oa South African Medical Journal - Renal denervation in South Africa - research

Volume 110 Number 2
  • ISSN : 0256-9574
  • E-ISSN: 2078-5135



To the Editor: Renal denervation (RD) is a minimally invasive therapy aimed primarily at hypertension.[1] The procedure involves modification of the renal sympathetic nerve supply, which courses around the renal arteries. Access to the renal arteries is obtained via peripheral vessels (femoral, radial or brachial artery), and radiofrequency energy is applied to the arterial wall.[2] After proofof- concept studies in animals and humans, the SYMPLICITY HTN-2 trial demonstrated a significant blood pressure reduction in patients with resistant hypertension, compared with pharmacological management.[3] Surprisingly, RD was not found to be more effective than a sham procedure for resistant hypertension in the SYMPLICITY HTN-3 trial.[4] This trial, however, was subject to significant limitations, including the inability to monitor treatment adherence and changes of pharmacotherapy during the trial, as well as variation in the extent of RD performed in individual patients. Three shamcontrolled trials have been published since, addressing many of the shortcomings of SYMPLICITY HTN-3. The SPYRAL-HTN-OFF MED trial[5] was designed to control for differences in betweengroup pharmacotherapy, and blood pressure at 3 months’ follow-up was significantly lower in the RD group than in the sham procedure group. In the SPYRAL-HTN-ON MED trial,[6] pharmacotherapy was continued, and blood pressure control was also improved in RD recipients. In the endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO) trial,[7] RD was more effective in decreasing blood pressure than a sham procedure.

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