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In a subpopulation of patients with essential hypertension, therapeutic targets are not met, despite the use of multiple types of medication. In this paper we describe our first experience with a novel percutaneous treatment modality using renal artery radiofrequency (RF) ablation.
Patients who were resistant to at least three types of antihypertensive medical therapy (office systolic blood pressure ≥ 160 mmHg; n = 9) or who did not tolerate medication (n = 2) were selected. Between July and November 2010, a total of 11 patients received percutaneous RF treatment. Patients were followed up for 1 month after treatment. Urine and blood samples were taken to evaluate the effects on renal function and neurohumeral factors.
No periprocedural complications or adverse events during follow-up were noted. A reduction of mean office blood pressure was seen from 203/109 ± 32/19 mmHg at baseline to 178/97 ± 28/21 mmHg at 1 month follow-up (mean difference 25 ± 12 mmHg, p < 0.01). Also, we noted a significant decrease in aldosterone level (391 ± 210 pmol/L versus 250 ± 142 pmol/L; p = 0.03), while there was no decrease in plasma renin activity (190 ± 134 fmol/L/s versus 195 ± 163 fmol/L/s; p = 0.43). No change in renal function was noted.
Catheter-based renal denervation seems an attractive novel minimally invasive treatment option in patients with resistant hypertension, with a low risk of serious adverse events.
Vliet AL, van den Hof S, Elvers LH, et al. Risicofactoren en gezondheidsevaluatie Nederlandse bevolking, een onderzoek op GGD’en (Regenboogproject). Jaarverslag 2001. RIVM rapport 260854004/2003.
Egan BM, Zhao Y, Rehman SU, et al. Treatment resistant hypertension in a community-based practice network. J Clin Hypertens 2009; OR-12:A6; (abstract).
Esler MD, et al on behalf of the Symplicity HTN-2 Investigators. Renal sympathetic denervation in patients with treatment resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Published Online November 17, 2010. doi: 10.1016/S0140-6736(10)62039-9.
2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007;25(6):1105–87.
Bernard C. Lec¸ons sur les Proprie´te´s et les Alte´rations Pathologiques des Liquides de L’Organisme, vol. 2. Paris: Baillie´re et Fils; 1859. p. 170–1.
Adson AW, Brown GE. Malignant hypertension. Report of case treated by bilateral section of anterior spinal nerve roots from the sixth thoracic to the second lumbar inclusive. JAMA. 1934;102:1115.
Krum H. Is hypertension the next frontier for interventional therapy? Transcatheter Cardiovascular Therapeutics 2010.
- Percutaneous renal denervation for the treatment of resistant essential hypertension; the first Dutch experience
W. L. Verloop
P. J. Blankestijn
P. R. Stella
P. A. Doevendans
- Bohn Stafleu van Loghum