Renal Sympathetic Denervation as Second-Line Therapy in Mild Resistant Hypertension: A Pilot Study

Study Questions:

What is the feasibility, safety, and effectiveness of catheter-based renal sympathetic denervation (CRD) in patients with longstanding mild hypertension despite treatment with ≥3 antihypertensive drugs?

Methods:

Consecutive patients with office systolic blood pressures (BPs) of 140-160 mm Hg despite ≥3 antihypertensive medications treated with CRD were included in this prospective study. Procedural safety and adverse events during follow-up were assessed. Clinical evaluations were performed at baseline, 3 months, and 6 months to determine changes in office systolic BPs, 24-hour ambulatory BPs, and medication doses. The primary endpoint was defined as change in mean systolic office BP at 6 months.

Results:

Twenty patients (mean age 60.6 ± 10.8 years, 45% female) treated with an average of 5.4 ± 1.5 antihypertensive drugs were treated with CRD. The procedure was successful in all patients. There were no procedure- or device-related complications. BP at baseline was 148.4/83.0 ± 6.6/11.0 mm Hg, and decreased by 5.7/0.6 ± 20.0/8.3 mm Hg (p = 0.2) and 13.1/5.0 ± 13.6/8.3 mm Hg (p < 0.01) at 3 and 6 months, respectively. Comparing baseline and 6-month follow-up, mean ambulatory 24-hour BP was reduced by 11.3/4.1 ± 8.6/7.3 mm Hg (p < 0.01). Four patients were able to reduce antihypertensive medications prior to their 3-month visit.

Conclusions:

The authors concluded that CRD is a safe and effective treatment for patients with milder drug-resistant hypertension.

Perspective:

The present study suggests that renal denervation significantly reduces systolic BPs in patients with milder forms of resistant hypertension. While it is possible that patients with mild resistant forms of hypertension may benefit from this novel technique as second-line to drug therapy, by reducing the general risks associated with longstanding uncontrolled arterial hypertension, more data are needed. The current study is small, nonrandomized, and lacks a control group, and randomized prospective trials are indicated to assess safety and efficacy of CRD in patients with milder forms of hypertension.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Hypertension

Keywords: Follow-Up Studies, Eye Abnormalities, Denervation, Blood Pressure Monitoring, Ambulatory, Sympathectomy, Cardiovascular Diseases, Catheters, Kidney, Hypertension, Systole, Treatment Outcome


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