1. Renal denervation for resistant hypertension: it’s time to reconsider!

2. Renal denervation in patients with uncontrolled hypertension: the SYMPLICITY HTN 3 trial • Approximately 10% of patients with diagnosed hypertension have “resistant” hypertension. • The sympathetic nervous system appears to play an important role in resistant hypertension. • Prior non-blinded studies have suggested that catheter-based renal artery denervation reduces blood pressure in resistant hypertension. • SYMPLICITY HTN-3 is the first prospective, multi-center, randomized, blinded, sham controlled study to evaluate both the safety and efficacy of percutaneous renal artery denervation in patients with severe treatment-resistant hypertension. • The trial included 535 patients enrolled by 88 participating US centers. Bhatt DL, Kandzari DE, O’Neill WW, et al. N Engl J Med. DOI: 10.1056/NEJMoa1402670.

3. Renal denervation is NOT associated with SIGNIFICANT additional reductions in office blood pressure… Bhatt DL, Kandzari DE, O’Neill WW, et al. N Engl J Med. DOI: 10.1056/NEJMoa1402670.

4. …whatever blood pressure level Bhatt DL, Kandzari DE, O’Neill WW, et al. N Engl J Med. DOI: 10.1056/NEJMoa1402670.

5. Optimal selection of antihypertensive combinationscan reduce the risk of developing resistant hypertension Among all determinants, combination of perindopril and amlodipine was the most protective variable against the risk of developing resistant hypertension [HR 0.57 (95% CI 0.50 – 0.60)] Gupta AK, Nasothimioua EG, Changa CL, Severa PS, Dahlof B, Poulter NR, on behalf of the ASCOT investigators. J Hypertens. 2011;29:2004-2013.