32. Efficacy and safety of renal sympathetic denervation in patients with uncontrolled hypertension in Vietnam
Main Article Content
Abstract
This study aimed to evaluate the efficacy and safety of renal sympathetic denervation (RDN) in the treatment of uncontrolled hypertension in Vietnam. A total of 70 patients were enrolled. Blood pressure was monitored through office measurements and 24-hour ambulatory blood pressure monitoring (ABPM) at 1, 3, and 6 months post-procedure. Study outcomes included antihypertensive efficacy, medication adjustments, renal function, and procedural complications. Multivariable analysis was used to identify associated factors. After 6 months, the mean reduction in office systolic blood pressure was 11.3 ± 9.3mmHg, while the mean 24-hour systolic BP decreased by 6.0 ± 9.1mmHg. Antihypertensive medication load decreased from 2.40 to 2.05 points (p < 0.001). The response rate to RDN at 6 months was 80%. No major vascular complications were observed; both estimated glomerular filtration rate (eGFR) and renal artery stenosis remained stable. Predictors of positive BP response included: low ASCVD risk, hypertension duration < 5 years, higher baseline 24-hour systolic BP, greater systolic BP variability, resting heart rate ≥ 75 bpm, and absence of accessory renal arteries. RDN is a safe and feasible technique in clinical practice, offering effective blood pressure reduction and medication burden relief in patients with difficult-to-control hypertension.
Article Details
Keywords
Renal sympathetic denervation, resistant hypertension, unipolar catheter, ambulatory blood pressure monitoring, Vietnam
References
2. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet Lond Engl. 2016; 387(10022): 957-967.
3. Krum H, Schlaich MP, Sobotka PA, et al. Percutaneous renal denervation in patients with treatment-resistant hypertension: final 3-year report of the Symplicity HTN-1 study. Lancet Lond Engl. 2014; 383(9917): 622-629.
4. Esler MD, Krum H, Schlaich M, et al. Renal sympathetic denervation for treatment of drug-resistant hypertension: one-year results from the Symplicity HTN-2 randomized, controlled trial. Circulation. 2012; 126(25): 2976-2982.
5. Bhatt DL, Kandzari DE, O’Neill WW, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014; 370(15): 1393-1401.
6. Azizi M, Schmieder RE, Mahfoud F, et al. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial. The Lancet. 2018; 391(10137): 2335-2345.
7. Azizi M, Sanghvi K, Saxena M, et al. Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, sham-controlled trial. The Lancet. 2021; 397(10293): 2476-2486.
8. Kandzari DE, Böhm M, Mahfoud F, et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. The Lancet. 2018; 391(10137): 2346-2355.
9. Warchol-Celinska E, Prejbisz A, Kadziela J, et al. Renal Denervation in Resistant Hypertension and Obstructive Sleep Apnea: Randomized Proof-of-Concept Phase II Trial. Hypertension. 2018; 72(2): 381-390.
10. Desch S, Okon T, Heinemann D, et al. Randomized Sham-Controlled Trial of Renal Sympathetic Denervation in Mild Resistant Hypertension. Hypertension. 2015; 65(6): 1202-1208.
11. Azizi M, Sapoval M, Gosse P, et al. Optimum and stepped care standardised antihypertensive treatment with or without renal denervation for resistant hypertension (DENERHTN): a multicentre, open-label, randomised controlled trial. The Lancet. 2015; 385(9981): 1957-1965.
12. Symplicity HTN-1 Investigators. Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months. Hypertens Dallas Tex 1979. 2011; 57(5): 911-917.
13. Kario K, Ogawa H, Okumura K, et al. SYMPLICITY HTN-Japan - First Randomized Controlled Trial of Catheter-Based Renal Denervation in Asian Patients -. Circ J Off J Jpn Circ Soc. 2015; 79(6): 1222-1229.
14. Kim BK, Böhm M, Mahfoud F, et al. Renal denervation for treatment of uncontrolled hypertension in an Asian population: results from the Global SYMPLICITY Registry in South Korea (GSR Korea). J Hum Hypertens. 2016; 30(5): 315-321.
15. Eikelis N, Lambert EA, Phillips S, et al. Muscle Sympathetic Nerve Activity Is Associated With Elements of the Plasma Lipidomic Profile in Young Asian Adults. J Clin Endocrinol Metab. 2017; 102(6): 2059-2068.
16. Mahfoud F, Kandzari DE, Kario K, et al. Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial. Lancet Lond Engl. 2022; 399(10333): 1401-1410.
17. Kandzari DE, Townsend RR, Kario K, et al. Safety and Efficacy of Renal Denervation in Patients Taking Antihypertensive Medications. J Am Coll Cardiol. 2023; 82(19): 1809-1823.
18. Böhm M, Kario K, Kandzari DE, et al. Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial. The Lancet. 2020; 395(10234): 1444-1451.
19. Hu X, Liao G, Wang J, et al. Patient-Specific Factors Predicting Renal Denervation Response in Patients With Hypertension: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2024; 13(14): e034915.
20. Id D, Kaltenbach B, Bertog SC, et al. Does the presence of accessory renal arteries affect the efficacy of renal denervation? JACC Cardiovasc Interv. 2013; 6(10): 1085-1091.