Renal Denervation, R.I.P.?
Renal Denervation, R.I.P.?
Hello. This is Jeffrey Berns, Editor-in-Chief of Medscape Nephrology. During the past several years, I have been closely following reports about using catheter-based renal denervation for treatment of resistant hypertension. This sure seemed to me and many of my colleagues to be a very exciting new tool in our armamentarium for management of patients with resistant hypertension. The early clinical trials looked very, very positive, and this seemed to be a very exciting advance.
This all came to a screeching halt earlier this month when Medtronic issued a press release stating that it was halting its US pivotal trials using renal denervation for treatment of severe hypertension because the study failed to reach its primary efficacy endpoint, although it did meet its primary safety endpoint.
This was a randomized controlled trial with a sham denervation procedure as the placebo control arm. All patients continued to take antihypertensive medications. We do not yet know whether intensive medical therapy was better than renal denervation or whether neither of these was particularly effective in managing resistant hypertension in these patients, so we will have to wait and see what the results are.
An interesting paper by Jin, Persu, and Staessen was published in the journal Current Opinion in Nephrology and Hypertension at the end of 2013. This review, "Renal Denervation and the Management of Resistant Hypertension: Current Evidence and Perspectives," is a very nice critique of the earlier renal denervation trials. The paper lists a number of trials that are ongoing, with a variety of different disease conditions and endpoints, so I am sure we will hear more about this technique as time goes on.
Although I believe that people are feeling dejected in the hypertension world because this strategy may not come to fruition, perhaps there is a bright side to this, in that it speaks to the value of nephrologists and others to medically manage resistant hypertension. Of course, we may find out that neither medical management nor renal denervation was effective. But assuming that well-thought-out, aggressive medical care with appropriate doses of appropriate medications can be effective for resistant hypertension, this may be an opportunity for non-interventional hypertension specialists to step up and provide care for this difficult population.
Stay tuned. I am sure that we will be hearing much more from Medtronic and other companies that are involved in this arena. I am also sure that we soon will see the results of the SYMPLICITY-3 hypertension trials published. Maybe we will see the end of this, but perhaps there will be a place for it in certain selected patients.
Again, this is Jeffrey Berns, Editor-in-Chief of Medscape Nephrology, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
Hello. This is Jeffrey Berns, Editor-in-Chief of Medscape Nephrology. During the past several years, I have been closely following reports about using catheter-based renal denervation for treatment of resistant hypertension. This sure seemed to me and many of my colleagues to be a very exciting new tool in our armamentarium for management of patients with resistant hypertension. The early clinical trials looked very, very positive, and this seemed to be a very exciting advance.
This all came to a screeching halt earlier this month when Medtronic issued a press release stating that it was halting its US pivotal trials using renal denervation for treatment of severe hypertension because the study failed to reach its primary efficacy endpoint, although it did meet its primary safety endpoint.
This was a randomized controlled trial with a sham denervation procedure as the placebo control arm. All patients continued to take antihypertensive medications. We do not yet know whether intensive medical therapy was better than renal denervation or whether neither of these was particularly effective in managing resistant hypertension in these patients, so we will have to wait and see what the results are.
An interesting paper by Jin, Persu, and Staessen was published in the journal Current Opinion in Nephrology and Hypertension at the end of 2013. This review, "Renal Denervation and the Management of Resistant Hypertension: Current Evidence and Perspectives," is a very nice critique of the earlier renal denervation trials. The paper lists a number of trials that are ongoing, with a variety of different disease conditions and endpoints, so I am sure we will hear more about this technique as time goes on.
Although I believe that people are feeling dejected in the hypertension world because this strategy may not come to fruition, perhaps there is a bright side to this, in that it speaks to the value of nephrologists and others to medically manage resistant hypertension. Of course, we may find out that neither medical management nor renal denervation was effective. But assuming that well-thought-out, aggressive medical care with appropriate doses of appropriate medications can be effective for resistant hypertension, this may be an opportunity for non-interventional hypertension specialists to step up and provide care for this difficult population.
Stay tuned. I am sure that we will be hearing much more from Medtronic and other companies that are involved in this arena. I am also sure that we soon will see the results of the SYMPLICITY-3 hypertension trials published. Maybe we will see the end of this, but perhaps there will be a place for it in certain selected patients.
Again, this is Jeffrey Berns, Editor-in-Chief of Medscape Nephrology, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.