Renal ablation for treatment of hypertension without Symplicity catheter: The first human experience

Hypertension (HTN) treatment has remained insufficient. New modalities such as "Symplicity method" for the treatment of HTN are a priority, especially in patients with resistant hypertension. In this study, we describe our first experience with a novel percutaneous treatment modality, without using Symplicity catheter.

30 Patients who were resistant to at least three types of antihypertensive medical therapy were selected. Patients received percutaneous renal artery denervation, without Symplicity catheter method, and were followed up for 1 week, 1, 3, and 6 months later after treatment. Ambulatory 24-hour blood pressure (BP) Holter was performed 1 week before intervention and after 1 month. The primary outcome was change in 24-hour ambulatory BP and change in office and home-based BP measurements.

The mean age of the studied patients was 52 ± 15.4 years and 43.3% (n = 13) were female. Systolic and diastolic BP at baseline was 163 ± 17.2 and 95 ± 8.2 mmHg, respectively. Patients took 3.6 ± 1.3 hypertensive medications. Systolic and diastolic BP at 1-week, 1-month, 3-month and 6-month after renal denervation significantly decreased compared to the baseline (P < 0.0001). Average BP derived from 24-hour ambulatory BP monitoring changed in parallel with office-based BP measurements. Most of patients (50%) who underwent renal denervation had reductions of 10 mmHg or greater in systolic BP and 56.7% of them had reductions of 5 mmHg or greater in diastolic BP. 33.3% of patients also achieved the target of systolic BP less than 140 mmHg and 60% achieved the target of diastolic BP less than 90 mmHg. No patients showed vascular damage at final angiography.

Catheter based renal ablation was associated with a significant reduction in both systolic and diastolic BP, on top of maximal medical therapy, which persisted throughout 6 months follow-up in the first-in-man study without the Symplicity catheter.