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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Surgery for hypertension?

The Lancet has published the results of a study that aimed to assess the efficacy and safety of catheter-based renal denervation for reduction of blood pressure in patients with treatment-resistant hypertension. This study has been reported in the general media (BBC).

The study recruited 106 patients with a systolic blood pressure of 160mmHg or more despite taking three or more antihypertensive drugs. Participants were randomly selected for an intervention of renal denervation by catheter-based short burst radio waves or continued on previous treatments. The primary endpoint was systolic blood pressure measured at six months.

52 patients underwent the procedure compared to 54 controls. There was a statistically significant difference in blood pressures between the two groups at six months of 33/11mmHg (p<0·0001). Blood pressure was reduced in the intervention group by an average of 32/12mmHg compared to an increase of 1/0mmHg in the control group.

The authors conclude that, "catheter-based renal denervation can safely be used to substantially reduce blood pressure in treatment-resistant hypertensive patients".

It should be noted that this new technique is still experimental and is an invasive procedure compared to the current method of treating raised blood pressure with lifestyle measures and medication. Further research is needed to assess the long term cardiovascular benefits and effects of this procedure. Patient acceptability of this invasive procedure compared to drug therapy will also need consideration.

Action: Clinicians should be aware of this research. Media coverage of this innovative procedure may generate patient queries.

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