Renal Denervation in Moderate Treatment-Resistant Hypertension

Objectives This study sought to investigate the effect of renal denervation (RDN) in patients with treatment-resistant hypertension according to the established definition (Joint National Committee VII and European Society of Hypertension/European Society of Cardiology guidelines), that is, office blood pressure (BP) >= 140/90mmHg (with at least three antihypertensive drugs, including a diuretic, in adequate doses) and confirmed by 24-h ambulatory BP monitoring (ABPM). Background RDN emerged as an innovative interventional antihypertensive therapy. However, so far, only patients with severe hypertension (systolic BP >= 160 mm Hg or >= 150 mm Hg for patients with type 2 diabetes) have been investigated. Methods In this study, there were 54 patients with moderate treatment-resistant hypertension (office BP >= 140/90 mm Hg and <160/100 mm Hg and diagnosis confirmed by 24-h ABPM of >= 130/80 mm Hg) who underwent catheterbased RDN using the Symplicity catheter (Medtronic Inc., Mountain View, California). Results Patients were treated with 5.1 +/- 1.4 antihypertensive drugs on average. Office BP was significantly reduced by 13/7mmHg 6 months after RDN (systolic: 151 +/- 6mmHg vs. 138 +/- 21mmHg, p < 0.001; diastolic: 83 +/- 11mmHg vs. 75 +/- 11 mm Hg, p < 0.001). In patients (n = 36) who underwent ABPM 6 months after treatment, there was a reduction in average 24-h ABPM by 14/7 mm Hg (systolic: 150 +/- 16 mm Hg vs. 136 +/- 16 mm Hg, p < 0.001; diastolic: 83 +/- 10 mm Hg vs. 76 +/- 10 mm Hg, p < 0.001). In 51% of patients, office BP was controlled below 140/90 mm Hg after RDN. In addition, heart rate decreased from 67 +/- 11 to 63 +/- 10 beats/min (p = 0.006). Conclusions Our data indicate that RDN may reduce office and 24-h ambulatory BP substantially in patients with moderate treatmentresistant hypertension. (Renal Denervation in Treatment Resistant Hypertension; NCT01687725) (C) 2013 by the American College of Cardiology Foundation