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Reductions in systolic BP linked with percutaneous ablation of renal sympathetic nerves
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Renal sympathetic denervation was associated with reductions in systolic BP in drug-resistant patients with hypertension and may be an alternative treatment for these patients, results from a pilot study suggested.
Researchers evaluated the safety and efficacy of percutaneous renal sympathetic denervation using an ablation catheter as a minimally invasive alternative to hypertensive drug therapy. According to Krishna Rocha-Singh, MD, patients resistant to drug therapy potentially have the most to gain from the technique.
“It is estimated that over 1 billion people have hypertension and that 10% of these patients have very little recourse and are deemed resistant,” Rocha-Singh, an interventional cardiologist at the Prairie Vascular Institute in Springfield, Ill., said. “The sympathetic nervous system, and in particular, the renal sympathetics, are important in the progression of hypertension in kidney disease and in HF.”
Researchers enrolled 20 patients with resistant hypertension, 15 of whom had qualifying anatomy. Patients were included if their systolic BP was >160 mm Hg and if they were assigned to at least three antihypertensive medications. The physicians delivered the Symplicity (Ardian) radiofrequency ablation catheter to four sites in the renal artery and applied radiofrequency ablation for about two minutes. Total procedure times were about 40 minutes.
One patient had progression of renal stenosis at late follow-up. The researchers reported significant reductions in systolic BP at one, three and six months and that 93% of patients assigned radiofrequency ablation were respondent. Systolic BP reductions were as high as 30 mm Hg. Rocha-Singh compared the results of the pilot study with those from a similarly designed study conducted in Europe and Australia, in which similar significant systolic BP reductions sustained out to one year were reported after renal sympathetic denervation with catheter ablation. No changes in renal function were reported in the patient population.
“This therapy will be one of those that may significantly change therapies for patients who heretofore had no options in the control of their BP,” Rocha-Singh concluded. “We realize how significant the sustained reduction in BP is in these patients with multiple–drug-resistant hypertension. We are looking forward to the initiation of a randomized, pivotal trial in the United States.”
For more information:
- Rocha-Singh K. Clinical trial data that may change your practice.