Efficacy and safety of renal denervation in elderly patients with resistant hypertension

Abstract

According to our findings, a similar magnitude of BP reduction as reported in previous trials can be expected in elderly patients. Elderly patients with rHTN should not be excluded from renal denervation.

Con: Renal denervation for all resistant hypertensive patients: the Emperor's new clothes

“…While RDN remained an experimental procedure in the USA, pending the results of Symplicity HTN-3 [8] (NCT01418261), a large randomized controlled trial including a sham procedure, reimbursement of RDN was granted in Germany, Australia, the Netherlands, Switzerland and Sweden, leading to an outburst in the number of procedures performed (>5000 worldwide, of which 600 in a single German centre) (). RDN was applied indiscriminately to patients with white-coat resistant hypertension [9], isolated systolic hypertension [10], stenotic [11] or stented [12] renal arteries and even in a patient with Münchausen syndrome [13]. Finally, based almost exclusively on observational, small studies, RDN was proposed as a potential treatment in a host of medical conditions, including chronic kidney disease, atrial fibrillation, heart failure, obstructive sleep apnoea, metabolic syndrome and polycystic ovary syndrome [14].…”

Can we predict the blood pressure response to renal denervation?

“…However, a few studies have been designed, at least in part, to test prospectively the effect of RDN on BP in specific patient groups, e.g. elderly subjects [12]. …”

Ethnicity and sympathetic tone: predictors of the blood pressure response to renal denervation?

“…[3][4][5][6] An additional seven studies that showed no decrease in 24-h ambulatory blood pressure after renal denervation were also not mentioned. [7][8][9][10][11][12][13] Admittedly, patient numbers in these 11 trials were small (n = 6-24), and the majority of clinical studies reported have shown a reduction in blood pressure with renal denervation. Nevertheless, being aware of these negative findings is important.…”

“…Nevertheless, being aware of these negative findings is important. [3][4][5][6][7][8][9][10][11][12][13] For example, Fadl Elmula et al reported that in six patients with true resistant hypertension, office blood pressure remained unchanged at 1, 3 and 6 months after renal denervation. 3 This study was the first to use witnessed intake of medication to exclude patients with poor drug adherence.…”