Renal nerve ablation reduces blood pressure in resistant hypertension: Long‐term clinical outcomes in a single‐center experience

Abstract

Approximately 10% of patients with hypertension have resistant hypertension, even if adequate pharmacological therapy is established. In this regard, renal nerve ablation (RNA) could represent a valid alternative treatment option. In a retrospective analysis with a follow-up of 6, 12, and 24 months, the authors investigated the efficacy and safety of catheter-based renal artery ablation in 57 patients undergoing RNA with multiple renal nerve ablation in both renal arteries. In addition to medical antihypertensive therapy (4.2 ± 1.4 drugs per patient), RNA using three different ablation systems was performed in patients with confirmed resistant hypertension (systolic blood pressure >140 mm Hg in spite of three drugs including a diuretic). The primary end point was the change in office ambulatory systolic blood pressure from baseline to 6, 12, and 24 months of follow-up after RNA. The primary safety end point was the change in plasma creatinine levels after 12 and 24 months compared with baseline. The mean office systolic blood pressure at baseline was 167.6 ± 22.4 and after 6, 12, and 24 months averaged 143.5 ± 21.1 (P < .05), 141.1 ± 21.1 (P < .05), and 139.4 ± 19.6 mm Hg (P < .05) respectively, with an average of 15.1 ± 5.3 nerve ablations performed. No significant changes in plasma creatinine levels were observed at 12 months (P = .421) and at 24 months (P = .217). There were no complications after RNA nor any relevant adverse vascular, renal, or cardiovascular events observed except in one patient in whom a covered stent had to be placed at the femoral puncture site. In this study, in all patients with resistant hypertension, RNA, if performed adequately in the number of ablations and energy delivery, is an efficient and safe treatment option to lower office and 24-hour blood pressure. Whether these blood pressure-lowering effects will lead to a reduction of cardiovascular morbidity and mortality will require further studies.

Renal sympathetic denervation: Ashes to ashes or rebirth from the ashes?

“…Of note, blood pressure response was associated with the number of ablations, and patients receiving more than 14 ablations experienced a sufficient systolic blood pressure reduction (office: 14 mm Hg; ambulatory: 7 mm Hg), thus underlining the importance of adequate renal denervation . It is noteworthy that the study by Denegri and colleagues actually duplicates the findings of the post‐hoc analysis of Symplicity‐3, because for a similar number of ablations an identical blood pressure reduction is achieved.…”

“…Regarding efficacy, renal sympathetic denervation resulted in pronounced blood pressure reduction. Office systolic blood pressure was reduced by 25 mm Hg and ambulatory systolic blood pressure was reduced by 14 mm Hg 2 years post procedure, whereas diastolic blood pressure was reduced by 7 mm Hg for both office and ambulatory measurements …”

“…In this issue, Denegri and colleagues report a case series of 57 patients with resistant hypertension who were treated interventionally . Renal sympathetic denervation was performed with 3 different devices (Symplicity, EnligHTN, and Vessix).…”

“…There are 3 main strengths in the study by Denegri and colleagues . First, it provides real‐life data, outside the “sterile” environment of clinical trials.…”

“…In this issue, Denegri and colleagues report a case series of 57 patients with resistant hypertension who were treated interventionally. 9 Renal sympathetic denervation was performed with 3 different devices (Symplicity, EnligHTN, and Vessix). The primary safety endpoint was renal function, and the primary efficacy endpoint was systolic ambulatory blood pressure for a follow-up period of 24 months.…”