Catheter-Based Renal Denervation for Resistant Hypertension

March 29, 2014

Catheter-Based Renal Denervation for Resistant Hypertension

  1. Allan S. Brett, MD

This procedure did not lower blood pressure significantly in a sham-controlled trial.

  1. Allan S. Brett, MD

Catheter-based radiofrequency denervation of the renal arteries has recently been developed as a possible treatment alternative for resistant hypertension. In the SYMPLICITY HTN-2 trial, renal denervation lowered blood pressure (BP) significantly at 6 months, compared with no intervention, in patients with resistant hypertension (NEJM JW Gen Med Dec 28 2010). Now we have the next step: the sham-controlled SYMPLICITY HTN-3 trial. The trial involved 535 patients with mean office systolic BPs >160 mm Hg despite treatment with at least three BP drugs at maximally tolerated doses. Patients were randomized to renal angiography plus renal-artery denervation or to a sham procedure (renal angiography only). Medication changes were not permitted during follow-up unless compelling reasons developed.

At 6 months, mean office systolic BP decreased by 14 mm Hg in the denervation group and 12 mm Hg in the sham group, a nonsignificant difference. Additionally, no differences were seen between groups in diastolic BP or 24-hour ambulatory BP measurements. Medications were changed in a minority of participants, with no differences between groups in types and numbers of medication changes. No major adverse events were noted.


This sham-controlled trial did not confirm previously reported positive results from uncontrolled or non-placebo-controlled studies; thus, renal denervation should still be considered unproven. Follow-up in SYMPLICITY HTN-3 will continue for 5 years to determine whether benefits or harms will emerge with time. Long-term outcomes of interest include not only blood pressure control but also effects on cardiovascular and renal endpoints. Finally, the procedure could have value if it allowed a patient with resistant hypertension to maintain a consistent BP while eliminating several poorly tolerated drugs.

Editor Disclosures at Time of Publication

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose


Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.