Anatomically-optimised distal renal denervation: sustained blood pressure lowering efficacy three years after intervention
Aim. To test the hypothesis that anatomical optimisation of radiofrequency renal denervation (RDN) by redistribution of treatment to segmental branches of the renal artery causes a durable increase in the efficacy of the intervention. Methods. A double-blind randomised control study in parallel groups with a 3-year follow-up was performed in patients with apparent resistant hypertension (office systolic BP >160 or diastolic BP >100 mmHg despite stable treatment with >3 drugs, including a diuretic). Exclusion criteria were secondary hypertension, mean 24-h systolic BP <135 mmHg, eGFR <30 mL/min/m<sup>2</sup> and severe comorbidity increasing procedural risks (investigator's assessment). Eligible patients were randomised 1:1 into distal RDN or RDN in the main trunk of the renal artery. Treatment assignment was done in the operation room immediately before the procedure. For the duration of the study, the assigned treatment was unknown to patients, physicians and other outcome assessors. Long-term efficacy of the procedure was measured by changes in BP (office and ambulatory), whereas safety was assessed by changes in the 24-h protein excretion, serum creatinine and eGFR 3 years postprocedure. Results. Of the 55 randomised patients, 39 (71%) completed a 3-year assessment (21 after distal RDN and 18 after RDN in the main trunk of the renal artery). Compared to baseline, the mean 24-h BP remained significantly lowered in the distal RDN group by -16.9 (95% CI -27.3;-6.5)/-8.5 (95% CI -14.2;-2.9) mmHg, p = 0.002/0.004 (systolic/diastolic, respectively). The lowering of the mean 24-h BP was almost twofold less and non-significant in the group of RDN in the main trunk of the renal artery: -8.7 (95% CI -19.6;2.2)/-5.8 (95% CI -11.8;0.1). Conclusion. Anatomical optimisation of endovascular renal denervation produces a powerful and sustained increase in the efficacy of the intervention.