Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Importance of thorough investigation of resistant hypertension before renal denervation: should compliance to treatment be evaluated systematically?

Journal of Human Hypertension volume 28, pages 684–688 (2014)Cite this article

Subjects

Abstract

Catheter-based renal denervation (RD) has been introduced recently as a potentially effective invasive treatment of refractory hypertension. The proportion of patients with severe hypertension suitable for RD is not clear. The aim of this study was to identify what percentage of patients has truly resistant essential hypertension and are thus potentially eligible for RD. We investigated 205 consecutive patients referred to a university hypertension center for severe hypertension within 12 months. Ambulatory 24-h blood pressure (BP) monitoring (24 h ABPM), secondary hypertension screening and compliance to treatment testing (by use of plasma drug level measurements) were performed in all patients. Fifty-seven patients (27.8%) did not have truly resistant hypertension (RH) based on clinical BP. Among the remaining 122 patients (59.5%) with RH confirmed by 24 h ABPM, 50 patients (24.4% of the original cohort) had a secondary cause of hypertension and in 27 (13.2%) non-compliance to treatment was confirmed. Thus, only 45 patients (22%) had truly resistant essential hypertension and were considered for RD. Only one-third (n=15, 7.3% of the original cohort) was, however, finally referred for RD (14 were excluded due to contraindications for RD and 16 refused the invasive treatment). In conclusion, thorough examination of severe hypertension including 24 h ABPM, secondary hypertension exclusion and drug compliance testing before considering RD reveals that majority of these patients are not suitable for RD. Specifically, compliance to treatment testing should be mandatory in order to identify eligible candidates for RD.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R . Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360 (9349): 1903–1913.

    Article  Google Scholar 

  2. MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J et al. Blood pressure, stroke, and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990; 335 (8692): 765–774.

    Article  CAS  Google Scholar 

  3. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34 (28): 2159–2219.

    Article  Google Scholar 

  4. Carey RM . Resistant hypertension. Hypertension 2013; 61 (4): 746–750.

    Article  CAS  Google Scholar 

  5. Savard S, Frank M, Bobrie G, Plouin PF, Sapoval M, Azizi M . Eligibility for renal denervation in patients with resistant hypertension: when enthusiasm meets reality in real-life patients. J Am Coll Cardiol 2012; 60 (23): 2422–2424.

    Article  Google Scholar 

  6. Verloop WL, Vink EE, Voskuil M, Vonken EJ, Rookmaaker MB, Bots ML et al. Eligibility for percutaneous renal denervation: the importance of a systematic screening. J Hypertens 2013; 31 (8): 1662–1668.

    Article  CAS  Google Scholar 

  7. Fadl Elmula FE, Hoffmann P, Fossum E, Brekke M, Gjonnaess E, Hjornholm U et al. Renal sympathetic denervation in patients with treatment-resistant hypertension after witnessed intake of medication before qualifying ambulatory blood pressure. Hypertension 2013; 62 (3): 526–532.

    Article  CAS  Google Scholar 

  8. Burnier M, Wuerzner G, Struijker-Boudier H, Urquhart J . Measuring, analyzing, and managing drug adherence in resistant hypertension. Hypertension 2013; 62 (2): 218–225.

    Article  CAS  Google Scholar 

  9. Ceral J, Habrdova V, Vorisek V, Bima M, Pelouch R, Solar M . Difficult-to-control arterial hypertension or uncooperative patients? The assessment of serum antihypertensive drug levels to differentiate non-responsiveness from non-adherence to recommended therapy. Hypertens Res 2011; 34 (1): 87–90.

    Article  CAS  Google Scholar 

  10. Jung O, Gechter JL, Wunder C, Paulke A, Bartel C, Geiger H et al. Resistant hypertension? Assessment of adherence by toxicological urine analysis. J Hypertens 2013; 31 (4): 766–774.

    Article  CAS  Google Scholar 

  11. Štrauch B, Petrák O, Zelinka T, Rosa J, Šomlóová Z, Indra T et al. Precise assessment of noncompliance with the antihypertensive therapy in patients with resistant hypertension using toxicological serum analysis. J Hypertens 2013; 31 (12): 2455–2461.

    Article  Google Scholar 

  12. Charles_University, (Czech_Republic). Renal Denervation in Refractory Hypertension (PRAGUE-15). In: ClinicalTrials.gov [Internet]; Bethesda (MD): National Library of Medicine (US). 2000- [cited 2012 March 19]. Available from: http://clinicaltrials.gov/show/NCT01560312 NLM Identifier: NCT01560312, 2012.

  13. Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93 (9): 3266–3281.

    Article  CAS  Google Scholar 

  14. Gonzalez O, Iriarte G, Rico E, Ferreiros N, Maguregui MI, Alonso RM et al. LC-MS/MS method for the determination of several drugs used in combined cardiovascular therapy in human plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878 (28): 2685–2692.

    Article  CAS  Google Scholar 

  15. Chytil L, Štrauch B, Cvačka J, Marešová V, Widimský J Jr, Holaj R et al. Determination of doxazosin and verapamil in human serum by fast LC-MS/MS: application to document non-compliance of patients. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878 (30): 3167–3173.

    Article  CAS  Google Scholar 

  16. Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Bohm M . Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet 2010; 376 (9756): 1903–1909.

    Article  Google Scholar 

  17. Symplicity HTN-1 Investigators. Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months. Hypertension 2011; 57 (5): 911–917.

    Article  Google Scholar 

  18. Brinkmann J, Heusser K, Schmidt BM, Menne J, Klein G, Bauersachs J et al. Catheter-based renal nerve ablation and centrally generated sympathetic activity in difficult-to-control hypertensive patients: prospective case series. Hypertension 2012; 60 (6): 1485–1490.

    Article  CAS  Google Scholar 

  19. Persu A, Azizi M, Burnier M, Staessen JA . Residual effect of renal denervation in patients with truly resistant hypertension. Hypertension 2013; 62 (3): 450–452.

    Article  CAS  Google Scholar 

  20. Persu A, Jin Y, Azizi M, Baelen M, Völz S, Elvan A et al. Blood pressure changes after renal denervation at 10 European expert centers. J Hum Hypertens 2014; 28 (3): 150–156.

    Article  Google Scholar 

  21. Mahfoud F, Luscher TF, Andersson B, Baumgartner I, Cifkova R, Dimario C et al. Expert consensus document from the European Society of Cardiology on catheter-based renal denervation. Eur Heart J 2013; 34 (28): 2149–2157.

    Article  Google Scholar 

  22. Schmieder RE, Redon J, Grassi G, Kjeldsen SE, Mancia G, Narkiewicz K et al. ESH position paper: renal denervation—an interventional therapy of resistant hypertension. J Hypertens 2012; 30 (5): 837–841.

    Article  CAS  Google Scholar 

  23. Witkowski A, Prejbisz A, Florczak E, Kadziela J, Sliwinski P, Bielen P et al. Effects of renal sympathetic denervation on blood pressure, sleep apnea course, and glycemic control in patients with resistant hypertension and sleep apnea. Hypertension 2011; 58 (4): 559–565.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was supported by research project of the Ministry of Education of Czech Republic NT14155-3/2013 and by Charles University research project UNCE No. 204010 and PRVOUK No. P35/LF1/5.

Author information

Authors and Affiliations

  1. 3rd Department of Medicine, Centre for Hypertension, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic

    J Rosa, T Zelinka, O Petrák, B Štrauch, Z Šomlóová, T Indra, R Holaj & J Widimský Jr

  2. Cardiocentre, Third Faculty of Medicine, Charles University, Prague, Czech Republic

    J Rosa, K Čurila, P Toušek & P Widimský

  3. Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA

    M Šenitko

Authors
  1. J Rosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T Zelinka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O Petrák
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B Štrauch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Z Šomlóová
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T Indra
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R Holaj
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. K Čurila
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. P Toušek
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M Šenitko
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. P Widimský
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. J Widimský Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J Rosa.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rosa, J., Zelinka, T., Petrák, O. et al. Importance of thorough investigation of resistant hypertension before renal denervation: should compliance to treatment be evaluated systematically?. J Hum Hypertens 28, 684–688 (2014). https://doi.org/10.1038/jhh.2014.3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2014.3

Keywords

This article is cited by

Search

Advanced search

Quick links