Health-Related Quality of Life After Renal Denervation in Patients With Treatment-Resistant Hypertension

Abstract

T he recent development and implementation of a percutaneous endovascular approach to ablate the renal sympathetic nerves has resulted in significant and sustained blood pressure reduction in patients with hypertension resistant to pharmacotherapy. [1][2][3] Although the catheter-based approach in this context represents an exciting and innovative development, surgical sympathectomy for the treatment of hypertension has a considerable history, with procedures predominantly being performed before the advent of more efficacious and varied pharmacotherapy. Although blood pressure reduction in response to surgical sympathectomy was encouraging, it should be noted that responses were variable and interventions were not without complications. Freyberg and Peet 4 reported a significant blood pressure reduction of ≈30/15 mm Hg ≥3 months after bilateral splanchnicectomy. Reports by Hoobler et al 5 and Smithwick and Thompson 6 noted a fall in blood pressure in 29% to 45% of patients 1 to 5 years postsympathectomy. These early studies, although principally dedicated to surgical development, blood pressure reduction, and mortality, also noted that benefits associated with sympathetic denervation may extend to improvement in renal function 4,7 and cardiac structure. 5 Similar findings have now been reported for renal denervation achieved using a catheter-based approach without significant side effects. [8][9][10] Interestingly, Hoobler et al also reported that subjective symptoms, including headache, dizziness, irritability, and nervousness, seemed to be improved disproportionately to the reduction in blood pressure and that 95% of patients expressed satisfaction that they underwent surgery. These observations are supported by Crile, 11 who noted that, in addition to effects on blood pressure, celiac ganglionectomy was associated with the alleviation of nervousness, fatigue, and irritability in 78% of cases, with patients becoming calmer and more equable in temperament. These findings suggest that sympathetic denervation, in the context of treatment of hypertension, is associated with an improvement in health-related quality of life.Abstract-Recent studies have demonstrated the effectiveness of radiofrequency ablation of the renal sympathetic nerves in reducing blood pressure (BP) in patients with resistant hypertension.

Prevalence and Characteristics of Treatment-Resistant Hypertension among Hypertensive Japanese Outpatients

“…In terms of surrogate endpoints, there is already evidence that renal denervation decreases arrhythmias such as atrial fibrillation, proteinuria, diabetes, sleep apnea syndrome, congestive heart failure, arteriosclerosis, and left ventricular remodeling [24]- [31]. More recently, it was reported that renal denervation improves depression and the quality of life [32] [33], while targeting suitable patients may contribute to reduction of medical expenses.…”

Sympathetic Nervous System and Hypertension

“…10 There was improvement in several items on the 36-Item Short-Form Health Survey and the Mental Component Summary. However, this improvement was not directly associated with the magnitude of the blood pressure reduction.…”

Recent Clinical Trials of Hypertension Management

“…As well as BP reduction there is preliminary evidence after treatment of effects on central noradrenergic activity, 6 preserved renal function, 7 metabolic benefits, and improved quality of life measures. 8 Before handing management of resistant hypertension over to the interventionists, however, there is evidence that pharmacological management could be improved with evidence-based regimens. [9][10][11][12] There is a need for rigorous trial design, comparisons with benchmark pharmacotherapy, and better classification of patient groups that will benefit from renal denervation therapy.…”