SYMPLICITY HTN-2 (Renal Denervation inPatients With Uncontrolled Hypertension)
SYMPLICITY HTN-2 (Renal Denervation inPatients With Uncontrolled Hypertension)MD Esler (Baker IDI Heart and Diabetes Institute, Melbourne, Australia)American Heart Association 2010 Scientific Sessions• Background: Renal sympathetic efferent and afferent nerves are crucial for the initiation and maintenance of systemic hypertension Denervation of the renal sympathetic nerve to reduce BP has been attempted, unsuccessfully, by surgical means years ago• Population and treatment: 106 patients with resistant hypertension (SBP >160 mm Hg, or >150 mm Hg for those with type 2 diabetes, taking ≥ three antihypertensive drugs) Randomized 1:1 to renal denervation + previous treatment (n=52) or previous treatment alone (n=51)• Primary outcome: BP reduction at six months
SYMPLICITY HTN-2: Results• Average office-based BP in the renal-denervation group was reduced 32/12 mm Hg (average baseline 178/96 mm Hg) six months after the ablation• Between-group differences in BP at six months were 33/11 mm Hg (p<0.0001)• Of the patients in the ablation arm, 84% had a 10-mm-Hg or greater drop in SBP vs 35% of controls (p<0.0001)• There did not appear to be any adverse events: Imaging of renal arteries for damage showed no evidence of renal artery stenosis or aneurysmal dilatation during the six-month follow-up There were no changes in renal function, even in those with mild to moderate renal failure
SYMPLICITY HTN-2: Commentary*"This has the potential for really revolutionizing the way we treat resistanthypertension, which is an enormous clinical need." - Dr Suzanne Oparil"Ive never seen BP falls as big as this from any other treatment process, whichmakes the possibility of cure realistic; it might be within reach." - Dr Murray D Esler"My only reservation about the study is that they have not compared thedenervation with the most effective add-on drug in patients with resistanthypertension, which is spironolactone." - Dr Peter Sever*All comments from A revolutionary road for resistant hypertension? Renal denervation in SymplicityHTN-2 (http://www.theheart.org/article/1151787.do)
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