BP reduced out to 9 years after renal denervation for resistant hypertension
There was a sustained reduction in ambulatory BP out to 9 years in patients who underwent renal denervation for resistant hypertension, according to a study published in Hypertension.
In addition, patients were on average taking one less antihypertensive medication at long-term follow-up compared with baseline, researchers reported.
Data were derived from Sesa-Ashton G, et al. Hypertension. 2023;doi:10.1161/HYPERTENSIONAHA.122.20853.
“Catheter-based renal denervation results in sustained and clinically relevant BP lowering up to 9 years. This was based on the gold-standard mode of BP measurement, namely ambulatory BP measurement,” Markus Schlaich, MD, FAHA, FESC, ISHF, nephrologist and hypertension specialist at the Dobney Hypertension Centre and the Medical School - Royal Perth Hospital Unit, University of Western Australia, president of Hypertension Australia and treasurer and director of the south pacific regional office of the World Hypertension League, told Healio. “This was achieved despite patients being on one less drug than at baseline. There were no adverse effects on renal function. BP management is a marathon, not a sprint, and renal denervation is associated with long-term BP reduction and therefore very likely with significant reduction of risk for CV events.”
This analysis included 66 participants (mean age, 70 years; 76% men) who underwent radiofrequency renal denervation for resistant hypertension with the same catheter ablation system (Symplicity Flex Catheter System, Medtronic) while participating in clinical trials evaluating the efficacy and safety of the system.
All participants had baseline assessments before renal denervation and repeat assessment during an average follow-up duration of approximately 9 years, including medical history, automated office and ambulatory BP measurement and routine blood and urine tests, according to the study.
Compared with baseline, average ambulatory systolic BP was reduced from 145.2 mm Hg to 133.1 mm Hg (mean difference, 12.1 mm Hg; P < .0001) and average diastolic BP was reduced from 81.2 mm Hg to 72.7 mm Hg (mean difference, 8.8 mm Hg; P < .0001).
Average heart rate was unaffected from baseline.
At approximately 9 years follow-up after renal denervation, participants were on one less antihypertensive medication compared with baseline (P = .0052), according to the study.
In addition, average time above target BP was reduced from approximately 75% at baseline to 47.3% at 9 years (P < .0001).
“Personally, I was not surprised by the findings since my own clinical observations over more than 15 years of experience with renal denervation — our group was the first to perform renal denervation in the world in 2007 — clearly indicated long-term benefit in most treated patients,” Schlaich told Healio.
Researchers reported that estimated glomerular filtration rate decreased within the expected age-associated rate from 71.1 mL/min/1.73 m2 to 61.2 mL/min/1.73 m2.
“Renal denervation is a safe procedure with minimal risk for adverse events, as shown in all studies. It results in clinically relevant BP lowering in most, but not all, patients. It is a valid additional/complementary BP lowering method to lifestyle and pharmacotherapy,” Schlaich said. “Renal denervation is a one-off procedure with minimal risk that will reduce the levels of BP irrespective of other therapies in most patients with hypertension, not only resistant hypertension. It may be a good option for patients with adherence issues to pharmacotherapy, intolerance of drugs and others. Patient preference should also be taken into account.”
For more information:
Markus Schlaich, MD, FAHA, FESC, ISHF, can be reached at markus.schlaich@uwa.edu.au.
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