Key result
Renal denervation initially showed promise for treating resistant hypertension, but the pivotal sham-controlled SYMPLICITY HTN-3 trial failed to demonstrate superiority over control.
Why the study?
Does catheter-based renal denervation reduce blood pressure in patients with resistant hypertension?
Does catheter-based renal denervation reduce blood pressure in patients with resistant hypertension?
While early trials showed promise, the sham-controlled SYMPLICITY HTN-3 trial failed to show a significant blood pressure benefit for renal denervation in resistant hypertension, highlighting the need for further research on procedural techniques and patient selection.
Caution against routine renal denervation for resistant hypertension; leaves open optimized techniques and patient selection.
Patients with resistant hypertension are a subgroup of the hypertensive population that are at even greater risk of cardiovascular outcomes. Therapeutic options for these patients are limited to antihypertensive medications. However, renal denervation (RDN) is a novel nonpharmacologic intervention that involves a catheter-based ablation of the sympathetic nerves within the renal artery wall. The procedure initially showed promise with remarkable blood pressure reductions until the pivotal SYMPLICITY HTN-3 trial failed to demonstrate superiority of RDN over control. This trial was notable for a substantial placebo effect and an attenuated response to RDN. These findings, which contradicted those of prior studies, have raised numerous questions, including whether adequate RDN occurred in those patients. Further research is planned to resolve some of these questions and to clarify the role of RDN in treating patients with resistant hypertension.
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Denker et al. (2015) conducted a review in Resistant hypertension. Renal denervation vs. Sham procedure or medical therapy was evaluated. Renal denervation initially showed promise for treating resistant hypertension, but the pivotal sham-controlled SYMPLICITY HTN-3 trial failed to demonstrate superiority over control.
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