Original title: Renal Sympathetic Denervation for Treatment of Drug-Resistant Hypertension Clinical Perspective Reference: Murray D. Ester et al. Circulation 2012; 126: 2976-2982
Renal sympathetic activation contributes to the pathogenesis of hypertension. The Symplicity HTN – 2 was a multicenter, randomized study which demonstrated that renal denervation produced a significant decrease in blood pressure at 6 months in patients with hypertension resistant to medical treatment. This paper presents the results at 1 year and also the results of patients who crossed over at 6 months from the control group to renal denervation.
106 hypertensive patients were included with ≥ 3 antihypertensive drugs and a baseline systolic pressure ≥ 160 mmHg (≥ 150 mmHg in patients with type 2 diabetes). After 6 months, the primary endpoint was achieved, which allowed patients to pass from the control group to renal denervation. At one year there was an average decrease in systolic blood pressure of 28.1 mmHg (p <0.001), similar to the average decline at 6 months of 31.7 mmHg. Therefore there was no significant difference between 6 months and one year.
For patients who crossed branch, the decrease was significant (from 190.0 ± 19.6 to 166.3 ± 24.7 mmHg, 23.7 ± 27.5 mmHg, a decrease of P <0.001). In this group there was one patient with renal dissection prior to denervation that was resolved with a stent and one patient who developed hypotension which was resolved with an adjustment in medication.
Conclusion
Hypertensive patients resistant to medical treatment showed decreased blood pressure after one year and patients in the control group who crossed branch showed a similar decline to those that originally received renal denervation.
Editorial Comment:
The results invite us to expand the use of renal denervation in patients with lesser degrees of hypertension, especially considering only just over 50% of patients get appropriate access to medical treatment.
Courtesy by Dr Gustavo Hidalgo.
Interventional Cardiology Fellowship.
Favaloro Foundation. Argentina.
Dr. Gustavo Hidalgo para SOLACI.ORG