Renal ablation for treatment of hypertension without Symplicity catheter: The first human experience

BACKGROUND: Hypertension (HTN) treatment has remained insufficient. New modalities such as “Symplicity method” for the treatment of HTN are a priority, especially in patients with resistant hypertension. In this study, we describe our first experience with a novel percutaneous treatment modality, without using Symplicity catheter. METHODS: ۳۰ Patients who were resistant to at least three types of antihypertensive medical therapy were selected. Patients received percutaneous renal artery denervation, without Symplicity catheter method, and were followed up for ۱ week, ۱, ۳, and ۶ months later after treatment. Ambulatory ۲۴-hour blood pressure (BP) Holter was performed ۱ week before intervention and after ۱ month. The primary outcome was change in ۲۴-hour ambulatory BP and change in office and home-based BP measurements. RESULTS: The mean age of the studied patients was ۵۲ ± ۱۵.۴ years and ۴۳.۳% (n = ۱۳) were female. Systolic and diastolic BP at baseline was ۱۶۳ ± ۱۷.۲ and ۹۵ ± ۸.۲ mmHg, respectively. Patients took ۳.۶ ± ۱.۳ hypertensive medications. Systolic and diastolic BP at ۱-week, ۱-month, ۳-month and ۶-month after renal denervation significantly decreased compared to the baseline (P < ۰.۰۰۰۱). Average BP derived from ۲۴-hour ambulatory BP monitoring changed in parallel with office-based BP measurements. Most of patients (۵۰%) who underwent renal denervation had reductions of ۱۰ mmHg or greater in systolic BP and ۵۶.۷% of them had reductions of ۵ mmHg or greater in diastolic BP. ۳۳.۳% of patients also achieved the target of systolic BP less than ۱۴۰ mmHg and ۶۰% achieved the target of diastolic BP less than ۹۰ mmHg. No patients showed vascular damage at final angiography. CONCLUSION: Catheter based renal ablation was associated with a significant reduction in both systolic and diastolic BP, on top of maximal medical therapy, which persisted throughout ۶ months follow-up in the first-in-man study without the Symplicity catheter.   Keywords: Renal Denervation, Resistant Hypertension, Catheter