Renal Denervation After SYMPLICITY HTN-3: Where Do We Go?

Previous preclinical and clinical studies provide insight into the mechanisms that account for the chronic lowering of blood pressure (BP) during suppression of central and peripheral sympathetic outflow. From these mechanisms, novel and alternative approaches to BP control in patients with hypertension resistant to medical therapy have been proposed. Over the past 5 years, data from prospective cohorts and randomized studies showed that renal denervation therapy is a safe procedure associated with a significant reduction of office BP but only a modest reduction in ambulatory BP despite intensive ongoing medical therapy. Recently, the failure of the most rigourously designed randomized study, SYMPLICITY HTN-3, to meet its primary efficacy end point has raised several questions and unresolved methodological issues. Further prospective randomized controlled trials are required to further assess the efficacy, durability, and cost-effectiveness of renal denervation therapy and its effects on cardiovascular and renal outcomes in carefully selected patients with true treatment-resistant hypertension.