Renal Sympathetic Denervation for Treatment of Drug-Resistant Hypertension
Top Cited Papers
- 18 December 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 126 (25), 2976-2982
- https://doi.org/10.1161/circulationaha.112.130880
Abstract
Background— Renal sympathetic nerve activation contributes to the pathogenesis of hypertension. Symplicity HTN-2, a multicenter, randomized trial, demonstrated that catheter-based renal denervation produced significant blood pressure lowering in treatment-resistant patients at 6 months after the procedure compared with control, medication-only patients. Longer-term follow-up, including 6-month crossover results, is now presented. Methods and Results— Eligible patients were on ≥3 antihypertensive drugs and had a baseline systolic blood pressure ≥160 mm Hg (≥150 mm Hg for type 2 diabetics). After the 6-month primary end point was met, renal denervation in control patients was permitted. One-year results on patients randomized to immediate renal denervation (n=47) and 6-month postprocedure results for crossover patients are presented. At 12 months after the procedure, the mean fall in office systolic blood pressure in the initial renal denervation group (−28.1 mm Hg; 95% confidence interval, −35.4 to −20.7; PP=0.16 versus 6-month change). The mean systolic blood pressure of the crossover group 6 months after the procedure was significantly lowered (from 190.0±19.6 to 166.3±24.7 mm Hg; change, −23.7±27.5; P<0.001). In the crossover group, there was 1 renal artery dissection during guide catheter insertion, before denervation, corrected by renal artery stenting, and 1 hypotensive episode, which resolved with medication adjustment. Conclusions— Control patients who crossed over to renal denervation with the Symplicity system had a significant drop in blood pressure similar to that observed in patients receiving immediate denervation. Renal denervation provides safe and sustained reduction of blood pressure to 1 year. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00888433.This publication has 26 references indexed in Scilit:
- Catheter‐Based Renal Denervation for Resistant Hypertension: Rationale and Design of the SYMPLICITY HTN‐3 TrialClinical Cardiology, 2012
- Prevalence of Resistant Hypertension in the United States, 2003–2008Hypertension, 2011
- Catheter-Based Renal Sympathetic Denervation for Resistant HypertensionHypertension, 2011
- Device-Based Antihypertensive TherapyCirculation, 2011
- Renal Denervation as a Therapeutic Approach for HypertensionHypertension, 2009
- Assessment of Sympathetic Cardiovascular Drive in Human HypertensionHypertension, 2009
- Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureHypertension, 2003
- Sympathetic modulation of renal hemodynamics, renin release and sodium excretionJournal of Molecular Medicine, 1989
- Assessment of human sympathetic nervous system activity from measurements of norepinephrine turnover.Hypertension, 1988
- Effect of renal sympathetic nerve stimulation on proximal water and sodium reabsorption.JCI Insight, 1976