A NOVEL HYPERTENSION TREATMENT 

Circulation. 2012 Dec 18;126(25):2976-2982.

Renal Sympathetic Denervation for Treatment of Drug-Resistant Hypertension: One-Year Results From the Symplicity HTN-2 Randomized, Controlled Trial.

Esler MD, Krum H, Schlaich M, Schmieder RE, Böhm M, Sobotka PA; for the Symplicity HTN-2 Investigators.

Source

MBBS, FRACP, Baker IDI Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia. Murray.Esler@bakeridi.edu.au.

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; P<0 -23.7="-23.7" -25.0="-25.0" -38.3="-38.3" .001=".001" 166.3="166.3" 190.0="190.0" 1="1" 6-month="6-month" 6="6" 95="95" adjustment.="adjustment." after="after" and="and" artery="artery" before="before" blood="blood" by="by" catheter="catheter" change="change" confidence="confidence" corrected="corrected" crossover="crossover" denervation="denervation" dissection="dissection" during="during" episode="episode" fall="fall" from="from" group="group" guide="guide" hg="hg" hypotensive="hypotensive" in="in" insertion="insertion" interval="interval" lowered="lowered" mean="mean" medication="medication" mm="mm" months="months" of="of" p="p" pressure="pressure" procedure="procedure" renal="renal" resolved="resolved" significantly="significantly" similar="similar" stenting="stenting" systolic="systolic" the="the" there="there" to="to" versus="versus" was="was" which="which" with="with">

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