title: Renal sympathetic denervation in patients with treatment-resistant hypertension after witnessed intake of medication before qualifying ambulatory blood pressure.
abstract: It is unknown whether the decline in blood pressure (BP) after renal denervation (RDN) is caused by denervation itself or concomitantly improved drug adherence. We aimed to investigate the BP lowering effect of RDN in true treatment-resistant hypertension by excluding patients with poor drug adherence. Patients with resistant hypertension (n=18) were referred for a thorough clinical and laboratory work-up. Treatment-resistant hypertension was defined as office systolic BP>140 mm Hg, despite maximally tolerated doses of ≥ 3 antihypertensive drugs, including a diuretic. In addition, ambulatory daytime systolic BP>135 mm Hg was required after witnessed intake of antihypertensive drugs to qualify. RDN (n=6) was performed with Symplicity Catheter System. The mean office and ambulatory BPs remained unchanged at 1, 3, and 6 months in the 6 patients, whereas there was no known change in antihypertensive medication. Two patients, however, had a fall in both office and ambulatory BPs. Our findings question whether BP falls in response to RDN in patients with true treatment-resistant hypertension. Additional research must aim to verify potential BP lowering effect and identify a priori responders to RDN before this invasive method can routinely be applied to patients with drug-resistant hypertension. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01673516.
authors.affiliation: Section for Cardiovascular and Renal Research, Department of Cardiology, Medical Clinic, Oslo University Hospital, Ullevål, Oslo, Norway.
authors.forename: Fadl Elmula Mohamed
authors.initials: FE
authors.lastname: Fadl Elmula
authors.forename: Pavel
authors.initials: P
authors.lastname: Hoffmann
authors.forename: Eigil
authors.initials: E
authors.lastname: Fossum
authors.forename: Magne
authors.initials: M
authors.lastname: Brekke
authors.forename: Eyvind
authors.initials: E
authors.lastname: Gjønnæss
authors.forename: Ulla
authors.initials: U
authors.lastname: Hjørnholm
authors.forename: Vibeke N
authors.initials: VN
authors.lastname: Kjær
authors.forename: Morten
authors.initials: M
authors.lastname: Rostrup
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: Ingrid
authors.initials: I
authors.lastname: Os
authors.forename: Aud-E
authors.initials: AE
authors.lastname: Stenehjem
authors.forename: Aud
authors.initials: A
authors.lastname: Høieggen
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D003131:Combined Modality Therapy; D003714:Denervation / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D007668:Kidney / Q000294:innervation*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D019233:Retreatment; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: drug adherence; renal sympathetic denervation; treatment-resistant hypertension