Renal sympathetic denervation after Symplicity HTN-3 and therapeutic drug monitoring in severe hypertension
Renal sympathetic denervation (RDN) has been and is still proposed as a new treatment modality in patients with apparently treatment resistant hypertension (TRH), a condition defined as persistent blood pressure elevation despite prescription of at least 3 antihypertensive drugs including a diuretic...
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2015-02-01
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doaj-a955e10fd6674b1e85ce4ceda00ed98c2020-11-25T00:36:36ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2015-02-01610.3389/fphys.2015.00009123450Renal sympathetic denervation after Symplicity HTN-3 and therapeutic drug monitoring in severe hypertensionSverre Erik Kjeldsen0Fadl Elmula M. Fadl Elmula1Anne Cecilie Larstorp2Alexandre ePersu3Yu eJin4Jan A. Staessen5Jan A. Staessen6Oslo University HospiitalOslo University HospiitalOslo University HospiitalUniversité Catholique de LouvainUniversity of LeuvenUniversity of LeuvenMaastricht UniversityRenal sympathetic denervation (RDN) has been and is still proposed as a new treatment modality in patients with apparently treatment resistant hypertension (TRH), a condition defined as persistent blood pressure elevation despite prescription of at least 3 antihypertensive drugs including a diuretic. However, the large fall in blood pressure after RDN reported in the first randomized study, Symplicity HTN-2 and multiple observational studies has not been confirmed in five subsequent prospective randomized studies and may be largely explained by non-specific effects such as improvement of drug adherence in initially poorly adherent patients (the Hawthorne effect), placebo effect and regression to the mean. The overall blood-pressure lowering effect of RDN seems rather limited and the characteristics of true responders are largely unknown. Accordingly, RDN is not ready for clinical practice. In most patients with apparently TRH, drug monitoring and improvement of drug adherence may prove more effective and cost-beneficial to achieve blood pressure control. In the meantime, research should aim at identifying characteristics of those patients with truly TRH who may respond to RDN.http://journal.frontiersin.org/Journal/10.3389/fphys.2015.00009/fullDrug MonitoringHypertensionrenal denervationantihypertensive drugsTreatment resistancce |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sverre Erik Kjeldsen Fadl Elmula M. Fadl Elmula Anne Cecilie Larstorp Alexandre ePersu Yu eJin Jan A. Staessen Jan A. Staessen |
spellingShingle |
Sverre Erik Kjeldsen Fadl Elmula M. Fadl Elmula Anne Cecilie Larstorp Alexandre ePersu Yu eJin Jan A. Staessen Jan A. Staessen Renal sympathetic denervation after Symplicity HTN-3 and therapeutic drug monitoring in severe hypertension Frontiers in Physiology Drug Monitoring Hypertension renal denervation antihypertensive drugs Treatment resistancce |
author_facet |
Sverre Erik Kjeldsen Fadl Elmula M. Fadl Elmula Anne Cecilie Larstorp Alexandre ePersu Yu eJin Jan A. Staessen Jan A. Staessen |
author_sort |
Sverre Erik Kjeldsen |
title |
Renal sympathetic denervation after Symplicity HTN-3 and therapeutic drug monitoring in severe hypertension |
title_short |
Renal sympathetic denervation after Symplicity HTN-3 and therapeutic drug monitoring in severe hypertension |
title_full |
Renal sympathetic denervation after Symplicity HTN-3 and therapeutic drug monitoring in severe hypertension |
title_fullStr |
Renal sympathetic denervation after Symplicity HTN-3 and therapeutic drug monitoring in severe hypertension |
title_full_unstemmed |
Renal sympathetic denervation after Symplicity HTN-3 and therapeutic drug monitoring in severe hypertension |
title_sort |
renal sympathetic denervation after symplicity htn-3 and therapeutic drug monitoring in severe hypertension |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Physiology |
issn |
1664-042X |
publishDate |
2015-02-01 |
description |
Renal sympathetic denervation (RDN) has been and is still proposed as a new treatment modality in patients with apparently treatment resistant hypertension (TRH), a condition defined as persistent blood pressure elevation despite prescription of at least 3 antihypertensive drugs including a diuretic. However, the large fall in blood pressure after RDN reported in the first randomized study, Symplicity HTN-2 and multiple observational studies has not been confirmed in five subsequent prospective randomized studies and may be largely explained by non-specific effects such as improvement of drug adherence in initially poorly adherent patients (the Hawthorne effect), placebo effect and regression to the mean. The overall blood-pressure lowering effect of RDN seems rather limited and the characteristics of true responders are largely unknown. Accordingly, RDN is not ready for clinical practice. In most patients with apparently TRH, drug monitoring and improvement of drug adherence may prove more effective and cost-beneficial to achieve blood pressure control. In the meantime, research should aim at identifying characteristics of those patients with truly TRH who may respond to RDN. |
topic |
Drug Monitoring Hypertension renal denervation antihypertensive drugs Treatment resistancce |
url |
http://journal.frontiersin.org/Journal/10.3389/fphys.2015.00009/full |
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