Great. Thank you. It's so great to see a packed room and so much interest in renal denervation. Thank the moderators for inviting me to be a part of this session. So what I've been tasked to do is to present to you guys some highlights from Sky's Expert Consensus Roundtable on renal denervation for hypertensive patients. And so here is the paper that I was asked to talk about, and I'll touch a little bit at the end on the paper that we're currently working on. But you can see the citation down here was published in CCI in 2021. And this was not a strict guideline. This was sort of an informal roundtable discussion between subject matter experts, both within Sky and in partnership with the National Kidney Foundation. And so they got around and formed some consensus around select topics. And so those were issues related to blood pressure control and risk, evaluation and treatment pathways, safety and effectiveness, and ideal patient for RDN. So I think the first thing is just in terms of a target number, the group sort of for at least for systolic blood pressure kind of generally accepted at 130 millimeters of mercury is a widely accepted treatment goal. But they did introduce sort of a new metric for folks, which is called TTR, or time and target range. So rather than being sort of black and white around a specific number, there's some variability. So there's a range. And if we could somehow measure sort of average time or frequency of time that someone is within a range, that could potentially be a new metric that has been in early studies linked to positive outcomes. And so the group kind of had some acknowledgment that that could be an important endpoint in future clinical trials or registries. Of course, patients need good access to care, they need providers they can trust, we need interdisciplinary collaborations, and they need as simplified of a regimen for hypertension as they can get. In terms of risk, outside of just the blood pressure number, there was some talk about prioritizing patients that have elevated cardiovascular risk for this procedure. That could be patients with history of stroke, MI, end organ damage, LVH, et cetera. There was no general definition on what constitutes a, quote, clinically meaningful reduction in blood pressure. We talked a little bit about that here before. But we do know that it depends on initial blood pressure level and baseline risk. And as we've seen, even a 5- to 10-millimeter mercury reduction is beneficial. The device itself, with treatment, provides stabilization of blood pressure, potential decrease in medications, and improvements in quality of life. For evaluation and treatment pathways, they really wanted to get the terminology right. So they wanted folks to recognize that many patients with uncontrolled blood pressure do not have true resistant hypertension. And we had a good talk at the luncheon symposium today with a case example around this. So unless they really meet the AHA definition of resistant hypertension, the better term is uncontrolled hypertension, and that's what's preferred. For truly resistant hypertension patients, a secondary hypertensive workup should be done with particular attention to aldosterone secretion. And of course, we also need to work on education throughout our health system. We can't leave this to one sort of provider. So this is a spectrum in the care of a patient, from primary care physicians to APPs and specialists. I won't dwell on the safety and effectiveness too much. I think we've talked about this. Just one thing to note is that when the treatment is done, it is constant reduction. It's sort of always on. And complication rates, as we've discussed, is extremely low. Patients are the ideal patient for RDN. So I think initially there will be a group that follows kind of the same patients that have the same inclusion-exclusion criteria for clinical trials initially on controlled hypertensive patients despite GDMT. Confirmation of hypertension by alternative means of blood pressure monitoring is going to become more important, so that's a slight shift in purely office-based blood pressures to more home and ambulatory pressure monitoring. And we've talked about treatment priority on those with elevated cardiovascular risk. And then shared decision-making is also very important. I think we'll hear some more case examples to this effect. There was a pool survey that was a German study that about one-third of hypertensive patients would prefer a catheter-based approach over escalation of medications. So this shared decision-making is extremely important. So that was the roundtable discussion. The next paper that has not been jumped into in detail, which is the current paper, and that we're working on right now, has a little bit of a different focus. It's focusing on the nuts and bolts around how do we actually get this device incorporated into clinical practice. So a deeper dive into patient selection, optimal techniques, competence, training, which are mentioned some of today, and organizational recommendations. So this document just went live for public review, public comment online a couple days ago. So I'd urge everyone to go online and take a look at it. These are just a couple of the figures that are draft figures in that document that focus on more of a skill set, like a checklist that operators would need to be proficient in renal denervation, sort of placing the emphasis there, a proposed workflow to get a patient through up to the point of renal denervation, and then what a hypertension sort of center look like and who the stakeholders are. So that's…I'll stop there.

renal denervation

hypertensive patients

blood pressure control

TTR

risk evaluation