Hypertension is a very common condition, and generally manageable. However, as we know, it is associated to cardiovascular events.
Even though the therapeutic arsenal enables us with drugs and drug combinations, in many occasions adequate control will elude us, or three or more drugs will be required.
Renal denervation (RDN) has been shown effective to reduce hypertension in different studies, although important questions remain unanswered, such as efficacy over time and whether it offers benefits vs. conventional treatment.
The SPYRAL HTN-ON MED was analyzed (a randomized controlled trial) including 337 hypertensive patients treated with 1 to 3 drugs with elusive results, defined as office systolic blood pressure (BP) >150 mmHg and ≤180 mmHg and diastolic BP ≥90 mmHg, or 24 hour ambulatory systolic BP >140 mmHg and≤170 mmHg. 206 of these patients received RDN.
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The groups were comparable: on average, antihypertensive medication was 1.8 among RDN patients and 1.7 in the control group (CG); mean patient age was 55; 80 % were men; their history included heart disease in 6 % and stroke or TIA in 1 %; conserved kidney function. Baseline Office BP was 163/101 mmHg and ambulatory BP 149/96 mmHg.
At 6 months, crossover was allowed and 66 patients received RDN.
At 24 months, patients receiving RDN presented significantly reduced systolic BP in ambulatory BP (−12.1±15.3 mmHg [n=176] vs. −7.0±13.1 mmHg [n=33]; difference: −5.7 mmHg; P=0.039) and office BP groups (−17.4±16.1 mmHg [n=187] vs. −9.0±19.4 mmHg [n=35]; difference: −8.7 mmHg; P=0.0034) vs. the control group. Also, the increase in number of antihypertensives was greater in the control group vs RDN patients (1.7–2.7 vs. 1.8–2.8; P=0.046).
Crossover patients also saw significantly reduced systolic BR vs. those who had received RDN from the start.
No patient presented severe renal stenosis at 24 months after RDN.
Conclusion
Renal denervation lead to a significant reduction of systolic BP, both in office and at 24-hour ambulatory monitoring vs. the control group, despite the latter used more antihypertensives.
Hipertensión/denervasión renal
Original Title: Long-Term Safety and Efficacy of Renal Denervation: 24-Month Results From the SPYRAL HTN-ON MED Trial.
Reference: David E. Kandzar, et al. Circ Cardiovasc Interv. 2025;18:e015194. DOI: 10.1161/CIRCINTERVENTIONS.125.015194.
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