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2015 ; 8
(ä): 57-69
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Renal denervation for the management of resistant hypertension
#MMPMID26672761
Patel HC
; Hayward C
; Vassiliou V
; Patel K
; Howard JP
; Di Mario C
Integr Blood Press Control
2015[]; 8
(ä): 57-69
PMID26672761
show ga
Renal sympathetic denervation (RSD) as a therapy for patients with resistant
hypertension has attracted great interest. The majority of studies in this field
have demonstrated impressive reductions in blood pressure (BP). However, these
trials were not randomized or sham-controlled and hence, the findings may have
been overinflated due to trial biases. SYMPLICITY HTN-3 was the first randomized
controlled trial to use a blinded sham-control and ambulatory BP monitoring. A
surprise to many was that this study was neutral. Possible reasons for this
neutrality include the fact that RSD may not be effective at lowering BP in man,
RSD was not performed adequately due to limited operator experience, patients'
adherence with their anti-hypertensive drugs may have changed during the trial
period, and perhaps the intervention only works in certain subgroups that are yet
to be identified. Future studies seeking to demonstrate efficacy of RSD should be
designed as randomized blinded sham-controlled trials. The efficacy of RSD is in
doubt, but many feel that its safety has been established through the thousands
of patients in whom the procedure has been performed. Over 90% of these data,
however, are for the Symplicity? system and rarely extend beyond 12 months of
follow-up. Long-term safety cannot be assumed with RSD and nor should it be
assumed that if one catheter system is safe then all are. We hope that in the
near future, with the benefit of well-designed clinical trials, the role of renal
denervation in the management of hypertension will be established.