Renal denervation for the management of resistant hypertension

Abstract

Renal sympathetic denervation (RSD) as a therapy for patients with resistant hypertension has attracted great interest. The majority of studies in this field have demonstrated impressive reductions in blood pressure (BP). However, these trials were not randomized or sham-controlled and hence, the findings may have been overinflated due to trial biases. SYMPLICITY HTN-3 was the first randomized controlled trial to use a blinded sham-control and ambulatory BP monitoring. A surprise to many was that this study was neutral. Possible reasons for this neutrality include the fact that RSD may not be effective at lowering BP in man, RSD was not performed adequately due to limited operator experience, patients’ adherence with their anti-hypertensive drugs may have changed during the trial period, and perhaps the intervention only works in certain subgroups that are yet to be identified. Future studies seeking to demonstrate efficacy of RSD should be designed as randomized blinded sham-controlled trials. The efficacy of RSD is in doubt, but many feel that its safety has been established through the thousands of patients in whom the procedure has been performed. Over 90% of these data, however, are for the Symplicity™ system and rarely extend beyond 12 months of follow-up. Long-term safety cannot be assumed with RSD and nor should it be assumed that if one catheter system is safe then all are. We hope that in the near future, with the benefit of well-designed clinical trials, the role of renal denervation in the management of hypertension will be established.

Exercise as a tool for hypertension and resistant hypertension management: current insights

“…Resistant hypertension is a medical problem without a clear solution, since antihypertensive medications and renal denervation – the common treatment options to lower blood pressure in these patients – have demonstrated reduced efficacy. 48 , 49 Recently, aerobic exercise training has been recognized as a promising therapeutic tool to reduce blood pressure in resistant hypertension; the blood pressure reduction observed in patients with resistant hypertension following an aerobic exercise training program is promising, but must be confirmed in larger randomized controlled studies.…”

The autonomic nervous system as a therapeutic target in heart failure: a scientific position statement from the Translational Research Committee of the Heart Failure Association of the European Society of Cardiology

“…The majority of experience with RDN in man has been derived in the context of treatment‐resistant hypertension (TRH) using the single‐electrode Symplicity™ catheter (Medtronic, Minneapolis, MN, USA) . The initial first‐in‐man study and open‐label RCT showed the treatment to have profound effects on blood pressure, which in further work were coupled mechanistically to improvements in renal norepinephrine spillover, MSNA and cardiac remodelling .…”

Effects of renal denervation on vascular remodelling in patients with heart failure and preserved ejection fraction: A randomised control trial

“…We then applied a minimum of four ablations to each main renal artery in a circumferential distribution as has been described elsewhere. 6 – 8 …”