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Renal denervation with cryoenergy improved BP outcomes in previous failures
Renal denervation with cryoablation was associated with improved office and ambulatory BP in a cohort of individuals with resistant hypertension who previously failed with radiofrequency energy. According to researchers, this may represent an effective second-line therapeutic option in nonresponders.
In the study, the researchers wrote that 15% to 30% of patients with resistant hypertension who are treated with renal denervation with radiofrequency fail to respond, which led them to examine whether renal denervation with cryoenergy could be useful as a second-line option in a cohort of 10 patients who were previous treatment failures.
The main criteria for nonresponse included systolic 24-hour ambulatory BP ≥150 mm Hg (median ambulatory BP, 183/102 mm Hg; median office-based BP, 191/108 mm Hg) even after treatment with at least four different antihypertensive drugs (mean, six drugs). They further had to demonstrate that systolic ambulatory BP did not decrease by ≥10 mm Hg at ≥3 months after renal denervation with radiofrequency.
Clinicians evaluated patients at 3, 6 and 12 months. At these points, patients underwent clinical and biochemical evaluation and office BP and ambulatory BP measurement. At the 6-month mark, clinicians also performed duplex sonography.
All patients underwent cryoablation with a 7F cryoablation catheter (Freezor Xtra, Medtronic). This procedure included four applications in both renal arteries every 4 minutes with a temperature of −75°C. There were no complications with the procedure.
Systolic office BP was reduced by −41 mm Hg at 3 months, −47 mm Hg at 6 months and −61 mm Hg at 12 months, according to the results (P=.044 for all). Diastolic office BP was reduced by −18 mm Hg at 3 months, −14 mm Hg at 6 months and −34 mm Hg at 12 months (P=.014 for all).
Similarly, the researchers observed reductions in systolic ambulatory BP of −38 mm Hg, −35 mm Hg and −52 mm Hg (P=.014 for all) and diastolic ambulatory BP of −20 mm Hg, −13 mm Hg and −18 mm Hg (P=.043 for all) at 3, 6 and 12 months, respectively.
No complications occurred during follow-up. Renal function remained unchanged, according to the researchers.
“The significant reduction in systolic [office] BP and [ambulatory] BP observed qualifies [renal denervation] with cryoenergy as an effective second-line therapeutic option in nonresponders to [renal denervation] with [radiofrequency],” they concluded.
Disclosure: The researchers report no relevant financial disclosures.