Transcatheter renal denervation represents a novel therapy for treating patients with treatment resistant hypertension, a condition which greatly increases the risk of myocardial infarction and stroke.
“The Symplicity Hypertension I and II studies have suggested that this procedure significantly lowers blood pressure in these patients with few remaining options in terms of treatment,” said Dr Mylotte. “However, patients included in clinical trials are often highly selected, and therefore may not reflect the patient encountered by physicians on a day-to-day basis. As such, the results of these trials may not be applicable to less-selected patient populations.”
In light of this potential problem, the investigators sought to evaluate the effect of transcatheter renal denervation in a group of patients with resistant hypertension in their own clinical practice at The Institut Cardiovasculaire de Paris Sud, Paris, France.
They intended to perform transcatheter renal denervation on 35 consecutive patients referred to the service with resistant hypertension. The study used the same definition as the Symplicity trials to define resistant hypertension (1).
Among these patients, 36.5% were female, 36.4% were diabetic, and 15.2% had kidney dysfunction. Baseline office blood pressure (BP) was 181.1±21.9 /100.8±16.8 mmHg, despite an average of 4.6±1.0 medications per patient. Successful bilateral sympathetic denervation was performed in 33 out of 35 patients (1 patient was not treated due to a stenosis of the renal artery; 1 patient had treatment on one side only, as multiple small renal arteries were found on the other side). No procedural complications occurred.
At 6-months follow-up, the average office BP reduction from baseline was 30.3±21.1/14.6±15.3 mmHg (P<0.0001). Similarly, ambulatory BP was reduced 23.3±12.1/10.2±9.9 mmHg from baseline (P<0.001). There were no adverse events during follow-up (death, myocardial infarction, or stroke), and no deterioration in renal function was observed.
“Transcatheter renal denervation is a safe and efficacious treatment, which results in significant reductions in blood pressure in real world patients with treatment resistant hypertension,” said Dr Mylotte. “Although longer-term results are required, renal denervation should be considered for all patients with treatment resistant hypertension, as it is likely to lower their blood pressure and reduce their chances of myocardial infarction and stroke.”
1 Symplicity HTN-2 Investigators, Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Böhm M. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet. 2010;376:1903-1909.
Authors: Dr Darren Mylotte (France), Institut Cardiovasculaire Paris Sud
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