Renal denervation for drug-resistant hypertension: Suffering its original sin, seeking redemption

摘要

Before the January 9, 2014 announcement that the randomized sham-controlled SYMPLICITY HTN-3 trial had not achieved its primary efficacy end point, the evolution of percutaneous renal denervation, a descendent of years of experimentation by a core group of thoughtful mechanistic investigators, had been characterized by international migration, exponential growth, and rapid dominance of the resistant hypertension environment. " Yet even without knowledge of this trial's full findings, which have yet to be published, this result could have been prophesied as an inevitable consequence of the 'original sin' of selecting as this technology's target 'drug-resistant hypertension,' a phenotype characterized by complexity, not simplicity. " Let us consider the rationale for this decision and its several key aftereffects.