Pharmacological Monotherapy versus Renal Artery Denervation in Controlled Hypertensive Patients

Marcio Galindo Kiuchi, Shaojie Chen, Gustavo Ramalho e Silva, Luis Marcelo Rodrigues Paz, Ary Getulio de Paula Filho, Tetsuaki Kiuchi, Neil Alexander Hoye, Gladyston Luiz Lima Souto


Aim: The aim of this prospective observational non-inferiority study was to compare the capacity for control of essential hypertension between renal sympathetic denervation (RSD) and either angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB).

Methods and results: Seventy-four previously controlled essential hypertensive patients on ACEI/ARB monotherapy were evaluated; eleven patients agreed to proceed with RSD and had their antihypertensive agent withdrawn on the day of the procedure. During the six months of follow-up, there was no significant change in mean 24-hour ambulatory blood pressure measurements (ABPM) from baseline to three and sixmonths in the ACEI/ARB group (118±8/80±3 vs. 116±8/79±3 and 115±8/79±4 mmHg, respectively).        No change was also observed in the RSD group (117±8/81±2 vs. 115±6/80±2 and 114±7/79±3 mmHg, respectively). There were no differences between groups at interval time points. There were also no changes in renal function or echocardiographic parameters, during follow-up.

Conclusions: For the first time, this study reports possible non-inferiority of RSD when compared to ACEI or ARB monotherapy in the control of essential hypertension. A randomized trial with appropriate concealment of treatment, more patients and an extended follow-up period is needed to evaluate the potential benefits of RSD in comparison to ACEI/ARB use in patients with controlled hypertension.


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