Interventional Therapy in Refractory Hypertension: An Update
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09. Sept. 2022
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Artikel-Kategorie: Review
Online veröffentlicht: 09. Sept. 2022
Seitenbereich: 79 - 84
DOI: https://doi.org/10.2478/rjc-2022-0021
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© 2022 Alexandra Clement et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Main indications and contraindications for renal denervation
| Refractory hypertension (after the exclusion of secondary forms of hypertension, pseudo-resistance, and “white coat” hypertension | Renal arteries abnormalities (e.g., aneurysms, stenosis, diameter < 4 mm) |
Major clinical trials on renal denervation
| Open-label, proof of concept | Prospective, randomized trial | Prospective, single-blind, randomized, sham-controlled trial | Prospective, open-label randomized controlled trial with blinded endpoint evaluation in patients with resistant hypertension | Randomized, single-blind, sham-control trial | |
| 153 subjects with an elevated office systolic blood pressure (SBP; ≥160 mm Hg) despite taking ≥ 3 antihypertensive drug classes, 1 of which was a diuretic | 106 subjects with a baseline SBP of 160 mm Hg or more despite taking three or more antihypertensive drugs were randomly allocated to renal denervation ( |
535 patients with severe resistant hypertension underwent randomization in a 2:1 ratio to renal denervation or a sham procedure | 106 subjects with resistant hypertension were randomly assigned in a 1:1 ratio to either renal denervation plus an antihypertensive regimen (renal denervation group) or the same antihypertensive treatment alone (control group) | 331 hypertensive subjects were randomly assigned to either renal denervation ( |
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| At 1, 3, 6 12, 18, and 24 months | Primary endpoint was assessed at 6 months | 6 months | 6 months | Primary endpoint (baseline-adjusted change in 24-hour SBP) was evaluated at 3 months | |
| 92% of patients had an office BP reduction of ≥ 10 mm Hg | 84% of the patients who underwent renal denervation had a reduction in SBP of 10 mm Hg or more, compared to 35% of controls ( |
No significant reduction of SBP in patients with resistant hypertension at 6 months after renal-artery denervation when compared with the control group | Renal denervation plus standardized treatment decreased ambulatory blood pressure more than the same treatment alone | At 3 months, the mean difference between the two groups for the primary endpoint was −3.9 mm Hg |