4A.07: PREVALENCE AND RISK FACTORS FOR REFRACTORY HYPERTENSION IN THE DENERHTN STUDY.

OBJECTIVE: The French DENERHTN trial has shown that renal denervation (RDN, Symplicity Catheter) in addition to standardized optimal medical treatment (SOMT) decreases ambulatory BP more (6 mmHg) than the same SOMT alone at 6 months in patients (pts) with resistant hypertension (RH). However, some pts did not respond to RDN or SOMT at 6 months. The aim of the study was to determine the prevalence and characteristics of refractory hypertension (RFH) to more than 5 antihypertensive treatments at 6 months in the 2 groups.

DESIGN AND METHOD: Pts with RH to >  = 3 antihypertensive drugs, including a diuretic, entered a 4-week standardised triple treatment with indapamide 1.5 mg/day, ramipril 10 mg/day (or irbesartan 300 mg/day if cough), and amlodipine (10 mg/day). After 4 weeks, pts with daytime ambulatory SBP/DBP (dASBP/dADBP) > = 135 or 85 mmHg were randomised to the RDN or control group. After randomisation, the SOMT included: spironolactone (25 mg/day), bisoprolol (10 mg/day), prazosin (5 mg/day), and rilmenidine (1 mg/day) sequentially added if home BP (HBP) was > = 135 or 85 mmHg at month 2, 3, 4 and 5.

RESULTS: 49/97 pts (50.5%) had RFH at 6 months (RDN: 20/44, 45.5% vs.

CONTROL: 28/53, 52.8%; p = 0.157). RFH pts were more frequently women, had more frequently OSA, had higher baseline BP values, responded less to any intervention (RDN + SOMT or SOMT alone) despite receiving more antihypertensive treatments, had lower plasma creatinine at baseline. The Morisky adherence score was lower (p = 0.085) at baseline than at 6 months in the RFH group.(Figure is included in full-text article.)

CONCLUSIONS: : In conclusion, despite following strictly ESH guidelines for treating patients with RH to a triple therapy, around 50% of the pts have RFH after 6 months follow-up in the DENERHTN trial. Female gender, high BP, low plasma creatinine, and lower adherence at baseline were associated with RFH.