This review provides an update on interventional therapies for resistant hypertension, highlighting the need for better patient selection and technological advancements following the neutral results of the SYMPLICITY 3 trial.
Challenges early RDN enthusiasm; leaves open whether refined techniques or selection improve outcomes in resistant hypertension.
Resistant hypertension remains a clinical challenge with few management options beyond maximisation of medications. Catheter- based renal artery denervation (RDN) was proposed in 2009 as a possible therapy for resistant hypertension and early feasibility trials caused excitement among cardiologists and antihypertensive specialists, showing remarkable and sustained blood pressure reductions. In 2014, enthusiasm for RDN dampened following the SYMPLICITY 3 trial results, which showed no statistically significant difference in blood pressure between the intervention and control arms. However, hope remains for the improved management of resistant hypertension; procedural understanding, technological advancements and alternative targets - such as baroreceptor activation therapy and arteriovenous shunts - may aid the identification of those patients for whom specific interventional therapies will be effective.
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Brandon et al. (2016) studied this question.
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