Renal denervation in therapy-resistant hypertension

RENAL denervation leads to significant and sustained blood pressure reduction for up to 18 months in patients with treatment resistant hypertension, or blood pressure that remains persistently high despite at least three prescription blood pressure medications, including a diuretic. This condition puts approximately 120 million people worldwide at risk of premature death from kidney disease and cardiovascular events such as stroke, heart attack and heart failure¹.

Clinical data from the Symplicity HTN-2 randomised clinical trial presented by principal investigator Dr Murray Esler presented at ESC Congress 2012 in August, indicates that renal denervation can be used to manage severe hypertension.

Renal denervation is a minimally invasive procedure which disrupts both afferent and efferent nerves leading into and out of the kidneys. It uses radio frequency energy emitted by a catheter device inserted into the renal arteries through the groin to treat patients resistant to drug therapy.

“Treatment resistant hypertension is one of the most challenging forms of hypertension to manage because it does not respond to blood pressure lowering drugs,” said Dr Esler, associate director of the Baker IDI Heart and Diabetes Institute of Melbourne, Australia.

The Symplicity HTN-2 trial is an international, multi-centre, prospective, randomised, controlled study of the safety and effectiveness of renal denervation with the catheter-based Symplicity² renal denervation system in patients with treatment resistant hypertension. Patients with treatment resistant hypertension were randomised in a one-to-one ratio to receive renal denervation plus antihypertensive medications or antihypertensive medications alone (control group) at 24 centres in 11 countries.

At baseline, the treatment (n=49 patients) and control (n=52 patients) groups had similar high blood pressures: 178/97 mmHg and 178/98 mmHg, respectively, despite both receiving an average daily regimen of five antihypertensive medications.

Patients in the control arm of the study were offered renal denervation following assessment of blood pressure, which was the trial’s primary endpoint, at 6 months post-randomisation. Thirty-five patients from the control group with sNIKE AIR HUARACHE