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Catheter-Based Renal Denervation: 9-Year Follow-Up Data on Safety and Blood Pressure Reduction in Patients With
Gianni Sesa-Ashton1,2, Janis M Nolde3, Ida Muente3
1Human Neurotransmitter and Neurovascular Hypertension and Kidney Diseases Laboratories (G.S.-A., R.L., Y.S., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne, Australia.
Insights
Catheter-based renal denervation (RDN) significantly lowers blood pressure in resistant hypertension patients long-term. This study shows sustained BP reduction and fewer medications up to 9 years post-procedure, with no adverse renal effects.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Catheter-based renal denervation (RDN) is a proven treatment for resistant hypertension.
- Long-term data on RDN's safety and efficacy beyond three years are limited.
- This study investigates outcomes of RDN in resistant hypertension patients with approximately 9-year follow-up.
Purpose of the Study:
- To evaluate the long-term safety and efficacy of catheter-based renal denervation (RDN).
- To assess blood pressure reduction and medication use up to 9 years post-RDN.
- To monitor renal function and identify any adverse consequences of RDN.
Main Methods:
- Recruitment of patients with resistant hypertension previously enrolled in RDN trials.
- Baseline and long-term follow-up assessments including medical history, blood pressure measurements (office and ambulatory), and laboratory tests.
- Analysis of changes in blood pressure, medication use, and renal function from baseline to long-term follow-up (mean 8.8 years).
Main Results:
- Ambulatory systolic blood pressure decreased by 12.1 mm Hg and diastolic by 8.8 mm Hg (P<0.0001).
- Patients used one less antihypertensive medication on average at long-term follow-up (P=0.0052).
- Renal function showed an expected age-related decline, with no RDN-specific adverse effects.
Conclusions:
- Catheter-based RDN provides significant and durable blood pressure reduction in patients with resistant hypertension.
- Long-term follow-up (≈9 years) demonstrates sustained efficacy with reduced medication needs.
- RDN is safe concerning renal function in the long term.
Background:
Recent sham-controlled randomized clinical trials have confirmed the safety and efficacy of catheter-based renal denervation (RDN). Long-term safety and efficacy data beyond 3 years are scarce. Here, we report on outcomes after RDN in a cohort of patients with resistant hypertension with an average of ≈9-year follow-up (FU).
Methods:
We recruited patients with resistant hypertension who were previously enrolled in various RDN trials applying radiofrequency energy for blood pressure (BP) lowering. All participants had baseline assessments before RDN and repeat assessment at long-term FU including medical history, automated office and ambulatory BP measurement, and routine blood and urine tests. We analyzed changes between baseline and long-term FU.
Results:
A total of 66 participants (mean±SD, 70.0±10.3 years; 76.3% men) completed long-term FU investigations with a mean of 8.8±1.2 years post-procedure. Compared with baseline, ambulatory systolic BP was reduced by -12.1±21.6 (from 145.2 to 133.1) mm Hg (P<0.0001) and diastolic BP by -8.8±12.8 (from 81.2 to 72.7) mm Hg (P<0.0001). Mean heart rate remained unchanged. At long-term FU, participants were on one less antihypertensive medication compared with baseline (P=0.0052). Renal function assessed by estimated glomerular filtration rate fell within the expected age-associated rate of decline from 71.1 to 61.2 mL/min per 1.73 m2. Time above target was reduced significantly from 75.0±25.9% at baseline to 47.3±30.3% at long-term FU (P<0.0001).
Conclusions:
RDN results in a significant and robust reduction in both office and ambulatory systolic and diastolic BP at ≈9-year FU after catheter-based RDN on less medication and without evidence of adverse consequences on renal function.
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