Renal denervation of accessory arteries may improve procedural efficacy

BARCELONA, Spain — Renal denervation was more successful at reducing BP in patients with resistant hypertension when the procedure included accessory renal arteries in addition to main renal arteries compared with just denervating the main arteries alone, data presented here concluded.

Perspective from Heinz Drexel, MD

“Accessory renal arteries are a common phenomenon in patients with resistant hypertension and are often detected in screening,” Linda Schmiedel, MD, of Technische Universitat Dresden, Germany, said at a press conference, adding that small arteries are frequently not accessible for renal denervation.

To further elucidate the potential effect of denervating accessory renal arteries, Schmiedel and colleagues enrolled patients with resistant hypertension (n=110) who had a mean baseline 24-hour ambulatory BP of 154 ± 10 /85 ± 9 mm Hg and mean office BP of 165 ± 15/85 ± 11 mm Hg.

At 6 months, Schmiedel and colleagues obtained measurements of office BP and 24-hour ambulatory BP monitoring in 66 patients who were available for follow-up.

Overall, 53 patients had complete renal denervation compared with 13 (19.7%) who had incomplete denervation.

“Patients with a complete renal denervation and response to the procedure (38 of 53 in office BP; 24 of 50 in 24-hour ambulatory BP monitoring) had significant BP reductions at 6 months compared with those with incomplete denervation, which didn’t show this effect,” Schmiedel said.

Specifically, Schmiedel said that patients with a complete renal denervation procedure had their office BPs decrease from around 171 mm Hg to 159 mm Hg (mean drop of –12 ± 23/–5 ± 15 mm Hg), whereas patients with accessory renal arteries not completely ablated had BPs remaining similar to the levels documented at baseline (173 ± 25 to 170 ± 20 mm Hg).

“This is the first study that points out that you have to do the renal denervation procedure completely, if it’s possible, to be successful in this treatment option,” Schmiedel concluded. “But if you have small accessory renal arteries and cannot perform renal denervation completely, you will have no success in the BP lowering effect of the therapy.” – by Brian Ellis

For more information:

Schmiedel L. Overweight Under Pressure. Presented at: the European Society of Cardiology Congress; Aug. 30-Sept. 3, 2014; Barcelona, Spain.

Disclosure: Schmiedel reports no relevant financial disclosures.

Perspective

Heinz Drexel, MD

This year we had the disappointing results of the SYMPLICITY HTN-3 trial that showed patients with resistant hypertension did not experience a significant BP reduction with renal denervation compared with a sham procedure. Some of us thought this was the end for renal denervation. Now at ESC Congress, we have heard that better selection of patients and considering denervating accessory renal arteries may make a difference in outcomes. After all, if you only destroy the nerves in one renal artery, the others would compensate for that and increase pressure by different mechanisms.

So, the statement of the moment should be that there is hope for renal denervation but not proof. One of the criticisms of SYMPLICITY HTN-3 was that the patient selection was not good. As we discussed today, this must be better and involve patients who are truly resistant. And second, you must look to do more with drugs than what was done in SYMPLICITY HTN-3. If the drugs work, that is enough and renal denervation should not be performed.

Heinz Drexel, MD

Academic Teaching Hospital

VIVIT Research Institute, Freiburg, Austria

Disclosures: Drexel reports no relevant financial disclosures.