|Home > Application > Hypertension|
Lancet. 2010 Dec 4;376(9756):1903-9. Epub 2010 Nov 17. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Symplicity HTN-2 Investigators, Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Bohm M. Collaborators (44) Bohm M, Mahfoud F, Sievert H, Wunderlich N, Rump LC, Vonend O, Schmieder RE, Uder M, Lobo M, Caulfield M, Erglis A, Azizi M, Sapoval M, Thambar S, Persu A, Renkin J, Schunkert H, Weil J, Hoppe UC, Krum H, Walton T, Schlaich MP, Esler MD, Scheinert D, Binder T, Januszewicz A, Witkowski A, Ruilope LM, Whitbourn R, Bruck H, Downes M, Luscher TF, Jardine AG, Webster MW, Zeller T, Sadowski J, Bartus K, Sobotka PA, Straley CA, Barman NC, Lee DP, Witteles RM, Bhalla V, Massaro JM. Source Baker IDI Heart and Diabetes Institute, PO Box 6492, St Kilda Road, Central Melbourne, VIC 8008, Australia. email@example.com Abstract BACKGROUND: Activation of renal sympathetic nerves is key to pathogenesis of essential hypertension. We aimed to assess effectiveness and safety of catheter-based renal denervation for reduction of blood pressure in patients with treatment-resistant hypertension. METHODS: In this multicentre, prospective, randomised trial, patients who had a baseline systolic blood pressure of 160 mm?Hg or more (≥150 mm?Hg for patients with type 2 diabetes), despite taking three or more antihypertensive drugs, were randomly allocated in a one-to-one ratio to undergo renal denervation with previous treatment or to maintain previous treatment alone (control group) at 24 participating centres. Randomisation was done with sealed envelopes. Data analysers were not masked to treatment assignment. The primary effectiveness endpoint was change in seated office-based measurement of systolic blood pressure at 6 months. Primary analysis included all patients remaining in follow-up at 6 months. This trial is registered with ClinicalTrials.gov, number NCT00888433. FINDINGS: 106 (56%) of 190 patients screened for eligibility were randomly allocated to renal denervation (n=52) or control (n=54) groups between June 9, 2009, and Jan 15, 2010. 49 (94%) of 52 patients who underwent renal denervation and 51 (94%) of 54 controls were assessed for the primary endpoint at 6 months. Office-based blood pressure measurements in the renal denervation group reduced by 32/12 mm?Hg (SD 23/11, baseline of 178/96 mm?Hg, p<0.0001), whereas they did not differ from baseline in the control group (change of 1/0 mm?Hg [21/10], baseline of 178/97 mm?Hg, p=0?77 systolic and p=0?83 diastolic). Between-group differences in blood pressure at 6 months were 33/11 mm?Hg (p<0.0001). At 6 months, 41 (84%) of 49 patients who underwent renal denervation had a reduction in systolic blood pressure of 10 mm?Hg or more, compared with 18 (35%) of 51 controls (p<0?0001). We noted no serious procedure-related or device-related complications and occurrence of adverse events did not differ between groups; one patient who had renal denervation had possible progression of an underlying atherosclerotic lesion, but required no treatment. INTERPRETATION: Catheter-based renal denervation can safely be used to substantially reduce blood pressure in treatment-resistant hypertensive patients.