title: Renal sympathetic denervation after Symplicity HTN-3 and therapeutic drug monitoring in severe hypertension.
abstract: Renal sympathetic denervation (RDN) has been and is still proposed as a new treatment modality in patients with apparently treatment resistant hypertension (TRH), a condition defined as persistent blood pressure elevation despite prescription of at least 3 antihypertensive drugs including a diuretic. However, the large fall in blood pressure after RDN reported in the first randomized study, Symplicity HTN-2 and multiple observational studies has not been confirmed in five subsequent prospective randomized studies and may be largely explained by non-specific effects such as improvement of drug adherence in initially poorly adherent patients (the Hawthorne effect), placebo effect and regression to the mean. The overall blood-pressure lowering effect of RDN seems rather limited and the characteristics of true responders are largely unknown. Accordingly, RDN is not ready for clinical practice. In most patients with apparently TRH, drug monitoring and improvement of drug adherence may prove more effective and cost-beneficial to achieve blood pressure control. In the meantime, research should aim at identifying characteristics of those patients with truly TRH who may respond to RDN.
authors.affiliation: Departments of Cardiology and Internal Medicine, Oslo University Hospital Ullevaal, Norway ; Faculty of Medicine, University of Oslo Oslo, Norway.
authors.forename: Fadl Elmula M
authors.initials: FE
authors.lastname: Fadl Elmula
authors.affiliation: Departments of Cardiology and Internal Medicine, Oslo University Hospital Ullevaal, Norway ; Faculty of Medicine, University of Oslo Oslo, Norway.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Larstorp
authors.affiliation: Departments of Cardiology and Internal Medicine, Oslo University Hospital Ullevaal, Norway ; Faculty of Medicine, University of Oslo Oslo, Norway.
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.affiliation: Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain Brussels, Belgium ; Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain Brussels, Belgium.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Persu
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven Leuven, Belgium.
authors.forename: Yu
authors.initials: Y
authors.lastname: Jin
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven Leuven, Belgium ; VitaK Development and Research, Maastricht University Maastricht, Netherlands.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
keywords: antihypertensive drugs; drug monitoring; hypertension; renal denervation; treatment resistance