Renal Denervation or Medication: which is most effective for the treatment of resistant high blood pressure?

This paper compared the effect of renal denervation to medication alone in patients with resistant high blood pressure. The authors concluded that renal denervation and intensified medical treatment is similar have similar effects on blood pressure.

Resistant hypertension is high blood pressure which cannot be controlled with medication. Patients with resistant hypertension may receive intensified treatment. 25 mg of Spironolactone (Aldactone) daily may be used as intense treatment to reduce blood pressure.

A recent procedure known as renal denervation has been developed in order to treat resistant hypertension. Renal denervation is a minimally invasive procedure where the nerves of the kidney are disrupted. It is not known whether renal denervation is more effective than treatment with drugs.

This study aimed to compare the effect of renal denervation and spironolactone on blood pressure.

52 patients were randomly assigned to receive renal denervation procedure. 54 patients were randomly assigned to receive just medication alone which included spironolactone. Patients in both groups continued to take the same medication they were receiving before the study. Their blood pressure was measured and they were followed-up for 1 year.

Both groups of patients had a significant reduction in the average 24 hour blood pressure. This reduction was comparable between both groups of patients. Patients receiving renal denervation had an average decrease in blood pressure by 6.4 mmHg while patients receiving medication only had an average 8.2 mmHg decrease in blood pressure. A single blood pressure measurement taken by a nurse or physician in the clinic was also reduced and comparable between both groups of patients.

With regards to safety, there were no severe complications for patients receiving the renal denervation procedure. 1 patient receiving the procedure had a stroke (disruption in blood supply to brain). 1 patient receiving the procedure had a heart attack. 1 patient receiving medication alone had chest pain. There were no deaths during the 1 year of follow-up. 

The authors concluded that renal denervation is not more effective than medication for the treatment of resistant high blood pressure. Intensifying treatment with spironolactone seems to be more effective than renal denervation.

There was a small number of patients studied.