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January 1, 2014European Cardiology ReviewOpen Access

Renal Denervation After Symplicity HTN-3 – Back to Basics. Review of the Evidence

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Key result

Renal sympathetic denervation has a limited overall blood pressure lowering effect in apparent treatment-resistant hypertension and is not ready for clinical practice based on recent trial evidence.

Why the study?

Does renal sympathetic denervation reduce blood pressure in patients with apparent treatment resistant hypertension?

Population

Patients with apparent treatment resistant hypertension

Comparison

Renal sympathetic denervation (RDN) vs Sham control or standard medical therapy

Design

Review

Authors

APAlexandre PersuVascular MedicineFEFadl Elmula M. Fadl ElmulaKing Faisal Specialist Hospital & Research CentreYJYu JinUniversity of Glasgow

Discussion

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Implication

Supports adherence optimization over RDN in resistant hypertension; leaves open refined selection and techniques for future sham-controlled trials.

Structured PICO

Does renal sympathetic denervation reduce blood pressure in patients with apparent treatment resistant hypertension?

P
Population
Patients with apparent treatment resistant hypertension (defined as office blood pressure elevation despite prescription of at least three antihypertensive drugs including a diuretic)
I
Intervention
Renal sympathetic denervation (RDN)
C
Comparator
Sham control or standard medical therapy (as evaluated in the reviewed trials)
O
Outcome
Blood pressure reductionsurrogate

Renal denervation is not currently ready for clinical practice for resistant hypertension, as recent sham-controlled trials failed to confirm the significant blood pressure reductions seen in earlier unblinded studies.

Limitations

  • The characteristics of true responders remain largely unknown
  • Earlier positive results may be largely due to non-specific effects such as improvement of drug adherence, placebo effect, and regression to the mean

Cite This Study

Persu et al. (2014) conducted a review in Apparent treatment resistant hypertension. Renal sympathetic denervation (RDN) was evaluated on Blood pressure reduction. Renal sympathetic denervation has a limited overall blood pressure lowering effect in apparent treatment-resistant hypertension and is not ready for clinical practice based on recent trial evidence.

synapsesocial.com/papers/6a239a63412756072fa5eb39https://doi.org/10.15420/ecr.2014.9.2.110
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Sympathetic Nervous System Involvement in Essential Hypertension: Increased Platelet Noradrenaline Coincides with Decreased β-Adrenoreceptor Responsiveness1994 · 24 citations
  2. 2Renal Sympathetic Denervation in Patients With Treatment-Resistant Hypertension After Witnessed Intake of Medication Before Qualifying Ambulatory Blood Pressure2013 · 114 citations
  3. 3Adjusted Drug Treatment Is Superior to Renal Sympathetic Denervation in Patients With True Treatment-Resistant Hypertension2014 · 211 citations
  4. 4Eligibility for Renal Denervation2014 · 62 citations
  5. 5ESH Position Paper2012 · 241 citations