Background: Renal sympathetic denervation (RDN) has been done in thousands of patients with apparent treatment resistant hypertension (TRH). However, the randomized and controlled documentation that RDN lowers blood pressure (BP) is limited. We aimed to investigate the BP lowering effect of RDN versus clinically adjusted drug treatment in true TRH after excluding patients with confounding poor drug adherence. Methods: Patients with apparent TRH (n=68) were referred to this trial. TRH was defined as office systolic BP>140 mmHg despite maximally tolerated doses of at least 3 antihypertensive drugs including a diuretic. Additionally, ambulatory daytime systolic BP>135 mmHg following witnessed intake of antihypertensive drugs was required. After a thorough clinical work-up, 49 patients were excluded mainly due to normal ambulatory daytime systolic BP (n=20) of whom 14 patients showed to have poor drug adherence. Patients with true TRH (n=19) were randomized to RDN (n=9) performed with SymplicityTM Catheter System versus clinically adjusted drug treatment according to ESH/ESC guidelines and guided by impedance cardiography (n=10). Results: BPs decreased significantly from baseline to 3 months (p<0.05) in the patients who had adjustments in their drug treatment compared to the RDN patients. Conclusion: Our findings suggest that adjusted drug treatment has superior BP lowering effects compared to RDN in patients with true TRH among whom patients with confounding poor drug adherence have been excluded. (Figure Presented).
Elmula, F. E. M. F., Hoffmann, P., Larstorp, A. C., Hoieggen, A., & Kjeldsen, S. (2014). ADJUSTED DRUG TREATMENT IS SUPERIOR TO RENAL SYMPATHETIC DENERVATION IN PATIENTS WITH TRUE TREATMENT RESISTANT HYPERTENSION, A RANDOMIZED CLINICAL TRIAL. Journal of the American College of Cardiology, 63(12), A1306. https://doi.org/10.1016/s0735-1097(14)61306-1