Key result
Renal denervation applies to only 0.5% of hypertensive outpatients after excluding age, CKD, and secondary causes.
Cross-Sectional (n=999)
No
Only a very small fraction (0.5%) of Japanese hypertensive outpatients are true candidates for renal denervation, highlighting the need for large cohort networks to recruit suitable patients for this procedure.
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R-HT prevalence estimates may guide RD candidate selection; leaves open whether denervation improves outcomes in this population.
Aims: To retrospectively investigate the prevalence and characteristics of treatment-resistant hypertension (R-HT) among consecutive hypertensive outpatients, since patients with R-HT are candidates for catheter-based renal sympathetic denervation (RD). Methods: Consecutive hypertensive outpatients (n = 999) were recruited in our hospital. R-HT patients who were candidates for RD had clinic systolic blood pressure > 160 mmHg despite taking three or more antihypertensive drugs including at least one diuretics at higher than standard doses. Results: Our survey indicated that only 26 patients (2.6%) were potential candidates for renal denervation. Candidates for RD showed a significantly higher age (P < 0.005), brain natriuretic peptide level (P = 0.0001), urinary albumin/creatinine excretion ratio in spot urine (P < 0.005), pulse wave velocity (P < 0.01), left ventricular end-diastolic diameter (P < 0.005), and interventricular septal thickness (P < 0.005) than the other 973 patients. Candidates for denervation had a significantly lower hemoglobin (P = 0.0001), serum albumin (P < 0.001), eGFR (P < 0.0005), plasma renin activity (P = 0.0001), and plasma aldosterone level (P < 0.005) than other patients, while their urinary sodium/creatinine ratio was higher, indicating that patients with R-HT appeared to have a high salt intake. Conclusion: Our retrospective clinical survey indicated that only 0.5% of Japanese hypertensive outpatients (5/999 patients) were candidates for RD. Therefore, establishment of hypertension cohort network will be essential to recruit R-HT patients for RD.
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Okamura et al. (2015) conducted a cross-sectional in Hypertension (n=999). Treatment-resistant hypertension vs. Non-treatment-resistant hypertension was evaluated on Prevalence of candidates for renal denervation. Among 999 Japanese hypertensive outpatients, only 0.5% were ultimately identified as candidates for catheter-based renal sympathetic denervation after excluding those with advanced age, chronic kidney disease, and secondary hypertension.
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