{"id":4965,"date":"2010-11-22T15:19:22","date_gmt":"2010-11-22T20:19:22","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=4965"},"modified":"2011-07-19T17:44:15","modified_gmt":"2011-07-19T21:44:15","slug":"treating-resistant-hypertension-singe-%e2%80%93-dont-stent-the-renal-artery","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2010\/11\/22\/treating-resistant-hypertension-singe-%e2%80%93-dont-stent-the-renal-artery\/","title":{"rendered":"Treating Resistant Hypertension: Singe \u2013 Don&#8217;t Stent &#8211; The Renal Artery"},"content":{"rendered":"<p><span style=\"color: #000000;\">For years, interventional cardiologists (and radiologists) have been stenting renal arterial stenoses in patients with resistant hypertension, despite\u00a0<a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa0905368\">evidence that doing so does not\u00a0lower blood pressure<\/a>.\u00a0 It appears we had the right organ (the kidney), but we\u2019ve been doing the wrong procedure. We should have been delivering a singe, not a stent.<\/span><\/p>\n<p><span style=\"color: #000000;\">Advances in endovascular catheter technology now allow us to access the sympathetic nerves located in the renal arterial adventitia, making possible selective denervation of the human kidney with radiofrequency energy delivered in the renal arterial lumen.\u00a0 In the multicenter <\/span><span style=\"color: #000000;\"><a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(10)62039-9\/fulltext\">Symplicity HTN-2 trial<\/a><\/span><span style=\"color: #000000;\">, catheter-based renal denervation resulted in significant reductions in blood pressure in patients with treatment-resistant essential hypertension. <\/span><\/p>\n<p><span style=\"color: #000000;\">The investigators randomized 106 patients with treatment-resistant hypertension (i.e., systolic blood pressure \u2265160 mm Hg [\u2265150 mm Hg for patients with diabetes] despite the use of \u22653<span style=\"text-decoration: line-through;\"> <\/span>antihypertensive drugs) to renal sympathetic denervation or continued medical therapy.<\/span><\/p>\n<p><span style=\"color: #000000;\">Renal denervation resulted in impressive reductions in office-based measurements of blood pressure (average decline, 32\/12 mm Hg at 6 months) as well as home-based (average decline, 20\/12 mm Hg) and ambulatory (average decline, 11\/7 mm Hg) measurements, whereas no reductions were observed in the control group. \u00a0Importantly, no serious procedure-related complications occurred. <\/span><\/p>\n<p><span style=\"color: #000000;\">In short, renal denervation resulted in an impressive reduction in blood pressure in these patients with otherwise refractory hypertension. <\/span><\/p>\n<p><strong><em><span style=\"color: #000000;\">Would you integrate percutaneous renal denervation into your practice now, or do you need validative findings from additional studies?<\/span><\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>For years, interventional cardiologists (and radiologists) have been stenting renal arterial stenoses in patients with resistant hypertension, despite\u00a0evidence that doing so does not\u00a0lower blood pressure.\u00a0 It appears we had the right organ (the kidney), but we\u2019ve been doing the wrong procedure. We should have been delivering a singe, not a stent. Advances in endovascular catheter [&hellip;]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,9,7],"tags":[454,581,580],"class_list":["post-4965","post","type-post","status-publish","format-standard","hentry","category-general","category-interventional-cardiology","category-prevention","tag-hypertension","tag-renal-denervation","tag-symplicity-htn-2"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/4965","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=4965"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/4965\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=4965"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=4965"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=4965"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}