Renal denervation predicted to reduce CV events across age groups

Issue: July 2013

A model-based calculation indicates that catheter-based renal denervation can be expected to provide meaningful reductions in CV events in patients with resistant hypertension across age groups and pre-treatment BP levels, according to data presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.

Perspective from Barry M. Cohen, MD

“Pretty much across the board there are clinically meaningful reductions that we project both in terms of absolute and relative reductions of clinical events in all three age groups [studied],” study researcher Jan B. Pietzsch, PhD, CEO of Wing Tech Inc. and a consulting associate professor at Stanford University, said in a press release.

Pietzsch and researchers of the analysis used a recently published lifetime Markov simulation model based on Framingham and other multivariate risk equations coupled with mortality data to calculate CV events during 10 years in hypothetical resistant hypertensive subgroups. The subgroups were aged 40, 55 and 70 years, had pretreatment systolic BPs of 165 mm Hg and 190 mm Hg, and treated with renal denervation or not.

Jan B. Pietzsch

Pietzsch and colleagues based cohort characteristics and clinical input parameters on the Symplicity HTN-2 randomized controlled trial and on input data from the National Health and Nutrition Examination Survey. They computed absolute event and RR reductions for each of the six modeled cohorts.

Estimates showed that renal denervation was expected to reduce pretreatment systolic BP from 165 mm Hg to 135 mm Hg and from 190 mm Hg to 150 mm Hg at 10 years.

Additional benefits of the therapy included 10-year RR reductions in the following: MI (–26.1% at age 70/165 mm Hg to –41.8% at age 40/190 mm Hg); stroke (–25.7% at age 70/190 mm Hg to –38.8% at age 40/165 mm Hg); HF (–19.7% at age 70/165 mm Hg to –26.4% at age 55/190 mm Hg); and end-stage renal disease (–28.3% at age 70/165 mm Hg to –35.0% at age 40/190 mm Hg).

For all clinical events, 10-year absolute reduction increased with age, whereas RRs followed an opposite trend, with RR reductions highest in those aged 40 years and lowest in those aged 70 years.

For more information:

Pietzsch JB. Poster B-026. Presented at: the Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 8-11, 2013; Orlando, Fla.

Disclosure: Pietzsch reports a financial relationship with Medtronic.

Perspective

Barry M. Cohen, MD

Dr. Pietzsch presented data on a model-based calculation on CV risk reduction in patients with resistant hypertension treated with renal denervation. Ten-year relative risk reduction is projected to reduce MI, stroke, HF and progression to end-stage renal disease in younger patients (aged 40 years) and seniors (age 70 years). While younger patients had the highest projected relative risk reduction, it is encouraging to know that seniors can also derive significant benefit. We believe that patients with resistant hypertension, many of whom are asymptomatic, should be aware of this new therapy. It is still in clinical trials in the United States but available in Europe where a lot of the initial research was performed.

Barry M. Cohen, MD

Medical Director, Cardiac Catheterization Lab

Morristown Medical Center, Morristown, N.J.

Disclosures: Cohen reports no relevant financial disclosures.