Renal Sympathetic Denervation for Treatment-Resistant Hypertension

Bruce Soloway, MD

As long as 3 years after RDN treatment, blood pressure remained low, and no adverse effects emerged.

In many studies, renal denervation (RDN) — catheter-mediated ablation of renal sympathetic nerves — has lowered blood pressure (BP) in patients with treatment-resistant hypertension. But the duration of this effect and the long-term safety of RDN remain unknown.

In an uncontrolled, manufacturer-funded, proof-of-concept study published in 2009 (NEJM JW Cardiol Mar 30 2009), 150 patients with treatment-resistant hypertension (systolic BP, ≥160 mm Hg despite optimized treatment with ≥3 antihypertensive agents) experienced rapid and persistent reductions in BP from a mean of 175/98 mm Hg at baseline to 149/84 mm Hg at 1 year after RDN.

In a new report, researchers present additional data on 88 of these patients who agreed to extended follow-up. BP continued to decline, reaching a mean 143/82 mm Hg at 3 years after RDN. No significant differences were seen in subgroups based on age, baseline renal function, or diabetes status; no major renal or vascular adverse events occurred. But patients were unable to eliminate drugs from their antihypertensive regimens, remaining on an average of 5.6 medications.

Citation(s):

Krum H et al. Percutaneous renal denervation in patients with treatment-resistant hypertension: Final 3-year report of the Symplicity HTN-1 study. Lancet 2013 Nov 7; [e-pub ahead of print].