Title: Renal sympathetic denervation after Symplicity HTN-3 and therapeutic drug monitoring in severe hypertension
Authors: Fadl Elmula, Fadl Elmula M
Larstorp, Anne C
Kjeldsen, Sverre E ×
Persu, Alexandre
Jin, Yu
Staessen, Jan A #
Issue Date: 2015
Publisher: Frontiers Research Foundation
Series Title: Frontiers in Physiology vol:6 pages:9
Article number: 10.3389/fphys.2015.00009
Abstract: Renal sympathetic denervation (RDN) has been and is still proposed as a new treatment modality in patients with apparently treatment resistant hypertension (TRH), a condition defined as persistent blood pressure elevation despite prescription of at least 3 antihypertensive drugs including a diuretic. However, the large fall in blood pressure after RDN reported in the first randomized study, Symplicity HTN-2 and multiple observational studies has not been confirmed in five subsequent prospective randomized studies and may be largely explained by non-specific effects such as improvement of drug adherence in initially poorly adherent patients (the Hawthorne effect), placebo effect and regression to the mean. The overall blood-pressure lowering effect of RDN seems rather limited and the characteristics of true responders are largely unknown. Accordingly, RDN is not ready for clinical practice. In most patients with apparently TRH, drug monitoring and improvement of drug adherence may prove more effective and cost-beneficial to achieve blood pressure control. In the meantime, research should aim at identifying characteristics of those patients with truly TRH who may respond to RDN.
ISSN: 1664-042X
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Department of Cardiovascular Sciences - miscellaneous
Hypertension and Cardiovascular Epidemiology
× corresponding author
# (joint) last author

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