Surgery successful for treating hypertension
Author: Ingrid Torjesen
A one-off operation that targets the nerves connected to the kidney has been found to maintain reduced blood pressure in hypertension patients for at least six months, in a clinical trial* published in the journal Circulation and presented at the American College of Cardiology Conference in New Orleans, USA.
Patients treated with the procedure required fewer blood pressure medications.
If the findings are confirmed in larger and longer clinical trials, the surgery could offer hope to patients with high blood pressure who do not respond to drugs, and are at increased risk of cardiovascular diseases, including stroke and heart attack.
The international clinical trial tested a one-hour operation called ‘renal denervation’, which uses ultrasound energy to disrupt the nerves between the kidneys and the brain. Patients in the United States, France, Germany, the Netherlands, Belgium and the United Kingdom were randomised to receive either ‘renal denervation’ or a ‘sham procedure’.
Initial results from the trial showed that ‘renal denervation’ led to a significant and safe blood pressure lowering effect after two months in patients not taking antihypertensive medication.
For this study the team followed up 140 patients to see if ‘renal denervation’ remained effective in patients who had the option of restarting their blood pressure medication if required.
They found that the blood pressure lowering effect of ‘renal denervation’ was maintained six months after the operation, with a greater proportion of patients treated with ‘renal denervation’ (58%) achieving blood pressure control compared to ‘sham’ (42%). Blood pressure was also reduced to a greater extent with ‘renal denervation’ compared with the ‘sham procedure’ (18.1 mmHg compared to 15.6 mmHg) at six months
Though the majority of patients needed the addition of medications to improve blood pressure control, more than twice as many patients were completely free of medication at six months in the treatment arm versus ‘sham’ arm (35.8% versus 15.5 %).
UK principal investigator Professor Melvin Lobo from Queen Mary University of London and Barts Health NHS Trust said: “These results point towards an exciting future for this new technology. If long term safety and efficacy is proven in larger trials which are currently under way, we hope that renal denervation therapy could soon be offered as an alternative to many lifelong medications for hypertension.”
*Azizi M, Schmieder RE, Mahfoud F, et al. Six-Month Results of Treatment-Blinded Medication Titration for Hypertension Control Following Randomization to Endovascular Ultrasound Renal Denervation or a Sham Procedure in the RADIANCE-HTN SOLO Trial. Circulation 17 March 2019, DOI: 10.1161/CIRCULATIONAHA.119.040451Circulation.