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Updated: Apr 26, 2026
Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Interventional management in hypertension: where do we stand?
1Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Philadelphia, USA.
Insights
Recent device-based interventions for drug-resistant hypertension show promise, with significant blood pressure reductions observed. However, the leading renal denervation trial failed its primary endpoint, prompting further investigation into techniques and patient selection for this complex condition.
Area of Science:
- Cardiology
- Nephrology
- Hypertension Management
Background:
- Drug-resistant hypertension presents complex management challenges.
- Device-based interventions are evolving as a therapeutic option.
- Recent advancements focus on improving blood pressure control in resistant cases.
Purpose of the Study:
- To review recent developments in device-based interventions for blood pressure management.
- To analyze new findings in the treatment of drug-resistant hypertension.
- To discuss the implications of recent clinical trial outcomes.
Main Methods:
- Literature review of published studies and abstracts from the past year.
- Analysis of clinical trial data, focusing on efficacy and outcomes.
- Exploration of potential reasons for trial failures and future research directions.
Main Results:
- Significant systolic blood pressure reductions (approx. 25 mmHg at 6 months) reported in some studies.
- The largest renal denervation trial (Symplicity HTN3) did not meet its primary efficacy endpoint.
- Speculations on the reasons for the trial's failure are discussed.
Conclusions:
- Current guidelines offer limited direction for drug-resistant hypertension due to a lack of hard cardiovascular outcome trials.
- The failure of the Symplicity HTN3 trial necessitates re-evaluation of renal denervation techniques and patient selection.
- Further research is needed to identify predictors of response and optimize denervation strategies, viewing the setback as a prompt for improvement rather than a definitive end.
Purpose Of Review:
Device-based interventions to lower drug-resistant hypertension have made the management of this disorder more complicated. In this review, we will focus on developments in this approach to blood pressure care which have appeared over the last year in a published or abstract form.
Recent Findings:
Much of the recent literature in this area is characterized by very large office systolic blood pressure reductions, on the order of 25 mmHg at 6 months after intervention. However, the largest and the most rigorously conducted trial of renal denervation failed to meet its efficacy endpoint. We will review some speculations on why that may have occurred.
Summary:
There is little guidance for the management of drug-resistant hypertension in existing guidelines due largely to an absence of clinical trials with hard cardiovascular outcomes; thus, most of the literature relies on short-term (generally less than 1 year) studies that are oriented toward efficacy (i.e., blood pressure reduction per se). With the failure of the Symplicity HTN3 trial to meet its efficacy endpoint, the entire field of renal denervation is under careful scrutiny. From this reviewer's perspective, this finding seems to be more of a speed-bump than a 'road closed' sign for renal denervation, a prompt to reconsider the adequacy of denervation techniques and an encouragement to continue the search for robust predictors of clinical response.
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