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Date of Award
Spring 2020
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Allison Ermol, PA-C
Abstract
Introduction: Hypertension is a chronic condition that contributes to various morbidity and mortality factors. Every 10 to 20 mm Hg increase in blood pressure nearly doubles an individual’s cardiovascular mortality.2 Managing an individual’s hypertension becomes problematic when the individual is medically optimized. Therefore, introducing renal denervation provides promising evidence in the effect it has on the renal sympathetic pathway.4 The basis of this procedure is to denervate the renal sympathetic nerve activity and subsequently decrease the renin-angiotensin-aldosterone system (RAAS).4 The RAAS pathway is a powerful arterial vasoconstrictor and the aim of this procedure is to act in vasodilation in helping to decrease blood pressure.4
Methods: A literature search was completed through PubMed in November 2018. A total of seven research articles were selected based on their relevance to the research question, study design, outcome measurements and results.
Results: Literature review of the seven articles examined critically evaluates the renal denervation procedure in adult patients with resistant hypertension on maximum pharmacological treatment. Resistant hypertension defined as uncontrolled blood pressure on three or more antihypertensive medications. One study found that 20% of patients in the renal denervation group achieved controlled daytime ambulatory blood pressure of <135/85 mm Hg in the absence of any antihypertensive medications compared with only 3% of patients in the sham procedure group. Further, one study found the renal denervation group had an average decrease in daytime ambulatory systolic blood pressure of 8.5 mm Hg, which was 6.3 mm Hg greater than the control group. On the other hand, studies also found that although there may be statistical significance in favor of renal denervation procedure, this does not translate to clinical significance in blood pressure reduction.
Discussion: Through the literature and current research, the evidence does not strongly point in favor or against renal denervation procedure to treat resistant hypertension in adult patients. It is still an early area of exploration and development. Understanding the current research presents a great benefit for the future of this procedure. While some studies used a randomized control trial and others a cohort study, there were differences in the data collected. Some studies found that although this procedure did reduce blood pressure to some degree, it was not significant enough in a clinical setting to make the conclusion that renal denervation should be the preferred method to treat resistant hypertension. However, on the other hand, some trials found that for patients that stopped antihypertensive medications and underwent renal denervation, they had experienced benefits that were both statistically and clinically significant in lowering and managing blood pressure. Each study has their own benefits and limitations and therefore make it an important area to further explore for the future of medicine.
Conclusion: Renal denervation is an interesting and promising procedure in adult patients with pharmacological resistant hypertension that is inadequately controlled by current medication guidelines. Renal denervation proves to be beneficial, to varying degree, in lowering blood pressure. However, evidence is still inconsistent in regard to the significance of the blood pressure lowering effects this procedure has in the clinical setting. Therefore, future studies should consider all the research that has been conducted and combine that data to a comprehensive, multi-level, double-blind randomized control trial with a larger sample population to determine how this procedure can not only lower blood pressure but improve clinical outcomes and ultimately morbidity and mortality.
Recommended Citation
Mangin, Alicia, "Efficacy of Renal Denervation Procedure Compared to Standard Pharmacological Methods to Treat Medication Resistant Hypertension in Adults" (2020). Capstone Showcase. 93.
https://scholarworks.arcadia.edu/showcase/2020/pa/93
Efficacy of Renal Denervation Procedure Compared to Standard Pharmacological Methods to Treat Medication Resistant Hypertension in Adults
Introduction: Hypertension is a chronic condition that contributes to various morbidity and mortality factors. Every 10 to 20 mm Hg increase in blood pressure nearly doubles an individual’s cardiovascular mortality.2 Managing an individual’s hypertension becomes problematic when the individual is medically optimized. Therefore, introducing renal denervation provides promising evidence in the effect it has on the renal sympathetic pathway.4 The basis of this procedure is to denervate the renal sympathetic nerve activity and subsequently decrease the renin-angiotensin-aldosterone system (RAAS).4 The RAAS pathway is a powerful arterial vasoconstrictor and the aim of this procedure is to act in vasodilation in helping to decrease blood pressure.4
Methods: A literature search was completed through PubMed in November 2018. A total of seven research articles were selected based on their relevance to the research question, study design, outcome measurements and results.
Results: Literature review of the seven articles examined critically evaluates the renal denervation procedure in adult patients with resistant hypertension on maximum pharmacological treatment. Resistant hypertension defined as uncontrolled blood pressure on three or more antihypertensive medications. One study found that 20% of patients in the renal denervation group achieved controlled daytime ambulatory blood pressure of <135/85 mm Hg in the absence of any antihypertensive medications compared with only 3% of patients in the sham procedure group. Further, one study found the renal denervation group had an average decrease in daytime ambulatory systolic blood pressure of 8.5 mm Hg, which was 6.3 mm Hg greater than the control group. On the other hand, studies also found that although there may be statistical significance in favor of renal denervation procedure, this does not translate to clinical significance in blood pressure reduction.
Discussion: Through the literature and current research, the evidence does not strongly point in favor or against renal denervation procedure to treat resistant hypertension in adult patients. It is still an early area of exploration and development. Understanding the current research presents a great benefit for the future of this procedure. While some studies used a randomized control trial and others a cohort study, there were differences in the data collected. Some studies found that although this procedure did reduce blood pressure to some degree, it was not significant enough in a clinical setting to make the conclusion that renal denervation should be the preferred method to treat resistant hypertension. However, on the other hand, some trials found that for patients that stopped antihypertensive medications and underwent renal denervation, they had experienced benefits that were both statistically and clinically significant in lowering and managing blood pressure. Each study has their own benefits and limitations and therefore make it an important area to further explore for the future of medicine.
Conclusion: Renal denervation is an interesting and promising procedure in adult patients with pharmacological resistant hypertension that is inadequately controlled by current medication guidelines. Renal denervation proves to be beneficial, to varying degree, in lowering blood pressure. However, evidence is still inconsistent in regard to the significance of the blood pressure lowering effects this procedure has in the clinical setting. Therefore, future studies should consider all the research that has been conducted and combine that data to a comprehensive, multi-level, double-blind randomized control trial with a larger sample population to determine how this procedure can not only lower blood pressure but improve clinical outcomes and ultimately morbidity and mortality.