Renal sympathetic denervation as second-line therapy in mild resistant hypertension: a pilot study.
BACKGROUND
Catheter-based renal sympathetic denervation (CRD) is associated with significant blood pressure (BP) reductions in patients with severe therapy-resistant hypertension (office systolic BP ≥ 160 mm Hg or ≥ 150 mm Hg in diabetic patients). Effects of renal denervation on BP in patients with milder forms of therapy-resistant hypertension have not been examined. We sought to investigate the feasibility, safety, and effectiveness of CRD in patients with longstanding mild hypertension despite treatment with ≥ 3 antihypertensive drugs.


METHODS
Consecutive patients with office systolic BPs of 140-160 mm Hg despite ≥ 3 antihypertensive medications treated with CRD were included in this prospective study. Procedural safety and adverse events during follow-up were assessed. Clinical evaluations were performed at baseline, 3, and 6 months to determine changes in office systolic BPs, 24-hr ambulatory BPs, and medication doses.


RESULTS
Twenty patients (mean age 60.6 ± 10.8 years; 45% female) treated with an average of 5.4 ± 1.5 antihypertensive drugs were treated with CRD. The procedure was successful in all patients. There were no procedure- or device-related complications. BP at baseline was 148.4/83.0 ± 6.6/11.0 mm Hg and decreased by 5.7/0.6 ± 20.0/8.3 mm Hg (P = 0.2) and 13.1/5.0 ± 13.6/8.3 mm Hg (P < 0.01) at 3 and 6 months, respectively. Comparing baseline and 6-month follow-up, mean ambulatory 24 hr-BP was reduced by 11.3/4.1 ± 8.6/7.3 mm Hg (P < 0.01). Four patients were able to reduce antihypertensive medications prior to their 3-month visit.


CONCLUSIONS
As in patients with severe treatment-resistant hypertension, CRD is a safe and effective treatment for patients with milder drug-resistant hypertension.
CardioVascular Center Frankfurt, Frankfurt am Main, Germany.
Benjamin
B
Kaltenbach
Jennifer
J
Franke
Stefan C
SC
Bertog
Daniel H
DH
Steinberg
Ilona
I
Hofmann
Horst
H
Sievert
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D017115:Catheter Ablation / Q000009:adverse effects; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010865:Pilot Projects; D011446:Prospective Studies; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents