I’m going to share with you some of my thoughts on the French consensus paper:
Expert consensus: Renal denervation for the treatment of hypertension, published in Archives of cardiovascular Disease 2012; 105, 386-393
“When confirmed, resistant hypertension requires specific management as indicated in the international guidelines – anti-hypertensive treatment dosage increase or adaption (use of maximum tolerance dose of anti-hypertensive agents, selection of another diuretic such as a low dose of spirolactone (25-50mg/d) addition of other pharmacological agents e.g, alpha blockers, beta blockers centrally acting anti-hypertensive agents, direct vasodilators, use of fixed combinations of hypertensive agents; use of home blood pressure to monitor treatment efficacy; and reinforcement of a salt-restricted diet.”
“In patients with resistant hypertension, blood pressure control may be improved via the implementation of device-based therapies that target the sympathetic or parasympathetic regulation of blood pressure including baro-reflex activation therapy and catheder-based renal denervation.”
One of the different reasons to explain uncontrolled blood pressure in hypertensive patients is a reluctance or poor adherence to lifelong multiple pills treatment or “poorly selected antihypertensive agents, inappropriate drug dosages or drugs not prescribed in the correct order, taking into account the patients particularities.”
So what? Why do we need “to increase until we reach the patients maximum tolerance” and then add more than 3 different drugs, creating a sort of ‘millefeuille’ or multi layered effect, before proposing device-based therapies particularly, but not only, in relatively young patients?
Perhaps it is time to investigate or extend device-based therapies to a less severe form of hypertension or earlier, without this escalation from the aforementioned ‘millefeuille’ effect?
Even if the number of patients is limited, the one-year follow up data of cross over patients in Simplicity HTN-2 trials “Esler MD et al. Circulation 2012:126:2976-2982” is in favour to extend the indications of RDN by using this Simplicity system.