Recent data from the Simplicity II Trial on renal denervation demonstrates that RF ablation techniques in renal arteries can disrupt the autonomic nerve conduction that surrounds theses arteries and could be very effective in treating hypertension non pharmacologically. A cardiac function substudy from this trial (Mathias Brandt, JACC, 3/6/12) now demonstrates reductions in left ventricular hypertrophy and improvements in diastolic function as early as 1 month after the procedure, with additional improvements at 6 months. This could translate into an improved prognosis in hypertensive heart disease as parameters such as degree of LVH (muscle mass) and biomarkers like proBNP, correlate strongly with prognosis in this condition.
Future refinements of this technique, further longitudinal followup of these patients to gauge the durability of these results over time should add greatly to our understanding of where this fits in our treatment algorithms for hypertensive heart disease. Other emerging technologies that modulate the neurohormonal components of hypertension may add to this data base. Designing these studies carefully to keep track of variables such as those studied by Brandt et al, as well as a host of other biochemical and clinical variables should emerge over time and provide us insight into this exciting field.
POSTED BY STEVEN C. AJLUNI, MD