November 22nd, 2010
Treating Resistant Hypertension: Singe – Don’t Stent – The Renal Artery
For years, interventional cardiologists (and radiologists) have been stenting renal arterial stenoses in patients with resistant hypertension, despite evidence that doing so does not lower blood pressure. It appears we had the right organ (the kidney), but we’ve been doing the wrong procedure. We should have been delivering a singe, not a stent.
Advances in endovascular catheter technology now allow us to access the sympathetic nerves located in the renal arterial adventitia, making possible selective denervation of the human kidney with radiofrequency energy delivered in the renal arterial lumen. In the multicenter Symplicity HTN-2 trial, catheter-based renal denervation resulted in significant reductions in blood pressure in patients with treatment-resistant essential hypertension.
The investigators randomized 106 patients with treatment-resistant hypertension (i.e., systolic blood pressure ≥160 mm Hg [≥150 mm Hg for patients with diabetes] despite the use of ≥3 antihypertensive drugs) to renal sympathetic denervation or continued medical therapy.
Renal denervation resulted in impressive reductions in office-based measurements of blood pressure (average decline, 32/12 mm Hg at 6 months) as well as home-based (average decline, 20/12 mm Hg) and ambulatory (average decline, 11/7 mm Hg) measurements, whereas no reductions were observed in the control group. Importantly, no serious procedure-related complications occurred.
In short, renal denervation resulted in an impressive reduction in blood pressure in these patients with otherwise refractory hypertension.
Would you integrate percutaneous renal denervation into your practice now, or do you need validative findings from additional studies?