Controversies Surrounding Renal Denervation: Lessons Learned From Real-World Experience in Two United Kingdom Centers

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• 作者：Amy E. Burchell ; Kenneth Chan ; Laura E.K. Ratcliffe ; Emma C. Hart ; Manish Saxena ; David J. Collier ; Ajay K. Jain ; Anthony Mathur ; Charles J. Knight ; Mark J. Caulfield ; Julian F.R. Paton ; Angus K. Nightingale ; Melvin D. Lobo and Andreas Baumbach
• 刊名：The Journal of Clinical Hypertension
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：18
• 期：6
• 页码：585-592
• 全文大小：524K
• ISSN：1751-7176

文摘

Renal denervation (RDN) is a therapy that targets treatment-resistant hypertension (TRH). The Renal Denervation in Patients With Uncontrolled Hypertension (Symplicity) HTN-1 and Symplicity HTN-2 trials reported response rates of >80%; however, sham-controlled Symplicity HTN-3 failed to reach its primary blood pressure (BP) outcome. The authors address the current controversies surrounding RDN, illustrated with real-world data from two centers in the United Kingdom. In this cohort, 52% of patients responded to RDN, with a 13±32 mm Hg reduction in office systolic BP (SBP) at 6 months (n=29, P=.03). Baseline office SBP and number of ablations correlated with office SBP reduction (R=−0.47, P=.01; R=−0.56, P=.002). RDN appears to be an effective treatment for some patients with TRH; however, individual responses are highly variable. Selecting patients for RDN is challenging, with only 10% (33 of 321) of the screened patients eligible for the study. Medication alterations and nonadherence confound outcomes. Adequate ablation is critical and should impact future catheter design/training. Markers of procedural success and improved patient selection parameters remain key research aims.