title: Controversies Surrounding Renal Denervation: Lessons Learned From Real-World Experience in Two United Kingdom Centers.
abstract: Renal denervation (RDN) is a therapy that targets treatment-resistant hypertension (TRH). The Renal Denervation in Patients With Uncontrolled Hypertension (Symplicity) HTN-1 and Symplicity HTN-2 trials reported response rates of >80%; however, sham-controlled Symplicity HTN-3 failed to reach its primary blood pressure (BP) outcome. The authors address the current controversies surrounding RDN, illustrated with real-world data from two centers in the United Kingdom. In this cohort, 52% of patients responded to RDN, with a 13±32 mm Hg reduction in office systolic BP (SBP) at 6 months (n=29, P=.03). Baseline office SBP and number of ablations correlated with office SBP reduction (R=-0.47, P=.01; R=-0.56, P=.002). RDN appears to be an effective treatment for some patients with TRH; however, individual responses are highly variable. Selecting patients for RDN is challenging, with only 10% (33 of 321) of the screened patients eligible for the study. Medication alterations and nonadherence confound outcomes. Adequate ablation is critical and should impact future catheter design/training. Markers of procedural success and improved patient selection parameters remain key research aims.
authors: CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.|School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK.
authors: Amy E
authors: AE
authors: Burchell
authors: William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.|Barts Blood Pressure Clinic, Barts Health NHS Trust, London, UK.
authors: Kenneth
authors: K
authors: Chan
authors: CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.|School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK.
authors: Laura E K
authors: LE
authors: Ratcliffe
authors: CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.|School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK.
authors: Emma C
authors: EC
authors: Hart
authors: William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.|Barts Blood Pressure Clinic, Barts Health NHS Trust, London, UK.
authors: Manish
authors: M
authors: Saxena
authors: William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.
authors: David J
authors: DJ
authors: Collier
authors: William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.|Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK.
authors: Ajay K
authors: AK
authors: Jain
authors: William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.|Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK.
authors: Anthony
authors: A
authors: Mathur
authors: William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.|Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK.
authors: Charles J
authors: CJ
authors: Knight
authors: William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.|Barts Blood Pressure Clinic, Barts Health NHS Trust, London, UK.
authors: Mark J
authors: MJ
authors: Caulfield
authors: CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.|School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK.
authors: Julian F R
authors: JF
authors: Paton
authors: CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.
authors: Angus K
authors: AK
authors: Nightingale
authors: William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.|Barts Blood Pressure Clinic, Barts Health NHS Trust, London, UK.
authors: Melvin D
authors: MD
authors: Lobo
authors: CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.|School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK.
authors: Andreas
authors: A
authors: Baumbach
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000294:innervation* / Q000601:surgery; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000959:Antihypertensive Agents