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Renal sympathetic denervation for treatment of hypertension

where are we now in 2019?

Dasgupta, Indranila; Sharp, Andrew S.P.b

Current Opinion in Nephrology and Hypertension: September 2019 - Volume 28 - Issue 5 - p 498–506
doi: 10.1097/MNH.0000000000000532
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Purpose of review Although sound physiological principles and surgical precedent underpin renal denervation as a therapy for treatment resistant hypertension, and early clinical studies had produced encouraging results, the first sham-controlled study (SYMPLICITY HTN-3) failed to achieve its primary efficacy endpoint. Lessons learnt from this trial, and the knowledge derived from further animal and autopsy work, have been applied in three recently published sham-controlled trials.

Recent findings These trials – SPYRAL OFF-MED, RADIANCE SOLO and SPYRAL ON-MED – using newer technologies, demonstrate a 5–10 mmHg incremental reduction in ambulatory SBP from RDN against sham-control, in patients with mild-to-moderate hypertension taking 0–3 drugs.

Summary These results provide proof of principle of the blood pressure-lowering effect of renal denervation. We now require data on long-term safety and durability of the procedure. Research is needed to identify predictive markers of response as about one-third of individuals do not respond to renal denervation. Hard-outcome data would be welcome but might be difficult to acquire. Individuals with treatment resistance are obvious treatment candidates, but RDN may also potentially benefit those with medication nonadherence and/or intolerance and those unwilling to take pills.

aUniversity Hospitals Birmingham NHS Foundation Trust and Honorary Reader, Institute of Applied Health Research, University of Birmingham, Birmingham

bRoyal Devon and Exeter Hospital, University of Exeter, Exeter, UK

Correspondence to Indranil Dasgupta, Renal Unit, Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK. Tel: +44 121 424 2158; e-mail: Indranil.dasgupta@uhb.nhs.ukTwitterhandle:@idasgupta7

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