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Renal denervation—a valid treatment option despite SYMPLICITY HTN-3

Nature Reviews Cardiology volume 11, page 638 (2014)Cite this article

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I thank Yutang Wang for his Correspondence (Ethnicity and sympathetic tone: predictors of the blood pressure response to renal denervation? Nat. Rev. Cardiol. doi:10.1038/nrcardio.2014.70-c1)1 on my News & Views article (How should data from SYMPLICITY HTN-3 be interpreted? Nat. Rev. Cardiol. 11, 375–376; 2014).2 Wang highlights 11 studies with low-level evidence and a small number of patients (n = 6–17) in which the efficacy of renal denervation for lowering blood pressure was examined. Although Wang acknowledges these study limitations, conclusions are still drawn from these reports. In contrast to these small studies, Mahfoud et al. conducted a large, prospective study involving 206 patients, and observed significant decreases in office and ambulatory blood pressure with renal denervation after 6 months.3 Data from the SYMPLICITY HTN-1 trial,4 and from the randomized, controlled SYMPLICITY HTN-2 trial,5 both published in 2014, have also demonstrated significant decreases in office blood pressure with renal denervation after 3 years.

In my News & Views article,2 I aimed to interpret the results from the SYMPLICITY HTN-3 trial,6 a prospective, randomized, masked, single-blind study that did not show a significant blood pressure reduction after renal denervation. In my opinion, some of the viewpoints expressed by Wang are not correct. Studies with witnessed intake of medication to exclude patients with poor drug adherence have been published;1 however, this observation would not help in the interpretation of the SYMPLICITY HTN-3 data,6 because poor drug adherence would have affected both the renal denervation and sham-controlled groups. Adherence to medical therapy in treatment-resistant hypertension is a serious obstacle. A study involving 79 patients with hypertension demonstrated a nonadherence rate of 25% and 23% at baseline and 6 months, respectively, after renal denervation, where adherence was assessed by toxicological urine measurements.7 Drug adherence was not verified in the SYMPLICITY HTN-3 trial,6 which is a serious limitation.

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References

  1. Wang, Y. Ethnicity and sympathetic tone: predictors of the blood pressure response to renal denervation? Nat. Rev. Cardiol. http://dx.doi.org/10.1038/nrcardio.2014.70-c1.

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  1. Department of Nephrology and Hypertension, Clinical Research Unit of Hypertension and Vascular Medicine, University Hospital Erlangen, Krankenhausstraße 12, 91054, Erlangen, Germany

    Roland E. Schmieder

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Correspondence to Roland E. Schmieder.

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The author has received speaker fees, consultancy and advisory board fees Boston Scientific, Kona Medical, Medtronic, Recor and Terumo. The University Hospital has received research funding from Medtronic and Rox Medical.

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Schmieder, R. Renal denervation—a valid treatment option despite SYMPLICITY HTN-3. Nat Rev Cardiol 11, 638 (2014). https://doi.org/10.1038/nrcardio.2014.70-c2

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