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The DENERHTN Randomized Controlled Trial: Renal Denervation for Resistant Hypertension Revisited

17 Feb, 15 | by Alistair Lindsay

Despite large reductions in blood pressure seen in early studies of renal denervation, the SYMPLICITY HTN-3 randomized trial failed to show a reduction in systolic blood pressure with renal denervation when compared to medical therapy alone. As a result, interest in renal denervation as a treatment for resistant hypertension has waned.  In the DENERHTN trial, Azizi and colleagues assessed the incremental benefit of adding renal denervation to standardized stepped-care antihypertensive treatment (SSAHT) for patients with resistant hypertension in an open-label, randomized-controlled trial with blinded endpoint evaluation. After four weeks of a standardized anti-hypertensive regimen to confirm resistant hypertension, patients were randomized to renal denervation in addition to SSAHT versus SSAHT alone. more…

Renal denervation misses the mark in resistant hypertension

8 Jun, 14 | by Alistair Lindsay

The prospect of percutaneous renal-artery denervation to treat hypertension has been widely heralded in response to pilot studies that demonstrated marked reductions in blood pressure after renal denervation.  Despite the rapid adoption of catheter-based renal artery denervation, data from large scale randomised controlled trials remains absent.  A total of  535 patients with severe resistant hypertension were randomized in a 2:1 ratio to renal denervation or a sham procedure consisting of renal angiography alone.  All study patients were receiving a minimum of three antihypertensive medications, including a diuretic, with persistently elevated systolic blood pressures of 160mmHg or more. The primary end point was the change in office systolic blood pressure at 6 months.  The change in mean 24-hour ambulatory systolic pressure at 6 months was used as a secondary end-point.   Compared with the sham procedure, renal-artery denervation resulted in no significant reductions in blood pressure as determined by office measurement of systolic pressure (-14.13±23.93 mm Hg vs -11.74±25.94 mm Hg; difference of -2.39 mm Hg, 95% confidence interval [CI] -6.89 to 2.12; P=0.26) or mean 24-ambulatory pressure (-6.75±15.11 mmHg vs. -4.79±17.25 mmHg; difference of -1.96 mm Hg, 95% CI, -4.97 to 1.06; P=0.98). more…

Blood pressure control, not the specific medication regimen, is what matters

22 Nov, 13 | by Alistair Lindsay

The Blood Pressure Lowering Treatment Trialists’ Collaboration examined primary data from 23 trials as well as summary data from an additional 3 trials to define the cardiovascular effects of lowering blood pressure in people with and without chronic kidney disease.  This study included randomized trials of drugs to lower blood pressure that were compared to placebo or other drugs with at least 1000 patient years of follow up in each treatment arm.  The primary outcome was major cardiovascular events (the composite of stroke, myocardial infarction, heart failure or cardiovascular death), with secondary outcomes of each element of the composite outcome as well as all-cause mortality.  These 26 trials included 152,290 patients, of which 30,295 had impaired renal function (estimated glomerular filtration rate [eGFR] of < 60 mL/min/1.73m2).   Meta-analysis according to baseline kidney function was performed and pooled hazard ratios were estimated per 5 mm Hg lower systolic blood pressure.   Blood pressure lowering was found to reduce the risk of the primary outcome by approximately 17% per 5 mm Hg reduction in systolic blood pressure, regardless of eGFR .  Furthermore, there was no evidence of any difference in effect by choice of blood pressure control regimen. more…

Low awareness, treatment and control of hypertension across the globe

22 Nov, 13 | by Alistair Lindsay

Hypertension is associated with 7.6 million deaths worldwide and is the leading modifiable risk factor for cardiovascular disease (CVD). However, global studies of hypertension prevalence, awareness, treatment, and control are lacking. The PURE (Prospective Urban Rural Epidemiology) study involves urban and rural communities in 3 high-income, 10 middle-income, and 4 low-income countries. CVD risk factors including blood pressure readings were collected by trained professionals from 142,042 adults aged 35 – 70 years between January 2003 and December 2009. Overall, 40.8% of participants had hypertension, only 46.5% of hypertensive patients were aware of their condition, and 40.6% of hypertensive patients were receiving treatment. Only 13.2% of hypertensive patients were controlled (<140/90 mmHg). Lowest rates of awareness, treatment and control were seen in low-income countries.  more…

Catheter-based treatment of hypertension shows promise

14 Apr, 09 | by Alistair Lindsay

Renal sympathetic efferent and afferent nerves are crucial for the initiation and maintenance of systemic hypertension, and as such renal sympathetic denervation is a potential therapeutic target for hypertension.Krum et al. describe the development of a novel, percutanoeus, catheter-based approach to renal sympathetic denervation.The lumen of the main renal artery is cannulated and the surrounding sympathetic nerves destroyed by radiofrequency waves, and in a swine model this technique has been shown to reduce noradrenaline content in the kidney by as much as 85%. more…

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