10-year follow-up of patients treated with catheter-based renal denervation for resistant hypertension: an...

Catheter-based renal denervation of the sympathetic nerves (RDN) is still not a generally accepted treatment option for patients with resistant hypertension. Data on long-term outcomes, efficacy and safety beyond three years are scarce. We aimed to report the clinical outcomes after RDN in a cohort of 19 patients with resistant hypertension, followed for up to 11 years.

We reviewed patient records from all consecutive patients who underwent RDN between January 2012 and October 2013. All recorded measurements of office blood pressure (BP) listed in the patient file, antihypertensive medications, cardiovascular events, and renal function between 2012 and 2023 were collected. For each year of follow-up (FU), the median office BP was calculated based on all available recordings. The primary endpoint was the change in systolic and diastolic office BP from baseline (prior RDN) to the final year of FU. A secondary endpoint was the change in office BP from baseline to the mean office BP across the entire FU period.

A total of 19 consecutive patients underwent RDN treatment, 10 men and 9 women with a median age of 63 years (range 35-74 years). The median patient FU was nine years (interquartile range (IQR) 8-10 years). The median systolic BP decreased from 181 mmHg (IQR 28.5 mmHg) to 142 mmHg (IQR 23.5 mmHg), with a median reduction of 41 mmHg (IQR 25 mmHg) (p < 0.001). Similarly, the median diastolic BP decreased from 97 mmHg (IQR 13.5 mmHg) to 77 mmHg (IQR 8.5 mmHg), with a median reduction of 21 mmHg (IQR 9.5) (p < 0.001). The changes in BP showed large interindividual variation and the BP reduction appeared to be progressive over time. The antihypertensive medication 10 years after RDN did not differ significantly from the treatment given at baseline. The overall median reduction in total Daily Defined Dose (DDD) was -0.68 and not statistically significant (p = 0.45).

In the present cohort of patients with resistant hypertension who underwent RDN 10 years previously, a sustained and progressive reduction in office BP was observed throughout the follow-up period, despite minimal changes in antihypertensive treatment.