Eligibility for renal denervation: Experience at 11 European expert centers

Alexandre Persu, Yu Jin, Marie Baelen, Eva Vink, Willemien L. Verloop, Bernhard Schmidt, Marie K. Blicher, Francesca Severino, Grégoire Wuerzner, Alison Taylor, Antoinette Pechère-Bertschi, Fadi Jokhaji, Fadl Elmula M.Fadl Elmula, Jan Rosa, Danuta Czarnecka, Georg Ehret, Thomas Kahan, Jean Renkin, Jiří Widimský, Lotte JacobsWilko Spiering, Michel Burnier, Patrick B. Mark, Jan Menne, Michael H. Olsen, Peter J. Blankestijn, Sverre Kjeldsen, Michiel L. Bots, Jan A. Staessen

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    Abstrakt

    Based on the SYMPLICITY studies and CE (Conformité Européenne) certification, renal denervation is currently applied as a novel treatment of resistant hypertension in Europe. However, information on the proportion of patients with resistant hypertension qualifying for renal denervation after a thorough work-up and treatment adjustment remains scarce. The aim of this study was to investigate the proportion of patients eligible for renal denervation and the reasons for noneligibility at 11 expert centers participating in the European Network COordinating Research on renal Denervation in treatment-resistant hypertension (ENCOReD). The analysis included 731 patients. Age averaged 61.6 years, office blood pressure at screening was 177/96 mm Hg, and the number of blood pressure-lowering drugs taken was 4.1. Specialists referred 75.6% of patients. The proportion of patients eligible for renal denervation according to the SYMPLICITY HTN- 2 criteria and each center's criteria was 42.5% (95% confidence interval, 38.0%-47.0%) and 39.7% (36.2%-43.2%), respectively. The main reasons of noneligibility were normalization of blood pressure after treatment adjustment (46.9%), unsuitable renal arterial anatomy (17.0%), and previously undetected secondary causes of hypertension (11.1%). In conclusion, after careful screening and treatment adjustment at hypertension expert centers, only ≈40% of patients referred for renal denervation, mostly by specialists, were eligible for the procedure. The most frequent cause of ineligibility (approximately half of cases) was blood pressure normalization after treatment adjustment by a hypertension specialist. Our findings highlight that hypertension centers with a record in clinical experience and research should remain the gatekeepers before renal denervation is considered.

    OriginalsprogEngelsk
    Sider (fra-til)1319-1325
    Antal sider7
    TidsskriftHypertension
    Vol/bind63
    Udgave nummer6
    DOI
    StatusUdgivet - jun. 2014

    Fingeraftryk Udforsk hvilke forskningsemner 'Eligibility for renal denervation: Experience at 11 European expert centers' indeholder.

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