field of hypertension treatment. For example, RNA has a 24/7 blood pressure lowering effect and is not affected by patient behavior. Usually, during the early morning and night time, patients have a higher risk of cardiovascular disease, and after receiving RDN treatment, patients' blood pressure can be controlled continuously. At the same time, the safety profile of the RDN is favorable. Because RDN does not involve permanent implantation and is less invasive, it causes relatively few side effects, and patients tend to have no adverse reactions and faster postoperative wound recovery. In addition, RDN effectively solves the problem of poor patient compliance.

Wide market space for RDN

 Hypertension is a disease highly associated with age and lifestyle. With the increasing aging of the population, the prevalence of hypertension is on the rise year by year. Data released by Frost & Sullivan shows that in 2019, the number of hypertensive patients in China reached 317 million; the number is expected to grow to 388 million by 2030.

 CICC data show that in 2021, the number of patients with controllable hypertension, uncontrolled hypertension, and recalcitrant hypertension in China will be about 0.76 billion, 205 million, and 0.50 billion, accounting for 23%, 62%, and 15%, respectively. The huge number of hypertensive patients has a huge demand for RNA and other interventional treatments for hypertension. Among them, controlled and uncontrolled hypertension patients are mostly young people, who tend to have busy work, irregular life, low medication adherence, and some resistance to lifelong medication treatment. RDN treatment can not only help these patients lower their blood pressure to a safe range, but also effectively reduce the burden of medication. At the same time, the medication burden of patients with persistent hypertension is also very large. Although RDN cannot help these patients to get rid of medication completely, it can help to reduce the physical and psychological burden of taking a large number of medications.

 Strong market demand drives the RDN market to expand continuously. According to CICC's estimation, China's RDN market is expected to reach 10 billion yuan in the long term.

 It is noteworthy that many domestic and foreign enterprises are actively developing RDN devices. Foreign enterprises mainly include Medtronic, St. Jude's, Johnson & Johnson, Poco, Kehui Medical, etc. Domestic enterprises mainly include Meiliweiye, Baxinan, Xinmai Medical, Microtronic Electrophysiology, Kang Feng Biological and so on. With the increase of R&D investment and technological development, RDN devices are being optimized and upgraded, and the prospect of clinical application is broad.

At the same time, due to the better efficacy, easy operation and higher safety of RDN, as the market promotion of related products and technologies continues to advance, the acceptance of RDN therapy by doctors and patients will continue to improve, and the market penetration rate of RDN devices will also be further enhanced. (Contributed by Siyu MedTech)