MORE GOOD NEWS FROM ESC 2012. RENAL DENERVATION IS LASTING AT 18 MTHS

Perhaps one of the better piece of news coming out of Munich, at the just concluded European Society of Cardiology Congress is the 18 month follow-up results of SYMPLICITY HTN 2. If you remember, we had blogged earlier about Renal Denervation as a treatment for Resistant Hypertension. Following Renal Denervation, the 6 months result was good with significant BP reduction. Many of us were wondering whether the body physiology will respond with a renal re-renervation, and whether the results will be attenuated over time. So a good 18 months or longer follow-up result will be re-assuring.
Well this was done and achieved by way of Dr Esler ( Australian prime mover of the technique ) in Munich, when he presented the 18 months follow-up of the cohort of about 106 patients. In fact, the investigators, following their good 6 months result, offered renal denervation to the placebo group after 6 months, and some accepted. So there is now another subset of patients who were not randomised to renal denervation, but who after 6 months received renal denervation. I have chosen to include the results tables as presented, so that you can appreciate then numbers. Basically, everything is rosey, and BP was reduced, without any increase MACE or complication.


Baseline preprocedure office blood-pressure measurements

Measure	Patients initially randomized to renal denervation (n=52)	Patients who crossed over to renal denervation at 6 mo (n=37)
Average systolic BP (mm Hg)	178.3	190
Average diastolic BP (mm Hg)	96.1	99.9

Change in blood pressure six months after renal-denervation therapy

Measure	Patients initially randomized to renal denervation (n=49)	Patients who crossed over to renal denervation at 6 mo (n=37)	p
Average change in systolic BP (mm Hg)	-31.7	-23.7	<0 .001=".001" br="br">
Average change in diastolic BP (mm Hg)	-11.7	-8.4	<0 .001=".001" br="br">

Change in blood pressure 12 months after renal-denervation therapy

Measure	Patients initially randomized to renal denervation (n=47)	Patients who crossed over to renal denervation at 6 mo (n=33)	p
Average change in systolic BP (mm Hg)	-28.1	-23.8	<0 .001=".001" br="br">
Average change in diastolic BP (mm Hg)	-9.7	-10.0	<0 .001=".001" br="br">

Change in blood pressure 18 months after renal-denervation therapy

measure	Patients initially randomized to renal denervation (n=43)	Patients who crossed over to renal denervation at 6 mo (n=7)	p
Average change in systolic BP (mm Hg)	-32.3	-28.4	<0 .001=".001" br="br">
Average change in diastolic BP (mm Hg)	-12.5	-13.6	<0 .00=".00" td="td">

The results are reassuring.
It only remains for the innovators to find a way of telling us a successful denervation at the cath lab. immediately post denervation, so that the operator and patient knows that the procedure had been successful. At the moment, it is an issue of trust me, I did a good job, and we will know the success in 6 months. In an era of instant everything, that may not sell very well. Not to forget that there is an issue of 20-30% non-responders.
I have also been invited to a workshop from 21st-22nd Sept 2012, on Renal Denervation, to be conducted by some overseas expert. As renal denervation looks like it is here to stay, I am seeing how to plan with the expert to start a program in Malaysia. I dislike this I do one or two cases once in awhile approach, where Tom, Dick, and Harry tries. Lets see whether we can do what we did for angioplasty, to start up a renal denervation program. Hypertension is serious problem. Prevention program takes too long to achieve its target.
Well, I will write more after the workshop, and keep you all informed.