Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study.

Abstract

BACKGROUND:

Renal sympathetic hyperactivity is associated with hypertension and its progression, chronic kidney disease, and heart failure. We did a proof-of-principle trial of therapeutic renal sympathetic denervation in patients with resistant hypertension (ie, systolic blood pressure >/=160 mm Hg on three or more antihypertensive medications, including a diuretic) to assess safety and blood-pressure reduction effectiveness.

METHODS:

We enrolled 50 patients at five Australian and European centres; 5 patients were excluded for anatomical reasons (mainly on the basis of dual renal artery systems). Patients received percutaneous radiofrequency catheter-based treatment between June, 2007, and November, 2008, with subsequent follow-up to 1 year. We assessed the effectiveness of renal sympathetic denervation with renal noradrenaline spillover in a subgroup of patients. Primary endpoints were office blood pressure and safety data before and at 1, 3, 6, 9, and 12 months after procedure. Renal angiography was done before, immediately after, and 14-30 days after procedure, and magnetic resonance angiogram 6 months after procedure. We assessed blood-pressure lowering effectiveness by repeated measures ANOVA. This study is registered in Australia and Europe with ClinicalTrials.gov, numbers NCT 00483808 and NCT 00664638.

FINDINGS:

In treated patients, baseline mean office blood pressure was 177/101 mm Hg (SD 20/15), (mean 4.7 antihypertensive medications); estimated glomerular filtration rate was 81 mL/min/1.73m(2) (SD 23); and mean reduction in renal noradrenaline spillover was 47% (95% CI 28-65%). Office blood pressures after procedure were reduced by -14/-10, -21/-10, -22/-11, -24/-11, and -27/-17 mm Hg at 1, 3, 6, 9, and 12 months, respectively. In the five non-treated patients, mean rise in office blood pressure was +3/-2, +2/+3, +14/+9, and +26/+17 mm Hg at 1, 3, 6, and 9 months, respectively. One intraprocedural renal artery dissection occurred before radiofrequency energy delivery, without further sequelae. There were no other renovascular complications.

INTERPRETATION:

Catheter-based renal denervation causes substantial and sustained blood-pressure reduction, without serious adverse events, in patients with resistant hypertension. Prospective randomised clinical trials are needed to investigate the usefulness of this procedure in the management of this condition.

• Authors: Henry Krum, Markus Schlaich, Rob Whitbourn, Paul A Sobotka, Jerzy Sadowski, Krzysztof Bartus, Boguslaw Kapelak, Anthony Walton, Horst Sievert, Suku Thambar, William T Abraham, Murray Esler
• Journal: Lancet (London, England) (Lancet) Vol. 373 Issue 9671 Pg. 1275-81 (Apr 11 2009) ISSN: 1474-547X [Electronic] England
• PMID: 19332353 (Publication Type: Controlled Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents
• Diuretics
• Norepinephrine

Topics

• Adult
• Aged
• Analysis of Variance
• Antihypertensive Agents (therapeutic use)
• Blood Pressure Monitoring, Ambulatory
• Catheter Ablation (methods)
• Diuretics (therapeutic use)
• Female
• Follow-Up Studies
• Glomerular Filtration Rate
• Humans
• Hypertension (blood, diagnosis, surgery)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Norepinephrine (blood)
• Radiography
• Renal Artery (diagnostic imaging, innervation)
• Safety
• Sympathectomy (methods)
• Treatment Outcome