Renal denervation ( RDN ) with radiofrequency ablation substantially reduces blood pressure in patients with treatment-resistant hypertension.
Researchers have assessed the long-term antihypertensive effects and safety.
Symplicity HTN-1 is an open-label study that enrolled 153 patients, of whom 111 consented to follow-up for 36 months. Eligible patients had a systolic blood pressure of at least 160 mm Hg and were taking at least three antihypertensive drugs, including a diuretic, at the optimum doses. Changes in office systolic blood pressure and safety were assessed every 6 months and reported every 12 months.
88 patients had complete data at 36 months. At baseline the mean age was 57 years, 37 ( 42% ) patients were women, 25 ( 28% ) had type 2 diabetes mellitus, the mean estimated glomerular filtration rate was 85 mL/min per 1.73 m2, and mean blood pressure was 175/98 mm Hg.
At 36 months significant changes were seen in systolic ( -32.0 mm Hg ) and diastolic blood pressure ( -14.4 mm Hg, -16.9 to -11.9 ).
Drops of 10 mm Hg or more in systolic blood pressure were seen in 69% of patients at 1 month, 81% at 6 months, 85% at 12 months, 83% at 24 months, and 93% at 36 months.
One new renal artery stenosis requiring stenting and three deaths unrelated to renal denervation occurred during follow-up.
In conclusion, changes in blood pressure after renal denervation persist long term in patients with treatment-resistant hypertension, with good safety. ( Xagena )
Krum H et al, The Lancet 2014; 622-629