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May 29, 2014Nephrology Dialysis TransplantationOpen Access

Con: Renal denervation for all resistant hypertensive patients: the Emperor's new clothes

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Key result

Renal denervation for resistant hypertension lacks solid evidence of efficacy and safety, as highlighted by the failure of Symplicity HTN-3 and highly variable blood pressure responses.

Why the study?

Does catheter-based renal denervation reduce blood pressure in patients with resistant hypertension?

Population

Patients with resistant hypertension

Comparison

Catheter-based endovascular sympathetic renal… vs Medical treatment only or sham procedure

Design

Editorial

Authors

APAlexandre PersuYJYu JinJLJean‐Philippe Lengelé

Discussion

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Overview

Cautions against routine renal denervation for resistant hypertension outside trials; leaves open its role pending rigorous RCTs.

Structured PICO

Does catheter-based renal denervation reduce blood pressure in patients with resistant hypertension?

P
Population
Patients with resistant hypertension
I
Intervention
Catheter-based endovascular sympathetic renal denervation (RDN)
C
Comparator
Medical treatment only or sham procedure
O
Outcome
Reduction in office and 24-h ambulatory blood pressuresurrogate

This editorial strongly cautions against the widespread adoption of renal denervation for resistant hypertension, citing weak evidence, methodological flaws in early trials, and potential safety concerns.

Limitations

  • Lack of per-protocol exclusion of white-coat and secondary hypertension in previous trials
  • Unblinded assessment of office rather than 24-h ambulatory BP in early studies
  • Small sample sizes and short-term follow-up in existing evidence

Cite This Study

Persu et al. (2014) conducted an editorial in Resistant hypertension. Renal denervation was evaluated. Renal denervation for resistant hypertension lacks solid evidence of efficacy and safety, as highlighted by the failure of Symplicity HTN-3 and highly variable blood pressure responses.

synapsesocial.com/papers/6a77975d6789de8d0af74ed8https://doi.org/10.1093/ndt/gfu098
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Also Consider

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

  1. 1Rationale and design of the Investigator-Steered Project on intravascular Renal Denervation for Management of Drug-Resistant Hypertension (INSPiRED) trial2014 · 18 citations
  2. 2Renal denervation in treatment-resistant hypertension: the need for restraint and more and better evidence2013 · 27 citations
  3. 3Renal Sympathetic Denervation in Patients With Treatment-Resistant Hypertension After Witnessed Intake of Medication Before Qualifying Ambulatory Blood Pressure2013 · 114 citations
  4. 4Prevalence of Resistant Hypertension and Eligibility for Catheter-Based Renal Denervation in Hypertensive Outpatients2013 · 36 citations
  5. 5Catheter-Based Renal Sympathetic Denervation for Resistant Hypertension2011 · 745 citations