Prevalence of resistant hypertension and eligibility for catheter-based renal denervation in hypertensive outpatients.
BACKGROUND
Studies of endovascular renal denervation (RDN) have demonstrated significant blood pressure reduction in eligible patients with resistant hypertension. These trials have used stringent inclusion and exclusion criteria in patient enrollment, potentially selecting for a small subset of patients with resistant hypertension. In this study, we examined the changes in estimated prevalence of resistant hypertension when using increasingly stringent definitions of resistant hypertension in a fixed population and assessed the generalizability of RDN when applying study criteria to a community-based hypertensive population.


METHODS
A retrospective chart review was done of hypertensive outpatients. Four increasingly stringent interpretations of the American Heart Association definition of resistant hypertension were used to calculate prevalence estimates. Patients eligible for RDN were identified using criteria from SYMPLICITY HTN-3. Demographic and clinical characteristics were compared.


RESULTS
We identified 1,756 hypertensive outpatients; 55.0% were male, 53.9% were white, and subjects had a mean age of 66.6 ± 12.5 years and a body mass index (BMI) of 30.1 ± 10.7 kg/m(2). Only 14 (0.8%) were eligible for RDN. Among these patients, 10 (71.4%) were female and all were black, with a mean age of 69.9 ± 8.8 and BMI of 35.7 ± 6.6. Congestive heart failure was more common in patients eligible for RDN.


CONCLUSIONS
Patients eligible for RDN based on published studies represent an exceedingly small proportion of the total hypertensive population. Further studies are necessary to determine if the benefits of RDN can be generalized to a broader range of hypertensive patients than those included in previous trials.
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Salim S
SS
Hayek
Mahmoud H
MH
Abdou
Benjamin D
BD
Demoss
Juan M Ortega
JM
Legaspi
Emir
E
Veledar
Anjan
A
Deka
Sandeep K
SK
Krishnan
Kobina A
KA
Wilmot
Aalok D
AD
Patel
Vikas R
VR
Kumar
Chandan M
CM
Devireddy
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015992:Body Mass Index; D057785:Catheters; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D007668:Kidney / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D015995:Prevalence; D012189:Retrospective Studies; D013562:Sympathectomy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents
SYMPLICITY HTN.; blood pressure; hypertension; prevalence; renal denervation; resistant hypertension