Renal denervation in South Africa

摘要

To the Editor: Renal denervation (RD) is a minimally invasivetherapy aimed primarily at hypertension.[1] The procedure involvesmodification of the renal sympathetic nerve supply, which coursesaround the renal arteries. Access to the renal arteries is obtainedvia peripheral vessels (femoral, radial or brachial artery), andradiofrequency energy is applied to the arterial wall.[2] After proofof-conceptstudies in animals and humans, the SYMPLICITYHTN-2 trial demonstrated a significant blood pressure reduction inpatients with resistant hypertension, compared with pharmacologicalmanagement.[3] Surprisingly, RD was not found to be more effectivethan a sham procedure for resistant hypertension in the SYMPLICITYHTN-3 trial.[4] This trial, however, was subject to significantlimitations, including the inability to monitor treatment adherenceand changes of pharmacotherapy during the trial, as well as variationin the extent of RD performed in individual patients. Three shamcontrolledtrials have been published since, addressing many of theshortcomings of SYMPLICITY HTN-3. The SPYRAL-HTN-OFFMED trial[5] was designed to control for differences in betweengrouppharmacotherapy, and blood pressure at 3 months’ follow-upwas significantly lower in the RD group than in the sham proceduregroup. In the SPYRAL-HTN-ON MED trial,[6] pharmacotherapywas continued, and blood pressure control was also improved inRD recipients. In the endovascular ultrasound renal denervation totreat hypertension (RADIANCE-HTN SOLO) trial,[7] RD was moreeffective in decreasing blood pressure than a sham procedure.