Reply

Abstract

We would like to thank Dr. Donatella Schiavone and colleagues for their interest and comments regarding our findings. We gladly take the opportunity to reply to their letter and add our concerns and viewpoints.Renal denervation (RDN) is an emerging research field that has attracted much attention recently but has been controversial. The dispute focuses on whether RDN is effective and usable in treating patients with hypertension and resistant hypertension. It also questions whether the existing RDN from the intima of the renal artery (intima-RDN) can reduce blood pressure and, subsequently, long-term cardiovascular events.Evidently, intimal injury is the initiating factor of atherosclerosis.Data from our team's previous studies suggest that intima-RDN may induce or trigger renal artery injury or stenosis. [1][2][3][4] Therefore, similar to the opinion of Dr. Donatella Schiavone and colleagues, even if intima-RDN can control blood pressure, it is not worth promoting.In 2012, a rare opportunity for our team to implement RDN from the adventitia of the renal artery (adventitia-RDN) in a patient with resistant hypertension produced surprising results. 5 To date, the patient's blood pressure remains well controlled, and he has recovered well from preoperative stroke, cerebral hemorrhage, and neurological dysfunction. This result has aroused our great interest in exploring the adventitia-RDN. Therefore, we designed a clinical trial on the treatment of resistant hypertension with adventitia-RDN. However, after approval by our hospital ethics committee, the progress of patient enrollment was slow-moving. We considered attributing this to the invasiveness of the surgical process, which may be traumatic for most patients who only take antihypertensive drugs. Thus, we revised our inclusion criteria to include patients with unilateral aldosteroneproducing adenoma (APA) complicated with resistant hypertension who needed laparoscopic surgery, considering that adventitia-RDN is laparoscopic-assisted. We obtained re-approval from the ethics committee of our hospital afterward. All patients signed the informed consent and were enrolled in the clinical trial for about 6 years. Although the sample size was small, the feasibility, safety, methodology, and preliminary efficacy of adventitia-RDN were preliminarily discussed. Sur-This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Primary Aldosteronism and Drug Resistant Hypertension: A “Chicken-Egg” Story

“…Lastly, along the recent wave of new interest for renal denervation in RH patients, scant data are available about patients with aldosterone excess, mostly because secondary cause of hypertension represents an exclusion criterion. In one trial, Liu et al [95] compared adrenalectomy plus renal denervation applied to the adventitia of the renal artery with adrenalectomy alone in PA patients with RH: a more significant reduction in BP in the first group (42.2 ± 21.6 mmHg vs 29.8 ± 13.5 mmHg, p = 0.029 between the groups) along with an overall good safety profile were claimed, but doubts remain on the rationale and utility of the procedure considering the proven efficacy of adrenalectomy itself [96,97].…”