Renal sympathetic denervation for treatment of hypertension: where are we now in 2019?

Dasgupta, Indranil and Sharp, Andrew S P (2019) Renal sympathetic denervation for treatment of hypertension: where are we now in 2019? Current opinion in nephrology and hypertension. ISSN 1473-6543.

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Abstract

PURPOSE OF REVIEW

Although sound physiological principles and surgical precedent underpin renal denervation as a therapy for treatment resistant hypertension, and early clinical studies had produced encouraging results, the first sham-controlled study (SYMPLICITY HTN-3) failed to achieve its primary efficacy endpoint. Lessons learnt from this trial, and the knowledge derived from further animal and autopsy work, have been applied in three recently published sham-controlled trials.

RECENT FINDINGS

These trials - SPYRAL OFF-MED, RADIANCE SOLO and SPYRAL ON-MED - using newer technologies, demonstrate a 5-10 mmHg incremental reduction in ambulatory SBP from RDN against sham-control, in patients with mild-to-moderate hypertension taking 0-3 drugs.

SUMMARY

These results provide proof of principle of the blood pressure-lowering effect of renal denervation. We now require data on long-term safety and durability of the procedure. Research is needed to identify predictive markers of response as about one-third of subjects do not respond to renal denervation. Hard-outcome data would be welcome but might be difficult to acquire. Individuals with treatment resistance are obvious treatment candidates, but RDN may also potentially benefit those with medication nonadherence and/or intolerance and those unwilling to take pills.

Item Type: Article
Subjects: WG Cardiovascular system. Cardiology
WJ Urogenital system. Urology
Divisions: Emergency Services > Renal
Related URLs:
Depositing User: Mrs Yolande Brookes
Date Deposited: 05 Jul 2019 12:46
Last Modified: 05 Jul 2019 12:46
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/2206

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