Renal Denervation For Resistant Hypertension Research Articles

Ultra-long-term efficacy and safety of catheter-based renal denervation in resistant hypertension: 10-year follow-up outcomes.

Randomized sham-controlled trials have confirmed the efficacy and safety of catheter-based renal denervation in hypertension. Data on the very long-term effects of renal denervation are scarce. This study evaluates the 10-year safety and efficacy of renal denervation in resistant hypertension. This prospective single-center study included patients with resistant hypertension undergoing radio-frequency renal denervation between 2010 and 2012. Office blood pressure, 24-h ambulatory blood pressure, antihypertensive medication, color duplex sonography, and renal function were assessed after 1-, 2- and 10-years. Thirty-nine patients completed the 10-year follow-up (mean follow-up duration 9.4 ± 0.7years). Baseline office and 24-h ambulatory systolic blood pressure were 164 ± 23mmHg and 153 ± 16mmHg, respectively. After 10years, 24-h ambulatory and office systolic blood pressure were reduced by 16 ± 17mmHg (P < 0.001) and 14 ± 23mmHg (P = 0.001), respectively. The number of antihypertensive drugs remained unchanged from 4.9 ± 1.4 to 4.5 ± 1.2 drugs (P = 0.087). The estimated glomerular filtration rate declined within the expected range from 69 (95% CI 63 to 74) to 60mL/min/1.73m2 (95% CI 53 to 68; P < 0.001) through 10-year follow-up. Three renal artery interventions were documented for progression of pre-existing renal artery stenosis in two patients and one patient with new-onset renal artery stenosis. No other adverse events were observed during the follow-up. Renal denervation was safe and sustainedly reduced ambulatory and office blood pressure out to 10years in patients with resistant hypertension.

Abstract 13660: Endovascular Ultrasound Renal Denervation for Resistant Hypertension: A Systematic Review and Meta-Analysis of Randomized Sham-Controlled Trials

Background: Radiofrequency renal denervation (RDN) is used as a treatment for resistant hypertension, although its efficacy is still under evaluation. Similarly, ultrasound RDN, a less invasive technique, has yielded inconsistent results in this population. Hypothesis: Ultrasound RDN may lower blood pressure in patients with resistant hypertension. Aims: To compare the efficacy of ultrasound RDN versus a sham procedure in treating resistant hypertension. Methods: We systematically searched PubMed, Cochrane Library, and Embase in May 2023 to include randomized sham-controlled trials assessing the efficacy of ultrasound RDN. Statistical analyses were performed using Review Manager 5.4.1 using generic inverse variance weighting to pool mean ± standard deviation and least square mean ± standard error. Results: We included three studies comprising 323 patients with resistant hypertension on ≥ three antihypertensive medications, of whom 51.7% were randomized to RDN. Follow-up at analysis ranged from 8 to 24 weeks. There were no significant differences between groups in terms of change from baseline in 24-hour ambulatory systolic blood pressure (SBP; MD -2.15 mmHg; 95% -5.07, 0.76; p=0.15; Fig. 1A), 24-hour ambulatory diastolic blood pressure (DBP; MD -1.19 mmHg; 95% CI -2.91, 0.53; p=0.18; Fig. 1B) or office SBP (MD -1.71 mmHg; 95% CI -9.62, 6.20; p=0.67; Fig. 1C). Conclusion: In this meta-analysis, ultrasound RDN did not significantly reduce blood pressure in patients with resistant hypertension as compared with a sham procedure.

TCT-210 Long-Term Safety and Efficacy of Endovascular Ultrasound Renal Denervation in Resistant Hypertension: 8-Year Results From the ACHIEVE Study

TCT-210 Long-Term Safety and Efficacy of Endovascular Ultrasound Renal Denervation in Resistant Hypertension: 8-Year Results From the ACHIEVE Study

Anatomic Variations of Renal Arteries as an Important Factor in the Effectiveness of Renal Denervation in Resistant Hypertension.

Hypertension remains the leading cause of death worldwide. Despite advances in drug-based treatment, many patients do not achieve target blood pressure. In recent years, there has been an increased interest in invasive hypertension treatment methods. Long-term effects and factors affecting renal denervation effectiveness are still under investigation. Some investigators found that the renal arteries' morphology is crucial in renal denervation effectiveness. Accessory renal arteries occur in 20-30% of the population and even more frequently in patients with resistant hypertension. Diversity in renal vascularization and innervation may complicate the renal denervation procedure and increase the number of people who will not benefit from treatment. Based on previous studies, it has been shown that the presence of accessory renal arteries, and in particular, the lack of their complete denervation, reduces the procedure's effectiveness. The following review presents the anatomical assessment of the renal arteries, emphasizing the importance of imaging tests. Examples of imaging and denervation methods to optimize the procedure are presented. The development of new-generation catheters and the advancement in knowledge of renal arteries anatomy may improve the effectiveness of treatment and reduce the number of patients who do not respond to treatment.

MRI in the assessment of cerebral injury and cerebroprotective effects of renal denervation in resistant hypertension

The purpose of this single-centre, prospective, comparative study was to evaluate the pattern and severity of the brain structural changes in patients with resistant hypertension based on MRI assessments and their changes one year after renal denervation.Material and Methods. The study comprised 53 patients with resistant hypertension (RH), aged 52.1 ± 9.1 years, who underwent renal denervation (RDN) following the Good Clinical Practice guidelines. Patients underwent office blood pressure measurements, 24-hour blood pressure monitoring (BPM), and brain MRI scanning. Using brain MRI, the cerebrospinal fluid (CSF) system measurements, the presence and severity of periventricular white matter lesion and focal changes in the brain white matter were evaluated.Results. Initially, patients with RH had a high incidence of the structural brain alterations: 43 (81%) patients with fine focal brain lesions, 43 (81%) patients with enlarged CSF spaces, and 48 (90%) patients with periventricular white matter lesions. After renal denervation, a significant hypotensive effect was noted. According to brain MRI, the number of patients without enlarged CSF spaces did not change significantly: 15 (25%) patients initially, and 12 (20%) patients a year later (χ2 = 0.63, р = 0.43 и χ2 = 0.72, р = 0.40). The incidence of periventricular white matter lesion did not significantly change one year after RDN; however, the incidence of fine focal brain lesions significantly decreased in 21 patients (81% to 60%, p = 0.02).Conclusion. Thus, it has been revealed that patients with resistant hypertension are characterised by a high incidence of structural brain alterations based on MRI assessments. Bilateral renal denervation is followed by a significant decrease in the incidence of fine focal brain lesions, without a significant change in the cerebrospinal fluid volume one year after the procedure.

Efficacy and safety of renal denervation in resistant hypertension: two years follow-up

Hypertension remains a major cause of cardiovascular morbidity and mortality globally. Difficulties faced by clinicians to obtain adequate blood pressure control in patients with resistant hypertension have led to the development of alternative device-based treatment methods, one of which is renal artery denervation. In the current paper, the results of the study carried out in the Hypertension Department of the Institute of Cardiology regarding the evaluation of the effectiveness and safety of renal artery denervation in patients with resistant HTN two years post-procedural are presented.

Renal denervation for resistant hypertension and heart failure with a reduced ejection fraction

Hypertension is a risk factor for the development of heart failure and has a negative impact on the survival of these patients. Although patients with these two conditions usually take different antihypertensive medications, some patients do not achieve adequate blood pressure control and their hypertension becomes resistant or refractory. In this scenario, percutaneous renal denervation has emerged in recent years as an alternative to achieve blood pressure control goals. We present the case of a 53-year-old woman with a medical history of essential hypertension, hypercholesterolemia, unipolar depression, and diabetes, who was diagnosed with dilated cardiomyopathy with reduced left ventricular ejection fraction (33%). Despite the initiation of multiple antihypertensive medications and placement of a cardiac resynchronization therapy pacemaker, the patient remained hypertensive with a left ventricular ejection fraction of 40%. At that time, percutaneous renal denervation was performed without complications, and one year after the procedure, the patient had improved better blood pressure control and the left ventricular ejection fraction increased to 51%. This case illustrates one of the clinical scenarios in which it has been suggested that renal denervation may be more beneficial, as in the situation of patients with refractory hypertension and heart failure.

Abstract 11428: A Comparison Between Endothelin Receptor Antagonists and Renal Denervation for Resistant Hypertension: A Systematic Review and Meta-Analysis of Sham and Placebo Controlled Trials

Introduction: Endothelin-1 causes vasoconstriction by activation of calcium flux in smooth muscle cells. Use of endothelin receptor antagonists (ERAs) has remained controversial. Renal denervation (RD) has also been investigated as a treatment option for resistant hypertension (RHTN). The efficacy of these two novel treatment strategies was compared. Methods: Placebo-controlled and sham-controlled randomized clinical trials testing ERA or RD as treatments for RHTN were selected. Prespecified subgroup analyses comparing the efficacy of ERA and RD were conducted for outcomes of 24-hour (hr) blood pressure (BP) and office BP. Results: Nine studies (3 ERA and 6 RD) were identified that included 1,708 participants (816 ERA and 892 RD). Cochran risk of bias assessment showed 72% of the domains to be low risk of bias for the ERA studies and 88% of the domains to be low risk of bias for the RD studies. The raw mean difference (RMD) between ERA and placebo control was statistically significant for 24-hr systolic (SBP) (-8.34 mmHg; 95% CI -11.51 to -5.81, 24-hr diastolic (DBP) (-6.77 mmHg; 95% CI -8.90 to -4.63), office SBP (-4.50 mmHg; 95% CI -6.92 to -2.08), and office DBP (-2.01 mmHg; 95% CI -2.13 to -1.88). The RMD between RD and sham control was not statistically significant for 24-hr SBP (-1.85 mmHg; 95% CI -3.88 to 0.18), 24-hr DBP (-0.67 mmHg; 95% CI -1.84 to 0.51), office SBP (-1.93 mmHg; 95% CI -5.17 to 1.31), and office DBP (-1.55 mmHg; 95% CI -3.43 to 0.33). The interaction between the treatment subgroups was statistically significant for 24-hr SBP and DBP, but not for office SBP and DBP. Discussion: ERAs had greater reduction in 24-hr and office BP compared to RD among patients with RHTN. Despite efficacy in reducing BP in RHTN, use of ERAs remains controversial given the cost and side effect profile. RD does not reduce BP among patients with RHTN. Medications are the optimal treatment for RHTN and sham controlled data showing efficacy is needed prior to widespread use and adoption of RD in RHTN.

Long-term antihypertensive effect of renal denervation in resistant hypertension: three years follow-up

Abstract Background Recent studies have shown proven efficacy of renal denervation in arterial hypertension, but there is a continuing need to assess the duration of antihypertensive effect. Purpose Evaluation of the long-term antihypertensive effect of renal denervation in patients with resistant hypertension. Methods 125 apparently resistant patients without comorbidities after a 3-week standardized treatment with Losartan 100 mg, Amlodipin 10 mg and Indapamid 1.5 mg and confirmation of their resistance were randomly assigned into three groups depending on treatment supplemented to previously administered: group I - selective I1-imidazoline agonist Moxonidine, group II - cardioselective beta-blocker Bisoprolol and group III – renal artery denervation. The compliance to treatment was confirmed using 8-item Morisky Medication Adherence Scale. Renal denervation was performed in the main renal arteries and their branches. Patients were assessed by ambulatory blood pressure monitoring at baseline, 3, 12, 24 and 36 months follow-up. Results The mean 24 hour systolic blood pressure (SBP) at baseline were 179.0±2.02 mmHg in group I versus 177.96±2.44 mmHg in group II and 176.92±1.97 mmHg in group III, p&amp;gt;0.05. A statistically significant reduction in SBP m/24 h was noted in all three groups starting at 3 months, the group of patients undergoing renal denervation showing superiority over both groups of pharmacological treatment: −6.48±0.81 mmHg in group I versus −6.2±0.88 mmHg in group II and −23.28±1.9 mmHg in group III, p&amp;lt;0.001. The progressive improvement continued until the end of the study, so at 3 years of evaluation in observational group supplemented with Moxonidine SBP m/24 h were 146.36±1.36 mmHg with a total reduction of −32.64±1.56 mmHg from baseline, in Bisoprolol group −152.88±1.56 mmHg with a reduction of −25.08±1.65 mmHg and 133.16±0.73 mmHg in renal denervation group with a total reduction of −282±1.30 mmHg in group III, p&amp;lt;0.001. The mean 24 hour diastolic blood pressure (DBP) increased at baseline in all three observational groups (105.52±1.28 mmHg in group I versus 108.6±1.6 mmHg in group II and 107.24±0.92 mmHg in group III, p&amp;gt;0.05) similar with SBP m/24 h noted an authentic reduction at 3 months follow-up. The maximum reduction in DBP m/24 h were registered at 3 years of evaluation, a comparative analyses of dynamics between groups showing a presence of statistical difference due to superiority of renal denervation in amelioration of this parameter: −18.36±1.88 mmHg in group I versus −16.84±1.76 mmHg in group II and −28.2±1.30 mmHg in group III, p&amp;lt;0.001. Conclusions All three regimens have been shown to be effective in reducing SBP and DBP m/24 h in patients with resistant hypertension, with a superior but comparable effect of Moxonidine to Bisoprolol and the absolute superiority of renal denervation treatment, the beneficial effect being maintained for a period of 3 years. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Agency for Research and Development

SYMPLICITY HTN-3: failure at 6 months, success at 3 years?

In The Lancet, Deepak L Bhatt and colleagues report long-term outcomes of renal artery denervation in patients denervated by single-electrode radiofrequency within the SYMPLICITY HTN-3 study. 1 Bhatt DL Vaduganathan M Kandzari DE et al. Long-term outcomes after catheter-based renal artery denervation for resistant hypertension: final follow-up of the randomised SYMPLICITY HTN-3 Trial. Lancet. 2022; (published online Sept 18.)https://doi.org/10.1016/S0140-6736(22)01787-1 Summary Full Text Full Text PDF Scopus (2) Google Scholar This large sham-controlled trial recruited 535 patients (210 [39%] women and 325 [61%] men; mean age in renal denervation group 57·9 years [SD 10·4]) with treatment-resistant hypertension enrolled in 88 centres in the USA. The trial was expected to provide definitive evidence of the efficacy of renal denervation in patients with treatment-resistant hypertension but did not meet its primary 6-month efficacy endpoint, 2 Bhatt DL Kandzari DE O'Neill WW et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014; 370: 1393-1401 Crossref PubMed Scopus (1592) Google Scholar raising an unprecedented wave of scepticism about renal denervation. 3 Persu A Jin Y Fadl Elmula FE Jacobs L Renkin J Kjeldsen S Renal denervation after Symplicity HTN-3: an update. Curr Hypertens Rep. 2014; 16: 460 Crossref PubMed Scopus (29) Google Scholar Long-term outcomes after catheter-based renal artery denervation for resistant hypertension: final follow-up of the randomised SYMPLICITY HTN-3 TrialThis final report of the SYMPLICITY HTN-3 trial adds to the totality of evidence supporting the safety of renal artery denervation to 36 months after the procedure. From 12 months to 36 months after the procedure, patients who were originally randomly assigned to receive renal artery denervation had larger reductions in blood pressure and better blood pressure control compared with patients who received sham control. Full-Text PDF

Renal Denervation for Resistant Hypertension: A Concise Update on Treatment Options and the Latest Clinical Evidence.

Evidence from recent sham-controlled trials supports the use of endovascular renal denervation (RDN) to lower blood pressure in general as well as in treatment-resistant hypertension. According to recent studies, the effects of RDN are long lasting. Newer technologies using multipolar radiofrequency catheters and an additional ablation of the renal side branches as well as ultrasound with improved circumferential tissue penetration have made these advances possible. This has initiated a change of the perspective on RDN in clinical guidelines and has thereby set a cornerstone for a broader clinical application of RDN in the future.

Renal denervation in resistant hypertension: a review of clinical trials and future perspectives.

A previous report using the National Health and Nutrition Examination Survey demonstrated an increase in the prevalence of resistant hypertension, which does not respond to traditional therapy and medication. Studies using various animal hypertensive models have demonstrated significant blood pressure (BP) reduction following renal artery denervation (RDN). Catheter-based RDN became available in clinical trials as a possible treatment option for resistant hypertension. Although first clinical trials of RDN have demonstrated the efficacy and safety of this treatment mortality for lowering BP in patients with resistant hypertension, the role of RDN has been questioned since the results of the Symplicity HTN-3 trial. Considering the ethnic differences demonstrated in the Symplicity HTN-Japan and Global Symplicity registry, by contrast, RDN might be an effective for resistant hypertension in Asian population. Here, we discuss RDN applications and technology, the old and new clinical evidence of RDN, patients' selection of RDN responder, and optimization of RDN procedure in this review. The available evidence demonstrates that RDN could be effective in carefully selected patients with resistant hypertension, paving the way for future research in this area.

Renal denervation for resistant hypertension.

Resistant hypertension is highly prevalent among the general hypertensive population and the clinical management of this condition remains problematic. Different approaches, including a more intensified antihypertensive therapy, lifestyle modifications or both, have largely failed to improve patients' outcomes and to reduce cardiovascular and renal risk. As renal sympathetic hyperactivity is a major driver of resistant hypertension, in the last decade renal sympathetic ablation (renal denervation) has been proposed as a possible therapeutic alternative to treat this condition. We sought to evaluate the short- and long-term effects of renal denervation in individuals with resistant hypertension on clinical end points, including fatal and non-fatal cardiovascular events, all-cause mortality, hospital admissions, quality of life, blood pressure control, left ventricular hypertrophy, cardiovascular and metabolic profile and kidney function, as well as the potential adverse events related to the procedure. For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to3 November 2020: Cochrane Hypertension's Specialised Register, CENTRAL (2020, Issue 11), Ovid MEDLINE, and Ovid Embase. The World Health Organization International Clinical Trials Registry Platform (via CENTRAL) and the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov were searched for ongoing trials. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. We considered randomised controlled trials (RCTs) that compared renal denervation to standard therapy or sham procedure to treat resistant hypertension, without language restriction. Two authors independently extracted data and assessed study risk of bias. We summarised treatment effects on available clinical outcomes and adverse events using random-effects meta-analyses. We assessed heterogeneity in estimated treatment effects using Chi² and I² statistics. We calculated summary treatment estimates as a mean difference (MD) or standardised mean difference (SMD) for continuous outcomes, and a risk ratio (RR) for dichotomous outcomes, together with their 95% confidence intervals (CI). Certainty of evidence has been assessed using the GRADE approach. We found 15 eligible studies (1416 participants). In four studies, renal denervation was compared to sham procedure; in the remaining studies, renal denervation was tested against standard or intensified antihypertensive therapy. Most studies had unclear or high risk of bias for allocation concealment and blinding. When compared to control, there was low-certainty evidence that renal denervation had little or no effect on the risk of myocardial infarction (4 studies, 742 participants; RR 1.31, 95% CI 0.45 to 3.84), ischaemic stroke (5 studies, 892 participants; RR 0.98, 95% CI 0.33 to 2.95), unstable angina (3 studies, 270 participants; RR 0.51, 95% CI 0.09 to 2.89) or hospitalisation (3 studies, 743 participants; RR 1.24, 95% CI 0.50 to 3.11). Based on moderate-certainty evidence, renal denervation may reduce 24-hour ambulatory blood pressure monitoring (ABPM) systolic BP (9 studies, 1045 participants; MD -5.29 mmHg, 95% CI -10.46 to -0.13), ABPM diastolic BP (8 studies, 1004 participants; MD -3.75 mmHg, 95% CI -7.10 to -0.39) and office diastolic BP (8 studies, 1049 participants; MD -4.61 mmHg, 95% CI -8.23 to -0.99). Conversely, this procedure had little or no effect on office systolic BP (10 studies, 1090 participants; MD -5.92 mmHg, 95% CI -12.94 to 1.10). Moderate-certaintyevidence suggested that renal denervation may not reduce serum creatinine (5 studies, 721participants, MD 0.03 mg/dL, 95% CI -0.06 to 0.13) and may not increase the estimated glomerular filtration rate (eGFR) or creatinine clearance (6 studies, 822 participants; MD -2.56 mL/min, 95% CI -7.53to 2.42). AUTHORS' CONCLUSIONS: In patients with resistant hypertension, there is low-certainty evidence that renal denervation does not improve major cardiovascular outomes and renal function. Conversely, moderate-certainty evidence exists that it may improve 24h ABPM and diastolic office-measured BP. Future trials measuring patient-centred instead of surrogate outcomes, with longer follow-up periods, larger sample size and more standardised procedural methods are necessary to clarify the utility of this procedure in this population.

Abstract 9910: Effect of Renal Denervation in Resistant Hypertension: A Meta-Analysis of Randomized Controlled Trials

Introduction: Resistant hypertension is defined as blood pressure that remains ≥ 140/90 mm Hg despite adherence to at least three maximally tolerated doses of antihypertensive medications, including a diuretic. Catheter based renal denervation has been studied as one of the interventions for blood pressure control in such patients. Data comparing renal denervation versus sham procedure have shown disparate results. This meta-analysis summarizes the current evidence on the effect of sham controlled renal denervation on the treatment of resistant hypertension. Methods: Embase, Pubmed and Cochrane Central databases were searched from inception until May 30, 2021. RCTs comparing catheter based renal denervation with a sham control were included. Outcomes assessed were change in 24h ambulatory systolic blood pressure, change in 24h ambulatory diastolic blood pressure, change in office systolic blood pressure, and change in office diastolic blood pressure. Weighted mean differences (WMD) were calculated and pooled into a random effects model meta-analysis. Results: Seven studies with 1,264 participants were included in the analysis. Catheter based renal denervation was associated with significant decrease in ambulatory systolic blood pressure (WMD: -3.76; 95% CI: -2.44 to -5.09, p value &lt;.00001) and ambulatory diastolic blood pressure (WMD: -1.78; 95% CI: -0.84 to -2.72, p value=0.0002) compared with sham. The reduction in office systolic and office diastolic blood pressure was also significantly greater with catheter renal denervation than sham control (WMD: -5.95; 95% CI: -3.93 to -7.97; p value&lt;0.00001 and WMD: -3.54; 95% CI: -2.35 to -4.72; p value&lt;0.00001). Conclusions: There was significant benefit of renal denervation for resistant hypertension for all the studied outcomes. Based on this data, compliant patients with resistant hypertension who are maxed on lifestyle and pharmacological management may benefit from catheter based renal denervation.

Comparison of Long-Term Outcomes for Responders Versus Non-Responders Following Renal Denervation in Resistant Hypertension.

BackgroundRecent trial results support the efficacy of renal sympathetic denervation in lowering blood pressure (BP). While BP reduction in general is associated with a clinically meaningful reduction in cardiovascular events and mortality, such a relationship has not been described for patients undergoing renal sympathetic denervation.Methods and ResultsClinical events were assessed in patients who underwent renal sympathetic denervation at our center using telephone‐ and clinical follow‐up, interviews with general practitioners, as well as review of hospital databases. Event rates were compared between BP responders (≥5 mm Hg 24‐hour ambulatory BP reduction) and non‐responders; 296 patients were included. Compared with baseline, 24‐hour systolic ambulatory BP was reduced by 8.3±12.2 mm Hg and diastolic BP by 4.8±7.0 mm Hg (P<0.001 for both) after 3 months. One hundred eighty patients were classified as BP responders and 116 as non‐responders. During a median follow‐up time of 48 months, significantly less major adverse cardiovascular events (cardiovascular death, stroke, myocardial infarction, critical limb ischemia, renal failure) occurred in responders than in non‐responders (22 versus 23 events, hazard ratio [HR], 0.53 [95% CI, 0.28 to 0.97], P=0.041). This was consistent after adjustment for potential confounders as well as confirmed by propensity‐score matching. A proportional relationship was found between BP reduction after 3 months and frequency of major adverse cardiovascular events (HR, 0.75 [95% CI, 0.58 to 0.97] per 10 mm Hg 24‐hour systolic ambulatory BP reduction).ConclusionsBased on these observational data, blood pressure response to renal sympathetic denervation is associated with improved long‐term clinical outcome.

Resurgence of renal denervation for resistant hypertension.

Endovascular, ultrasound-based renal sympathetic denervation reduces blood pressure in patients with drug-resistant hypertension, according to data from the RADIANCE-HTN TRIO trial.

Renal Denervation for Resistant Hypertension: Time to Improve Patient Selection. The Lesson From ADPKD

Renal Denervation for Resistant Hypertension: Time to Improve Patient Selection. The Lesson From ADPKD

Renal Denervation for Resistant Hypertension: Where Do We Stand?

To review the data about the use of renal denervation (RDN), a minimally invasive surgery, for resistant hypertension (RH) and to provide practical guidance for practitioners who are establishing an RDN service. RDN can selectively ablate renal sympathetic nerve fibres, block the transmission of nerve impulses between central sympathetic nerve and kidney, to control blood pressure to as a novel promising non-drug treatment option for RH. At present, there are many researches on the treatment of RH by RDN, but there are some controversies. This review summarises and critically examines the evidence for RDN in the treatment of RH and identifies areas for future research. With the development of RDN, the continuous innovation of RDN technology and methods, the development about better evaluating the real-time success of RDN and the improvement for identifying individuals who are most likely to benefit from RDN will ultimately determine whether RDN represents a feasible way to manage RH in the future.

4-3RENAL DENERVATION FOR RESISTANT HYPERTENSION POST-SIMPLICITY-3 HTN TRIAL: META-ANALYSIS AND SYSTEMATIC REVIEW

Background: Following the result from SIMPLICITY-3 trial that failed to show the benefit of renal denervation over sham control, the interest on renal denervation had fallen into hibernation. However, there were some authors indicated that SIMPLICITY-3 trial result seemed to have major problems regarding incomplete denervation that led experts to researched and carefully designed studies regarding renal denervation. Since then, there was three carefully-designed, sham-controlled studies published about the issue. However, there was no published meta-analysis on randomized trials after SIMPLICITY-3 era. We aimed to conduct a meta-analysis of RCTs to determine the effect of renal denervation in resistant hypertension. Methods: A search on MEDLINE and EMBASE was conducted in January 2020. Randomized clinical studies comparing renal denervation and sham-controlled trial published after SIMPLICITY-3 trial were included for this meta-analysis. Study selection: only fully published RCT and abstracts of RCT comparing renal denervation and sham control for resistant hypertension published after SIMPLICITY-3 trial was included. Studies which were duplicated and non-randomized were excluded. Results: The analysis included 149 patients from 3 trials with a duration of follow up of 2–6 months. The reduction in 24-h ambulatory SBP was significantly greater in the renal denervation group compared to the sham procedure (WMD −4.74 mmHg, 95% CI −6.5, −2.99; p &lt; 0,001). There was also significant reduction in 24-h DBP (WMD −3.11 mmHg, 95% CI −3.98, −2.23; p &lt; 0,001), office SBP (WMD −7.1 mmHg, 95% CI −9.12, −5.08; p &lt; 0,001), and office DBP (WMD −4,63 mmHg, 95% CI −5.98, −3.28; p &lt; 0,001). Conclusion: Following SIMPLICITY-3 trial, there were positive results regarding renal denervation on resistant hypertension. Renal denervation significantly reduced blood pressure compared to sham control. Our meta-analysis underscores the importance of conducting new well-designed studies to confirm our observed results.

Activated double-negative T cells (CD3+CD4−CD8−HLA-DR+) define response to renal denervation for resistant hypertension

PurposeTo explore the cellular immune response of patients with resistant hypertension treated with renal denervation (RDN). Methods and resultsTwenty-three patients were included and blood samples were obtained in six timings, pre and post procedure. Response was evaluated at six-months and one year and was observed in 69.6% and 82.6% of patients, respectively. Absolute values of HLA-DR+ double negative (DN) T cells were significantly lower in the group of ‘responders’ at one year, and interaction between the timings were found in three T cell subsets (T CD4, T CD8 and naïve T CD8 cells), with the ‘responders’ tending to present with lower absolute values and little inter-timing variation. Conclusions‘Responders’ significantly present with lower absolute values of activated DN T cells and have lower and more stable values of total T CD8+, CD4+, and naïve T CD8+ cells. These cell types may be able to predict response to RDN.