Renal sympathetic denervation in patients with treatment-resistant hypertension

January 01, 0001

Renal sympathetic denervation in patients with treatment-resistant hypertension

Activation of renal sympathetic nerves is key to pathogenesis of essential hypertension. The researchers aimed to assess effectiveness and safety of catheter-based renal denervation for reduction of blood pressure in patients with treatment-resistant hypertension. In this multicentre, prospective, randomised trial, patients who had a baseline systolic blood pressure of 160 mm Hg or more (greater than or equal to 150 mm Hg for patients with type 2 diabetes), despite taking three or more antihypertensive drugs, were randomly allocated in a one-to-one ratio to undergo renal denervation with previous treatment or to maintain previous treatment alone (control group) at 24 participating centres. 56% of 190 patients screened for eligibility were randomly allocated to renal denervation (n=52) or control (n=54) groups between June 9, 2009, and Jan 15, 2010.

Office-based blood pressure measurements in the renal denervation group reduced by 32/12 mm Hg whereas they did not differ from baseline in the control group. Between-group differences in blood pressure at 6 months were 33/11 mm Hg (significant). At 6 months, 84% of 49 patients who underwent renal denervation had a reduction in systolic blood pressure of 10 mm Hg or more, compared with 35% of 51 controls (significant). No serious procedure-related or device-related complications were noted and occurrence of adverse events did not differ between groups; one patient who had renal denervation had possible progression of an underlying atherosclerotic lesion, but required no treatment.

The researchers concluded: "Catheter-based renal denervation can safely be used to substantially reduce blood pressure in treatment-resistant hypertensive patients."

Long term outcomes will be worth following and also benefits for less resistant hypertension.

For the full abstract, click here.

The Lancet published online 17 November 2010
© 2010 Elsevier Ltd
Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Symplicity HTN-2 Investigators.

Category: K. Circulatory Keywords: renal, sympathetic, denervation, treatment resistant, hypertension, multi-centre prospective randomised controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 10 December 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.