A Three-Arm Randomized Trial of Different Renal Denervation Devices and Techniques in Patients With Resistant...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Hypertension Management

Background:

• Resistant hypertension poses a significant clinical challenge.
• Endovascular renal sympathetic denervation (RDN) using radiofrequency (RF) and ultrasound technologies shows efficacy.
• Direct comparisons between RF and ultrasound RDN are limited.

Purpose of the Study:

• To compare the efficacy of endovascular ultrasound-based RDN versus RF-based RDN in patients with resistant hypertension.
• To evaluate different RF RDN strategies: main renal arteries only versus main arteries plus branches.
• To determine the primary endpoint of change in systolic daytime ambulatory blood pressure at 3 months.

Main Methods:

• A randomized head-to-head trial comparing three RDN strategies in 120 resistant hypertension patients.
• Group 1: RF RDN of main renal arteries.
• Group 2: RF RDN of main arteries, side branches, and accessories.
• Group 3: Ultrasound-based RDN of the main renal artery.

Main Results:

• All RDN approaches reduced systolic daytime ambulatory blood pressure by 3 months.
• Ultrasound RDN demonstrated a significantly greater blood pressure reduction compared to RF RDN of the main renal artery only (-13.2 vs -6.5 mm Hg).
• No significant difference in blood pressure reduction was observed between the two RF RDN strategies or between ultrasound RDN and the combined RF RDN approach.

Conclusions:

• Endovascular ultrasound-based RDN is superior to RF RDN targeting only main renal arteries for resistant hypertension.
• A comprehensive RF RDN approach including side branches and accessories did not yield superior outcomes compared to targeting main arteries alone.
• Ultrasound RDN presents a promising alternative for hypertension management.