In today’s session on hot topics in hypertension, Debbie Cohen reviewed the early promise and perplexing failure of renal denervation.  It made so much sense — local sympathectomy for resistant hypertension.  The first studies, done in Europe, were promising.  Then came SYMPLICITY-3 — which quite prominently did not meet its prespecified outcomes — change in systolic blood pressure — at 6 months .

Dr. Cohen was optimistic, suggesting that the renal denervation story is not yet over.  Although this large RCT did not show a benefit on the primary outcome — or in the many subgroup analyses done to try to explain the primary outcome — I think I agree with her for several reasons.  First, it’s clear that the control group’s blood pressure got much better than one would have predicted ahead of time… perhaps because of better medication adherence than usually seen.  Second, from a different and perhaps more pragmatic vantage point, if (as Dr Michael Weber pointed out in the previous talk) we admit that it is nearly impossible despite decades of work on this topic to convince patients to actually take multiple medications then perhaps the idea of a surgical intervention that approximates the use of 1-2 medications is not completely out of the question.  Other talks here at NKF (Dr. Shari Ling from CMS) have highlighted the lifetime perspective and the patient-centered approach of our evolving health care system.  If long-term health is the goal, and we accept the difficulties in long-term medication adherence, then perhaps renal denervation can rise again from the ashes of SYMPLICITY-3.