Renal Denervation—Ready for Prime Time!?

The steep SPYRAL stairs to RADIANCE in hypertension treatment

Originally published 25 Jun 2018 | Hypertension

Two successive presentations at this year’s EuroPCR in Paris with simultaneous publication of the SPYRAL HTN-ON MED (Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial)1 and the RADIANCE-HTN SOLO (Endovascular ultrasound renal denervation to treat hypertension [RADIANCE-HTN SOLO]: a multicentre, international, single-blind, randomised, sham-controlled trial)2 trials in The Lancet may well go down as a turning point in the renal denervation saga. After much controversy around the efficacy of renal denervation as an interventional approach to lower blood pressure (BP), both studies, one performed with a multielectrode radiofrequency ablation device in hypertensive patients on concurrent medication (SPYRAL HTN-ON MED) and the other using a high-frequency ultrasound device in drug-naive hypertensive patients (RADIANCE-HTN SOLO), show a convincing and clinically relevant reduction of ambulatory BP compared with respective sham control groups. In concert with the recently published SPYRAL HTN-OFF MED3 study (Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications [SPYRAL HTN-OFF MED]: a randomised, sham-controlled, proof-of-concept trial), robust evidence is now available from 3 consecutive and adequately designed randomized, sham-controlled trials confirming the BP-lowering efficacy of catheter-based renal denervation approaches.

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