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January 1, 2017Cleveland Clinic Journal of MedicineOpen Access

Renal denervation: What happened, and why?

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Key result

Renal denervation failed to significantly reduce office systolic blood pressure compared to a sham procedure at 6 months (mean reduction of 14.13 mm Hg vs 11.74 mm Hg, difference of 2.39 mm Hg) in patients with resistant hypertension.

Population

Patients with resistant hypertension

Design

Editorial

Authors

MSMehdi H. ShishehborTHTarek A. HammadGTGeorge Thomas

Discussion

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Member takes

Overview

Does not support renal denervation for resistant hypertension; leaves open questions on patient selection and technique in future trials.

Structured PICO

P
Population
535 patients with resistant hypertension (systolic blood pressure ≥ 160 mm Hg on ≥3 medications) randomized to renal denervation or a sham procedure and followed for 6 months.
I
Intervention
Renal denervation

Main Result

Mean Difference: 2.39

Absolute Event Rate: 14.13% vs 11.74%

p-value: p=Not statistically significant

This editorial discusses the implications of the SYMPLICITY HTN-3 trial's failure to meet efficacy endpoints for renal denervation in resistant hypertension.

Limitations

  • True medication adherence is difficult to ascertain
  • Maximal tolerated doses is vague, possibly enrolling patients without true resistant hypertension
  • At least 40% of patients required medication changes during the study
  • Unclear if all patients underwent specific testing to rule out secondary hypertension
  • Renal denervation is a blind procedure with no nerve mapping to ascertain the degree of ablation

Cite This Study

Shishehbor et al. (2017) conducted a review in Resistant hypertension (n=535). Renal denervation vs. Sham procedure was evaluated on Reduction in office systolic blood pressure at 6 months (MD 2.39 mm Hg, p=Not statistically significant). Renal denervation failed to significantly reduce office systolic blood pressure compared to a sham procedure at 6 months (mean reduction of 14.13 mm Hg vs 11.74 mm Hg, difference of 2.39 mm Hg) in patients with resistant hypertension.

synapsesocial.com/papers/6ab634cdb43f9cebc36fea13https://doi.org/10.3949/ccjm.84a.14129
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Also Consider

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

  1. 1Renal Denervation: Past, Present, and Future2016 · 3 citations
  2. 2Renal denervation for the treatment of resistant hypertension: review and clinical perspective2015 · 51 citations
  3. 3Renal denervation: Are we on the right path?2017
  4. 4Renal Denervation: Past, Present, and Future2015 · 5 citations
  5. 5Renal Denervation after Symplicity HTN-3: An Update2014 · 35 citations