Is renal denervation a safe and effective treatment for resistant hypertension?

This study examined the safety and effectiveness of renal denervation compared to intense drug treatment for resistant hypertension. The authors concluded that renal denervation achieved a decrease in blood pressure similar to that seen with intense drug treatment.

Patients with hypertension have a higher resting blood pressure than the body needs. The blood pressure needs to be lowered to avoid complications such as heart attacks, strokes and heart failure. Resistant hypertension, where blood pressure is consistently higher than 140/90 mm Hg, usually requires treatment with three or more drugs.

Intense treatment with drugs can cause unwanted side effects, and non-drug treatments for resistant hypertension are being sought. Renal denervation is one such non-drug treatment. This is a procedure where patient’s nerve endings are disrupted with small radio pulses. This procedure is minimally invasive and has been shown to reduce blood pressure levels in patients with resistant hypertension. It is not clear whether renal denervation is as effective as intensifying medication treatment.

106 patients were split into two groups. One group received renal denervation treatment and the other group received intense drug treatment. Blood pressure measurements were taken before the treatment and six months after treatment began.

Renal denervation led to a significant decrease of 8.6 mm Hg in systolic blood pressure (SBP – pressure when the heart is contracting) and 5.7 mm Hg in diastolic blood pressure (DBP – pressure when the heart is between beats). Drug treatment lead to a similar significant decrease of 8.1 mm Hg in SBP 4.5 mm Hg in DBP.

No significant complications were recorded in association with the renal denervation procedure.

The authors concluded that renal denervation can lead to a reduction of blood pressure that is comparable to intense drug treatment in resistant hypertension. 

This study was carried out on a small number of patients. The renal denervation procedure itself may have affected the outcome of the study and therefore an imitation procedure should have been carried out in the drug treatment group.