Long-term outcome of renal nerve denervation (RDN) for resistant hypertension

Panchavinnin, Pradit; Wanthong, Sirisawat; Roubsanthisuk, Weranuj; Tresukosol, Damras; Buranakitjaroen, Peera; Chotruangnapa, Chavalit; Watanapa, Wattana B.; Pongakasira, Rungtiwa; Wongpraparut, Nattawut

doi:10.1038/s41440-022-00910-7

Cited by 14 publications

(9 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present results supporting RDN efficacy to at least 3 years of follow-up confirm and extend recent pre-clinical [32,33] and clinical trial [25,[34][35][36][37] reports of long-term safety and efficacy of radiofrequency RDN. Note that no repeat procedures have been performed to date in the SPYRAL HTN trials.…”

Section: Discussionsupporting

confidence: 90%

Long-term reduction in morning and nighttime blood pressure after renal denervation: 36-month results from SPYRAL HTN-ON MED trial

et al. 2022

View full text Add to dashboard Cite

Elevated morning and nighttime blood pressures (BP) are associated with increased risk of cardiovascular events such as stroke and myocardial infarction. We compared the long-term changes in morning and nighttime BP in patients with uncontrolled hypertension (office systolic BP between 150 and <180 mmHg/diastolic BP ≥ 90 mmHg; mean ambulatory systolic BP (SBP) between 140 and <170 mmHg; 1–3 prescribed antihypertensive medications). Eighty patients were randomized to RDN or sham control. In patients taking at least 3 antihypertensive medications at 36 months (N = 23 RDN group; N = 23 sham group), the 24 h ambulatory SBP as well as morning (7:00–9:00AM) and nighttime (1:00–6:00AM) ambulatory SBP were significantly lower for the RDN group compared to sham control (24 h SBP: −20.2 vs. −10.2, p = 0.0087; morning SBP: −23.9 vs. −8.0 mmHg, p = 0.029; nighttime SBP: −20.8 vs. −7.2 mmHg, p = 0.0011). At 36 months, 24 h SBP was controlled to <130 mmHg in 40% of RDN patients in the morning compared to 6% for the sham group; P = 0.021 and in 80% of the RDN patients at night compared to 39% in the sham group; P = 0.019. Major adverse events through 36 months were rare in both groups, and there were no renal artery re-interventions or vascular complications. Morning and nighttime SBP were significantly lower in patients prescribed at least 3 antihypertensive medications at 36 months in the SPYRAL HTN-ON MED trial for RDN compared with sham control. The results suggest RDN has significant benefit when the risk of cardiovascular events is highest.

show abstract

Section: Discussionsupporting

confidence: 90%

Long-term reduction in morning and nighttime blood pressure after renal denervation: 36-month results from SPYRAL HTN-ON MED trial

et al. 2022

View full text Add to dashboard Cite

show abstract

“…As reported in the previous clinical trials above, although the responders received a signi cant reduction of blood pressure after RDN and the e cacy exists persistently [18,19] (up to 9-year follow-up [20]), there were about 25-30% nonresponders manifesting unchanged or elevated blood pressure postoperatively, which runs counter to our therapeutic purpose and burdens the patients. erefore, indicators before/during RDN procedure become particularly important and indispensable to screen susceptible subjects, especially those with high sympathetic tone, leading to more predictable results and avoiding harm to patients.…”

Section: Introductionmentioning

confidence: 64%

Present Evidence of Determinants to Predict the Efficacy of Renal Denervation

Zhou

Chen

et al. 2022

International Journal of Hypertension

View full text Add to dashboard Cite

Sympathetic overactivation is one of the main contributors to development and progress of hypertension. Renal denervation (RDN) has been evidenced by series of clinical trials for its efficacy and safety to treat overactivated sympathetic nervous system induced diseases. However, the results were inconsistent and not all patients benefited from RDN. Appropriate patient selection and intraoperative factors to improve the efficacy of RDN need to be solved urgently. Over the decade, research studies on the correlations between indicators and the antihypertensive effects have been conducted and made a fairly well progress. Herein, we comprehensively reviewed the research studies on how to make RDN more predictable or improve the efficacy of RDN and summarized these potential indicators or devices which might be applied in clinical settings.

show abstract

“…In Thailand, the first report on the efficacy of RDN in patients with resistant hypertension was published in 2014 [ 9 ]. The effectiveness of RDN outcomes was maintained for up to 9 years in Thai patients [ 17 ]. The strongest predictor of BP reductions following RDN was baseline systolic BP in the post hoc analyses of the SYMPLICITY HTN-3 trial and meta-analysis (Fig.…”

Section: Introductionmentioning

confidence: 99%

“…The BP reduction effect of RDN in humans is durable for at least 3 years, as shown in the Global SYMPLICITY registry [ 22 ], SPYRAL HTN-ON MED study [ 23 ], SYMPLICITY HTN-3 trial [ 24 ] and a report from Thailand [ 17 ]. In the SYMPLICITY HTN-3 trial [ 24 ], RDN induced a significant reduction in both office systolic BP (−26.4 versus −5.7 mmHg, p < 0.0001) and 24-h ambulatory systolic BP (−15.6 versus −0.3 mmHg, p = 0.0001) compared to the sham control at the 3-year follow-up.…”

Section: Introductionmentioning

confidence: 99%

“…Long-term follow-up in 18 Thai subjects receiving RDN has shown at least 80% effectiveness of RDN, defined by a reduction in office systolic BP > 10 mmHg, a reduction in the number of antihypertensive drugs taken, or both. The mean and longest follow-up periods in our study were 52 months and 104 months, respectively [ 17 ]. Therefore, we still need future studies concerning renal nerve regeneration, BP lowering, and safety information related to RDN in the future.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

2022 Renal denervation therapy for the treatment of hypertension: a statement from the Thai Hypertension Society

Roubsanthisuk

Kunanon²,

Chattranukulchai³

et al. 2023

Hypertens Res

Self Cite

View full text Add to dashboard Cite

Hypertension remains a significant risk factor for major cardiovascular events worldwide. Poor adherence to treatment is extremely common in clinical practice, leading to uncontrolled hypertension. However, some patients with resistant hypertension still have uncontrolled blood pressure despite good medical compliance. A specific group of patients also develop adverse reactions to many blood pressure-lowering medications. These scenarios indicate that innovative strategies to lower blood pressure in challenging cases of hypertension are needed. The blood pressure-lowering efficacy of catheter-based renal denervation therapy to decrease sympathetic tone has been confirmed in many publications in recent years. Apart from both the invasiveness and the expensiveness of this technology, appropriate case selection to undergo this procedure is still developing. The utilization of renal denervation therapy for hypertension treatment in Thailand has lasted for 10 years with a good response in most cases. Currently, only certain interventionists at a few medical schools in Thailand can perform this procedure. However, more physicians are now interested in applying this technology to their patients. The Thai Hypertension Society Committee has reviewed updated information to provide principles for the appropriate utilization of renal denervation therapy. The blood pressure-lowering mechanism, efficacy, suitable patient selection, pre- and postprocedural assessment and procedural safety of renal denervation are included in this statement.

show abstract

Long-term outcome of renal nerve denervation (RDN) for resistant hypertension

Cited by 14 publications

References 16 publications

Long-term reduction in morning and nighttime blood pressure after renal denervation: 36-month results from SPYRAL HTN-ON MED trial

Long-term reduction in morning and nighttime blood pressure after renal denervation: 36-month results from SPYRAL HTN-ON MED trial

Present Evidence of Determinants to Predict the Efficacy of Renal Denervation

2022 Renal denervation therapy for the treatment of hypertension: a statement from the Thai Hypertension Society

Contact Info

Product

Resources

About