DB 03-2 RENAL SYMPATHETIC DENERVATION IS STILL A VIABLE OPTION FOR TREATING RESISTANT HYPERTENSION (CON).

Renal denervation started out as a very promising approach to treat resistant hypertension with a very strong conceptual and basic science frame work from Gerald DiBona's lab and extending into the early non shame clinical studies demonstrating proof of concept in SYMPLICITY HTN-1 and 2. SYMPLICITY-HTN 3 a properly done, sham control trial failed to show a benefit on further reduction of BP compared to the sham group. The conclusion the procedure doesn't work. How could this be-it was clearly effective in animal models but why not in man. The answer lies with a number of issues. First, there was a significant increase in patient adherence. Second, all white coat hypertension was excluded from the trial and hence, reduced confounding of large BP reductions that would have been seen in other studies. Additionally, other factors played a role in the lack of effect, one the key factors was-did the procedure get performed adequately at all centers and was the approach correct in the first place. Lastly, is the use of spironolactone as good as denervation as some studies suggest. As to the procedure a seminal study funded by Medtronic clearly shows a more extensive procedure is needed to achieve more complete denervation as assessed by norepinephrine spillover data. Subsequent studies demonstrate the potential for much more extensive vascular injury with the new procedure and the potential for renal artery stenosis is higher with more extensive burns that are needed. Hence, the procedure may work but may not be as safe as was originally reported. Given this is a debate no further details will be divulged at this time.