New data show promise for renal denervation in hypertension
Renal denervation provides meaningful reductions in systolic blood pressure (BP) in hypertensive patients on or off BP-lowering medications, results of the SPYRAL HTN-ON MED and RADIANCE-HTN SOLO trials have shown.
In SPYRAL HTN-ON MED, 467 patients with uncontrolled hypertension despite the use of up to three antihypertensive medications were randomized to undergo renal denervation or a sham control procedure. Results from the first 80 patients showed significantly greater reductions in the renal denervation vs sham control group in office systolic BP (difference, -6.8 mm Hg; p=0.05), 24-hour systolic BP (difference, -7.4 mm Hg; p=0.0051), office diastolic BP (difference, -3.5 mm Hg; p=0.0478) and 24-hour diastolic BP (difference, -4.1 mm Hg, p=0.0292) at 6 months. [Lancet 2018, doi: https://doi.org/10.1016/S0140-6736(18)30951-6]
In RADIANCE-HTN SOLO, 146 patients with hypertension after discontinuation of up to two antihypertensive medications were randomized to undergo renal denervation or a sham procedure. At 2 months, patients in the renal denervation group had greater reductions in daytime ambulatory systolic BP than those in the sham control group (difference, -6.3 mm Hg; p=0.0001). [Lancet 2018, doi: https://doi.org/10.1016/S0140-6736(18)31082-1]
The two trials enrolled different patient populations. In SPYRAL HTN-ON MED, eligible patients had an office systolic BP of 150–180 mm Hg and a diastolic BP of ≥90 mm Hg, a 24-hour ambulatory systolic BP of 140–170 mm Hg at second screening, and were on 1–3 antihypertensive medications at stable doses for at least 6 weeks. In contrast, RADIANCE-HTN SOLO enrolled patients with ambulatory BP of ≥135/85 mm Hg and <170/105 mm Hg after a 4-week discontinuation of ≤2 antihypertensive medications.
No major adverse events were reported for either procedure in both trials. In SPYRAL HTN-ON MED, adherence to antihypertensive medications was incomplete, at about 60 percent, and varied for individual patients throughout the trial.