By Dr Jonathan Shurlock
We have previously covered the role of renal denervation in blood pressure control, presented by Professor Markus Schlaich, The RADIANCE-HTN TRIO trial is now published. This multi-centre randomised controlled trial enrolled 136 participants with resistant hypertension, defined as a blood pressure >135/85 despite four weeks of triple therapy (ARB, CCB and thiazide diuretic). Participants were randomised to renal denervation or sham therapy, with no change to antihypertensive treatment within two months post-randomisation. In the following three months standardised stepwise escalation of antihypertensive treatment was initiated. The primary outcomes measured included anti-hypertensive medication burden and change in ambulatory and home systolic blood pressure at 6 months.
Ambulatory blood pressure monitoring data was available for 65 out of 69 in the renal denervation group and 64 out of 67 in the sham group. Daytime ambulatory blood pressure at 6 months was not significantly different between groups (Mean (SD) 138.3 (15.1) mm Hg renal denervation group vs 139.0 (14.3) mm Hg sham group. Fewer anti-hypertensive agents were required by the renal denervation group vs control group (0.7 + 1.0 vs 1.1 (1.1), p = 0.045). In addition, fewer individuals in the renal denervation group were prescribed aldosterone antagonists (26 of 65 [40.0%] vs 39 of 64 [60.9%]; P = 0.02).
Home systolic blood pressure was reduced to a significant degree in the renal denervation group compared with sham (4.3 mm Hg reduction (95% CI, 0.5-8.1 mm Hg; P = 0.03).
The authors discuss the challenges of renal denervation trials in demonstrating sustained blood pressure reduction. In conjunction with renal denervation, fewer anti-hypertensive medications are required to achieve sustained blood pressure reduction. Overall, the findings add data to the ongoing discussion.
See the full study here: https://jamanetwork.com/journals/jamacardiology/fullarticle/2798468