Renal Denervation Found to Treat Resistant Hypertension
CHICAGO—Renal denervation (RDN), a new procedure in which a catheter-based probe is inserted into the renal artery to deactivate nerves near the kidneys with high-frequency energy, may be effective for treating resistant hypertension, according to French researchers.
“Renal denervation, a minimally invasive, effective treatment, appears to be safe in the short-term with a low incidence of local complications,” said lead investigator Marc Sapoval, MD, Professor of Clinical Radiology and Chair of the Cardiovascular Radiology Department at Hôpital Europeen Georges-Pompidou in Paris.
“After six months, 39% of patients receiving the endovascular denervation treatment had reached the recommended blood pressure level and, overall, 50% of patients showed a measurable benefit from the intervention.”
Dr. Sapoval, who presented the study findings at the Society of Interventional Radiology's 2011 Annual Scientific Meeting, said the study enrolled 106 adults with resistant essential hypertension. He and his colleagues randomized 54 patients to receive oral medications and 52 to undergo RDN. At six months, patients receiving RDN experienced a mean 32 mm Hg decrease in systolic pressure and 12 mm Hg decrease in diastolic pressure.
“Given its impact on the central sympathetic drive, endovascular renal denervation may have applicability in additional disease states such as heart failure, cardio-renal syndrome, hepato-renal syndrome, and in the prevention of progression of chronic kidney disease and hypertension in end-stage renal disease (ESRD),” Dr. Sapoval said.
The primary inclusion criteria for this study was a systolic pressure of 160 mm Hg or greater (or 150 mm Hg or greater in type 2 diabetics) despite receiving three or more antihypertensive mediations. Key exclusion criteria included an estimated glomerular filtration rate less than 45 mL/min/1.73 m2, unsuitable renal artery anatomy, or presence of a hemodynamically significant renal artery stenosis. The primary endpoint was the change in office-based systolic pressure at six months.
A multicenter, randomized, controlled trial at 24 international sites is underway. “We need more patients and more trials before we can offer this to the larger public,” Dr. Sapoval told Renal & Urology News. “This [procedure] is very, very promising.”