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‘Promising’ new technique for hard-to-treat hypertension

By Lilian Anekwe

A randomised controlled trial of renal denervation, a new technique to lower blood pressure in patients whose blood pressure has been resistant to current medications has shown large reductions in blood pressure, according to Australian research.

Renal denervation involved deactivating nerves in the kidney using a burst of radiofrequency energy delivered through a catheter.

In the study – published in the Lancet yesterday – 106 patients with a baseline systolic blood pressure of 160 mm Hg or more, or 150 mm Hg or more in patients with Type 2 diabetes despite taking three or more antihypertensive drugs, were randomly allocated to undergo renal denervation or to maintain previous treatment.

94% patients who underwent renal denervation and controls were assessed for the primary endpoint, a change in seated office-based measurement of systolic blood pressure at six months.

Office-based blood pressure measurements in the renal denervation group reduced by 32 mm Hg systolic and 12 mm Hg diastolic, from a baseline of 178/96 mm Hg, whereas they did not significantly differ from baseline in the control group.

At six months, 84% of patients who underwent renal denervation achieved the secondary endpoint, a reduction in systolic blood pressure of 10 mm Hg or more, compared with 35% of controls.

There were no serious procedure-related or device-related complications such as blood clots in the renal arteries and occurrence of adverse events did not differ between groups.

Professor Murray Esler, associate director of the Baker IDI heart and diabetes institute in Melbourne concluded: ‘Catheter-based renal denervation can safely be used to substantially reduce blood pressure in treatment-resistant hypertensive patients.’

Professor Bryan Williams, professor of medicine at Leicester University said: ‘The results of this preliminary study look promising. The main issues going forward will be longer term safety and effectiveness of the procedure. The other key issue is deciding if and when this would be used in the hierarchy of routine clinical practice.’

New technique for hard-to-treat hypertension