Abstract
Aims: To retrospectively investigate the prevalence and characteristics of treatment-resistant hypertension (R-HT) among consecutive hypertensive outpatients, since patients with R-HT are candidates for catheter-based renal sympathetic denervation (RD). Methods: Consecutive hypertensive outpatients (n = 999) were recruited in our hospital. R-HT patients who were candidates for RD had clinic systolic blood pressure > 160 mmHg despite taking three or more antihypertensive drugs including at least one diuretics at higher than standard doses. Results: Our survey indicated that only 26 patients (2.6%) were potential candidates for renal denervation. Candidates for RD showed a significantly higher age (P < 0.005), brain natriuretic peptide level (P = 0.0001), urinary albumin/creatinine excretion ratio in spot urine (P < 0.005), pulse wave velocity (P < 0.01), left ventricular end-diastolic diameter (P < 0.005), and interventricular septal thickness (P < 0.005) than the other 973 patients. Candidates for denervation had a significantly lower hemoglobin (P = 0.0001), serum albumin (P < 0.001), eGFR (P < 0.0005), plasma renin activity (P = 0.0001), and plasma aldosterone level (P < 0.005) than other patients, while their urinary sodium/creatinine ratio was higher, indicating that patients with R-HT appeared to have a high salt intake. Conclusion: Our retrospective clinical survey indicated that only 0.5% of Japanese hypertensive outpatients (5/999 patients) were candidates for RD. Therefore, establishment of hypertension cohort network will be essential to recruit R-HT patients for RD.
Highlights
Development of better antihypertensive drugs during the last 40 years has led to marked improvement of outcomes and there is a trend for the mean blood pressure (BP) to decrease in Japan and worldwide
Several studies performed in Australia and Europe have demonstrated that catheter-based renal sympathetic denervation is effective for resistant hypertension (R-HT) [2]-[4], and this treatment will be investigated in Japan in near future
The urinary sodium (U-Na)/urinary creatinine (U-cre) ratio is a simple marker of salt intake used in clinical practice [8], and this ratio tended to be higher in our renal denervation group
Summary
Development of better antihypertensive drugs during the last 40 years has led to marked improvement of outcomes and there is a trend for the mean blood pressure (BP) to decrease in Japan and worldwide. Including people with high normal blood pressure, the so-called spare group of HT, the total number could be more than 60 million. Management of hypertension is essential for preventing cardiovascular disease both in people with hypertension and those with high normal blood pressure, as has been demonstrated by many clinical studies of antihypertensive drugs. It is sometimes very difficult to manage hypertension, which is known as treatment-resistant hypertension (R-HT), and there may be poor control of both ambulatory and home BP despite using 5 or 6 antihypertensive drugs. The blinded Symplicity HTN-3 trial did not show a significant decrease of BP after renal denervation compared with the sham control [5], and this result has led to controversy [6]
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