DB 03-1 RENAL SYMPATHETIC DENERVATION IS STILL A VIABLE OPTION FOR TREATING RESISTANT HYPERTENSION (PRO). (September 2016)

• Record Type: Journal Article
• Authors: Schlaich, Markus
• Is Part Of: Journal of hypertension. Volume 34:(2016) Supplement 1
• Publication Date: 2016-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000500961.64090.be
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Accumulating evidence from mainly uncontrolled and unblinded clinical studies with various types of ablation catheters have shown that renal denervation (RDN) can be applied safely and is effective in lowering blood pressure (BP) in most patients with treatment resistant hypertension. Sustained BP lowering has been documented up to 3 years at this stage. Furthermore, RDN has been associated with regression of target organ damage, such as left ventricular hypertrophy, arterial stiffness and others. Several studies indicate potential benefit in other common clinical conditions associated with increased sympathetic tone including chronic kidney disease and heart failure. However, the recently published Symplicity HTN-3 trial, the largest and most rigorously designed clinical trial including a sham procedure, while confirming the safety of the procedure, failed to demonstrate a BP lowering effect beyond that of a sham procedure in a cohort of patients with resistant hypertension. Efforts to unravel the reasons for the discrepant results from Symplicity HTN-3 have focused on a range of potential confounders including anatomical and procedural aspects. Indeed, data form post-hoc analyses indicate that sufficient renal deneravtion may not have been achieved in the majority of patients in Symplicity HTN-3. Furthermore, recent evidence from human post-mortem and functional animal studies revealed new insights into the anatomical distribution of renal nerves and their accessibility by intravascular therapeutic approaches. Integrating these important findings into newly designed clinical trials will be key to determine the true potential of renal denervation in the treatment of hypertension and other clinical conditions characterized by increased sympathetic drive.