Abstract
Background
Renal denervation (RDN) has been proposed as a novel antihypertensive intervention for treating resistant hypertension. It remains to be investigated which patient groups can potentially benefit from RDN. The present study aimed to evaluate the efficacy and safety of RDN in patients with mild–moderate resistant hypertension, i. e., systolic office blood pressure (BP) of 140–160 mm Hg despite treatment with three antihypertensive drugs including one diuretic, or mean systolic BP by ambulatory BP monitoring (ABPM) of 135–150 mm Hg.
Methods
We evaluated data from four relevant clinical studies, all conducted in Europe, comprising 185 eligible patients. The patients’ age was 62.1 ± 10.3 years and 73% were male (RDN group n = 149, control group n = 36).
Results
A self-control comparison showed that RDN led to significantly reduced ABPM at the 6‑month follow-up (systolic ABPM: 147.3 ± 13.4 mm Hg vs. 136.9 ± 15.5 mm Hg; diastolic ABPM: 81.1 ± 9.6 mm Hg vs. 76.2 ± 9.7 mm Hg; p < 0.001). RDN was associated with a greater improvement in ABPM as compared with that in the control group (∆systolic-ABPM: −10.4 ± 9.4 vs. −3.5 ± 9.6 mm Hg, p < 0.001; ∆diastolic-ABPM: −5 ± 5.8 vs. −2.1 ± 5.5 mm Hg; p = 0.005, respectively). The decrease of office BP in the RDN group was also statistically significant. RDN led to a reduced number of antihypertensive medications. No severe adverse events were found during follow-up. Regression analysis showed that the available baseline characteristics did not correlate with the ABPM improvement after RDN.
Conclusion
RDN appears to be a safe and effective intervention for patients with mild–moderate resistant hypertension; however, randomized studies are warranted.
Zusammenfassung
Hintergrund
Die renale Denervierung (RDN) wurde als eine neuartige Intervention zur Behandlung der therapieresistenten Hypertonie vorgeschlagen. Es muss noch untersucht werden, welche Patientengruppen von der RDN möglicherweise einen Nutzen haben. Die vorliegende Studie hatte zum Ziel, die Wirksamkeit und Sicherheit der RDN bei Patienten mit leicht- bis mittelgradiger therapieresistenter Hypertonie zu untersuchen, d. h. bei Vorliegen eines systolischen Blutdrucks in der Praxis von 140–160 mm Hg trotz Behandlung mit 3 Antihypertensiva einschließlich eines Diuretikums oder bei einem durchschnittlichen systolischen Blutdruck im Rahmen der ambulanten Blutdruckmessung („ambulatory BP monitoring“, ABPM) von 135–150 mm Hg.
Methoden
Die Autoren werteten die Daten von 4 relevanten klinischen Studien aus, die alle in Europa durchführt worden waren und 185 entsprechende Patienten umfassten. Das Alter der Patienten betrug 62,1 ± 10,3 Jahre, 73 % waren Männer (RDN-Gruppe: n = 149, Kontrollgruppe: n = 36).
Ergebnisse
Ein Vergleich im Rahmen einer Eigenkontrolle zeigte, dass die RDN zu einem signifikant verminderten ABPM bei der Nachuntersuchung nach 6 Monaten führte (systolischer ABPM: 147,3 ± 13,4 mm Hg vs. 136,9 ± 15,5 mm Hg; diastolischer ABPM: 81,1 ± 9,6 mm Hg vs. 76,2 ± 9,7 mm Hg; p < 0,001). Die RDN war gegenüber der Kontrollgruppe mit einer stärkeren Verbesserung beim ABPM assoziiert (∆systolischer ABPM: −10,4 ± 9,4 vs. −3,5 ± 9,6 mm Hg; p < 0,001; ∆diastolischer ABPM: −5 ± 5,8 vs. −2,1 ± 5,5 mm Hg; p = 0,005). Die Reduktion des Blutdrucks in der Praxis in der RDN-Gruppe war ebenfalls statistisch signifikant. Die RDN führte zu einer geringeren Anzahl notwendiger Antihypertensiva. Es wurden während der Nachbeobachtung keine unerwünschten Ereignisse festgestellt. Die Regressionsanalyse ergab, dass die verfügbaren Ausgangsmerkmale nicht mit der Verbesserung des ABPM nach RDN korreliert waren.
Schlussfolgerung
Die RDN scheint eine sichere und wirksame Maßnahme für Patienten mit leicht- bis mittelgradiger therapieresistenter Hypertonie zu sein, allerdings sind hier noch randomisierte Studien notwendig.
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Acknowledgement
We thank all the participants in this study. Dr. S Chen receives the Fellowship Awards from European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC).
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S. Chen, M.G. Kiuchi, B. Schmidt, N.A. Hoye, W.-J. Acou, S. Liu, K.R. J. Chun, and H. Pürerfellner declare that they have no competing interests.
This article does not contain any studies with human participants or animals performed by any of the authors.
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Chen, S., Kiuchi, M.G., Schmidt, B. et al. Renal denervation for mild–moderate treatment-resistant hypertension. Herz 44, 412–418 (2019). https://doi.org/10.1007/s00059-017-4664-0
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DOI: https://doi.org/10.1007/s00059-017-4664-0