Renal artery denervation: Treatment for drug resistant hypertension

This study evaluated the safety and efficacy of a procedure called renal artery sympathetic denervation (RASD) for patients with high blood pressure or hypertension (HTN) resistant to maximal treatment.

HTN is the leading treatable cardiovascular risk factor worldwide. More than 50% of the patients do not achieve the goal blood pressure (BP) despite the use of several drugs. Resistant HTN has a more than three-fold increase in cardiovascular risk. The need to control BP introduced RASD which is a minimally invasive procedure that targets nerves along the renal arteries supplying the kidneys. This intentional disruption of the nerves may cause a decrease in blood pressure. The current study aimed to evaluate the outcomes of patients with resistant HTN after treatment with RASD.

This is a first-in human study that included 46 adults whose BP remained over 160 mmHg despite the use of at least three anti-hypertensive medications at maximally tolerated doses and who completed the RASD procedure. The primary objective was the reduction of the BP at 6 months after the procedure compared with the initial evaluation.

The medium procedure time was 34 minutes. The most frequent adverse event was vascular access site hematoma (localized collection of blood). No patient needed clinical intervention at 6 months and the renal function remained stable. At the initial point the average BP was 176/96 mmHg. The average reduction in BP at 1, 3 and 6 months were with -28/-10, -27/-10 and -26/-10 mmHg, respectively. During the follow-up period, more than 80% of patients had a reduction of at least 10 mmHg and up to 41% of patients achieved a BP of less than 140 mmHg. Also, over the 6 months of follow-up, 13% of patients had a decrease in their anti-hypertensive medications.

In conclusion, renal artery sympathetic denervation was performed safely in patients with drug-resistant HTN, resulting in a significant reduction in BP. The reduction was sustained through the 6 month follow-up period.

This system represents a promising therapy for the treatment of drug-resistant HTN. However, additional larger studies would be beneficial for the assessment of the risks and benefits of this therapy.

Talk to your doctor about the most appropriate treatment in your situation.