title: Renal denervation in comparison with intensified pharmacotherapy in true resistant hypertension: 2-year outcomes of randomized PRAGUE-15 study.
abstract: The randomized, multicentre study compared the efficacy of renal denervation (RDN) versus spironolactone addition in patients with true resistant hypertension. We present the 24-month data.
  
  
  
  A total of 106 patients with true resistant hypertension were enrolled in this study: 52 patients were randomized to RDN and 54 patients to the spironolactone addition, with baseline SBP of 159 ± 17 and 155 ± 17 mmHg and average number of drugs 5.1 and 5.4, respectively. Two-year data are available in 86 patients. Spironolactone addition, as crossover after 1 year, was performed in 23 patients after RDN, and spironolactone addition followed by RDN was performed in five patients.
  
  
  
  Similar and comparable reduction of 24-h SBP after RDN or spironolactone addition after randomization was observed, 9.1 mmHg (P = 0.001) and 10.9 mmHg (P = 0.001), respectively. Similar decrease of office blood pressure (BP) was observed, 17.7 mmHg (P < 0.001) versus 14.1 mmHg (P < 0.001), whereas the number of antihypertensive drugs did not differ significantly between groups. Crossover analysis showed nonsignificantly better efficacy of spironolactone addition in 24-h SBP and office SBP reduction than RDN (3.7 mmHg, P = 0.27 and 4.6 mmHg, P = 0.28 in favour of spironolactone addition, respectively). Meanwhile, the number of antihypertensive drugs was significantly increased after spironolactone addition (+0.7, P = 0.001).
  
  
  
  In the settings of true resistant hypertension, spironolactone addition (if tolerated) seems to be of better efficacy than RDN in BP reduction over a period of 24 months. However, by contrast to the 12-month results, BP changes were not significantly greater.
authors.affiliation: a3rd Department of Medicine, Centre for Hypertension, General University Hospital and First Faculty of Medicine, Charles University bCardiocentre cDepartment of Anaesthesiology, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague dDepartment of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, University Hospital Olomouc and Palacký University, Olomouc eCardiocentre, Nemocnice Podlesí, Třinec fDepartment of Radiology gDepartment of Nephrology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Ján
authors.initials: J
authors.lastname: Rosa
authors.forename: Petr
authors.initials: P
authors.lastname: Widimský
authors.forename: Petr
authors.initials: P
authors.lastname: Waldauf
authors.forename: Tomáš
authors.initials: T
authors.lastname: Zelinka
authors.forename: Ondřej
authors.initials: O
authors.lastname: Petrák
authors.forename: Miloš
authors.initials: M
authors.lastname: Táborský
authors.forename: Marian
authors.initials: M
authors.lastname: Branny
authors.forename: Petr
authors.initials: P
authors.lastname: Toušek
authors.forename: Karol
authors.initials: K
authors.lastname: Čurila
authors.forename: Lukáš
authors.initials: L
authors.lastname: Lambert
authors.forename: František
authors.initials: F
authors.lastname: Bednář
authors.forename: Robert
authors.initials: R
authors.lastname: Holaj
authors.forename: Branislav
authors.initials: B
authors.lastname: Štrauch
authors.forename: Jan
authors.initials: J
authors.lastname: Václavík
authors.forename: Eva
authors.initials: E
authors.lastname: Kociánová
authors.forename: Igor
authors.initials: I
authors.lastname: Nykl
authors.forename: Otakar
authors.initials: O
authors.lastname: Jiravský
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rappová
authors.forename: Tomáš
authors.initials: T
authors.lastname: Indra
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Krátká
authors.forename: Jiří
authors.initials: J
authors.lastname: Widimský
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D003329:Coronary Vasospasm / Q000628:therapy*; D018592:Cross-Over Studies; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007668:Kidney / Q000294:innervation* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D011446:Prospective Studies; D013148:Spironolactone / Q000627:therapeutic use*; D013562:Sympathectomy; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone