Medication Changes After Renal Denervation: Current Evidence and Patient Perspectives

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Hypertension Management

Background:

• Renal denervation (RDN) is an established adjunct therapy for hypertension.
• RDN demonstrates consistent blood pressure-lowering efficacy and a favorable safety profile.
• Changes in antihypertensive medication (AHM) burden are a significant outcome of RDN.

Purpose of the Study:

• To review current clinical trials and patient perspectives on AHM use following RDN.
• To analyze the impact of RDN on medication burden across different follow-up durations.
• To identify gaps between RDN evidence and patient expectations regarding medication changes.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) and patient data.
• Analysis of AHM burden in patients undergoing RDN compared to sham controls.
• Examination of medication changes at follow-ups of ≤6 months and >6 months.

Main Results:

• RCTs show RDN leads to lower blood pressure with similar AHM burden or similar blood pressure with reduced AHM burden.
• Short-term follow-ups (≤6 months) show stable or increased AHM use, potentially due to study protocols.
• Long-term follow-ups (>6 months) indicate consistent blood pressure reduction with decreasing or stable AHM burden, with some exceptions.

Conclusions:

• RDN consistently lowers blood pressure and can reduce medication burden over time.
• Discrepancies exist between RDN evidence and patient expectations for medication reduction.
• Improved communication, shared decision-making, and refined RDN procedures are needed. Novel methods to assess medication burden changes are recommended.