Original title: Renal denervation in moderate treatment resistant hypertension. Reference: Christian Ott et al. J Am Coll Cardiol 2013. Article in press.
Symplicity trials HTN1 and HTN 2 demonstrated that renal denervation is apparently safe in patients with severe resistant hypertension, (≥ 160 mm Hg despite ≥ 3 drugs including a diuretic). This cut of more than 160 mmHg was highly specific for initial studies but it is obvious that most resistant hypertensives are actually below these figures. It was for this reason that the present pilot study included 54 resistant patients according to JNC 7 and ESH/ESC guides but with records between 140/90 and 160/100 mmHg. For denervation a radiofrequency catheter Symplicity™ renal denervation system, (Medtronic Inc., Mountain View, CA), was used with at least 4 ablations of 120s duration each per artery. Diffuse visceral pain during applications was handled with anxiolytics and narcotics.
At six months after denervation there was a significant reduction in blood pressure, (systolic 151 ± 6 versus 138 ± 21 mm Hg, p <0.001, diastolic 83 ± 11 versus 75 ± 11 mm Hg, p <0.001). Both day and night records were significantly reduced without modifying the dipper path. At six months heart rate was also significantly reduced, (67 ± 11 vs. 63 ± 10 beats / min, p = 0.006), and this effect was independent of the blood pressure observed.
Conclusion:
Renal denervation can significantly reduce blood pressure in patients with moderate resistant hypertension.
Commentary:
The major limitation of this study is the lack of a control group and the small sample size. However, this is a pilot study that opens the way for randomized controlled jobs. Reduction after denervation was less pronounced compared to previous reports but that was expected as the major determinant of the extent of reduction is a high degree of pre-procedure. In any case it is clear that beyond the initial number, any intervention that leads to even a modest reduction is associated with a significant reduction in cardiovascular morbidity and mortality
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