A new option for the treatment of resistant hypertension, RDN will be praised again!

     Editor：Jiamo Ren Data：03-07-2020

Currently, one-third of adults worldwide have hypertension, and the prevalence of hypertension in low- and middle-income countries exceeds that in high-income countries. Patients with hypertension have higher cardiovascular events and stroke risk than their peers, and hypertension treatment is essential to prevent cardiovascular and kidney diseases. There is still a lot of room for improvement in the treatment of hypertension. In recent years, renal sympathetic denervation (RDN) has made good progress. During CIT 2020, our journal specially invited Professor Felix mahfoud of Saar University Hospital in Germany share us  his opinion on  SPYRAL HTN-OFF MED trial related issues.

 

International Circulation：Renal sympathetic denervation (RDN) is an emerging non-pharmacological method for the treatment of resistant hypertension.Would you please introduce us its current application status?

 

Prof.Felix mahfoud: Renal denervation is under investigation for the treatment of uncontrolled hypertension. We now have three randomized sham-controlled trials that have investigated renal denervation in patients who received medication, but also in patients who were not treated with concomitant anti-hypertensive medication. These randomized sham-controlled trials all prove the efficacy and safety of renal denervation as applied in these studies. The technologies used consisted of radiofrequency energy and ultrasound. So we have now a couple of clinical studies that prove the value of renal denervation in patients with hypertension. 

 

International Circulation：What are the current research evidences about RDN? What is the result?

 

Prof.Felix mahfoud: As I said, we now have three randomized sham-controlled trials that have proven the efficacy and safety of renal denervation. A couple of pivotal studies are ongoing. These studies will be used to obtain approval from the Food and Drug Administration in the United States. These are bigger studies. The first pivotal study has been competed, the SPYRAL HTN-OFF MED trial, and that confirmed the efficacy of renal denervation, and showed the superiority of the procedure compared to sham in patients not treated with any anti-hypertensive medication.

 

International Circulation：Excessive sympathetic nerve activation is a key factor in the development and maintenance of hypertension. How to evaluate the excitability of renal sympathetic nerves when applying RDN technology?

 

Prof.Felix mahfoud:  It is quite difficult in clinical practice to assess sympathetic nervous system activity in humans. There are no really reliable tests available. We have some surrogates of sympathetic activity that include blood pressure (the higher the blood pressure, the greater the fall we typically see following renal denervation), as well as heart rate. We have evidence indicating that patients with a higher heart rate tend to respond better to renal denervation than patients with a lower heart rate. Also obesity. Obese patients tend to have larger falls in blood pressure compared to lean patients. So these are all indirect surrogates of sympathetic activity, but to-date, we have not proven that a surrogate like catecholamine concentration in serum or plasma is a reliable assessment of sympathetic activity.