title: Renal sympathetic denervation after Symplicity HTN-3 and therapeutic drug monitoring in patients with resistant hypertension to improve patients' adherence.
abstract: Renal sympathetic denervation (RDN) has been proposed as a new treatment modality in patients with apparent treatment-resistant hypertension (TRH), a condition defined as persistent blood pressure (BP) elevation despite prescription of at least three anti-hypertensive drugs including a diuretic. However, the large fall in BP reported after RDN in Symplicity HTN-2, the first randomized study, and in multiple observational studies has not been confirmed in five subsequent prospective randomized studies. The reduction in BP may be mostly due to 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 BP lowering effect of RDN seems rather limited and the characteristics of the true responders remain largely unknown. Accordingly, RDN is not ready for clinical practice. In most patients with TRH, drug monitoring and subsequent improvement of drug adherence may prove more effective and cost-effective to achieve BP control. In the meantime, research should aim at identifying characteristics of those few patients adherent to drug treatment who has TRH and may respond to RDN.
authors.affiliation: Departments of Cardiology, Internal Medicine and Nephrology, Ullevaal University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway sverrkj@online.no.
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.affiliation: Departments of Cardiology, Internal Medicine and Nephrology, Ullevaal University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Fadl Elmula M
authors.initials: FE
authors.lastname: Fadl Elmula
authors.affiliation: Departments of Cardiology, Internal Medicine and Nephrology, Ullevaal University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Os
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 Vitek Development and Research, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000294:innervation; D010349:Patient Compliance; D013562:Sympathectomy / Q000379:methods*
chemical_list: D000959:Antihypertensive Agents
keywords: Anti-hypertensive Drugs; Drug Monitoring; Hypertension; Renal Denervation