New meta-analysis shows renal denervation resulted in substantial reduction in mean blood pressure (BP) at six months in patients with resistant hypertension (RH), according to an article published in the Journal of the American College of Cardiology.

Additional Resources Journal Scan ECD from the ESC on Catheter-Based Renal Denervation Resistance is Futile: Renal Denervation Takes on Hypertension (CardioSource Interventional News) Looking into the Crystal Ball for Renal Denervation (ACC in Touch Blog)

The authors conducted a systematic review and meta-analysis of previously published small studies evaluating the effect of renal denervation in patients with RH, and found that "in controlled studies, there was a reduction in mean systolic and diastolic BP at 6 months of -28.9 (95 percent CI -37.2, -20.6) and -11.0 (95 percent CI -16.4, -5.7) mmHg, respectively, compared to medically treated patients (for both, p<0.0001). In uncontrolled studies, there was a reduction in mean systolic and diastolic BP at 6 months of -25.0 (95 percent CI -29.9, -20.1) and -10.0 (95 percent CI -12.5, -7.5) mmHg, respectively, compared to pre-renal denervation values (for both, p<0.00001)."

The authors conclude, "with few adverse events reported, available data also suggest that renal denervation had favorable safety profile. Nonetheless, large randomized controlled trials with long-term follow-up are needed to confirm the sustained efficacy and safety of renal denervation in this patient population."

Of note, the Symplicity HTN 3 trial is currently underway, and according to Michael Scherlag, MD, FACC, chief of cardiology at Oklahoma Heart Hospital in Oklahoma City, OK, and governor of the Oklahoma chapter of the ACC, "the [renal denervation] procedure is easy to perform and assuming the Symplicity HTN 3 trial  is positive, and assuming that the U.S. Food and Drug Administration approves it, and assuming that Centers for Medicare & Medicaid Services will reimburse it, our patients will no longer be subjected to drugs that are unproven/difficult to take."

Recently, the European Society of Cardiology released an expert consensus document on catheter-based renal denervation to provide "guidance regarding appropriate patient selection, efficacy, safety, limitations, and potential new indications for renal denervation for referring physicians, interventionalists, and health care providers." Moving forward, the authors note that since renal denervation "also reduces whole-body sympathetic nerve activity [which] suggests that this therapy may be beneficial in other clinical states characterized by sympathetic nervous system activation – this may ultimately lead to new indications."

Keywords: Follow-Up Studies, Denervation, United States Food and Drug Administration, Sympathetic Nervous System, Medicaid, Blood Pressure, Kidney, Medicare, Hypertension

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