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Renal sympathetic denervation for resistant hypertension: a transiently sustained placebo effect?

Journal of Human Hypertension volume 29, pages 396–397 (2015)Cite this article

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Renal sympathetic denervation (RDN) using endovascular radio-frequency ablation (RFA) has been widely adopted in the treatment of resistant hypertension (RH). The Symplicity non-randomised HTN-11 and randomised HTN-2 trials2 reported significant reductions in mean office blood pressure (BP) at 6 months after RDN. The blinded Symplicity HTN-3 trial, however, showed no significant reduction in systolic BP at 6 months following RDN compared with a sham procedure,3 which may be related to provision of free medications or improved medication adherence, although adherence was not formally tested.3 The relative sustainability of this ‘placebo’ effect remains unknown. Here we present a unique case of a patient who underwent two RDN procedures with transient success and late failure.

A 58-year-old Caucasian male with hypertension for 8 years, type 1 diabetes mellitus and a family history of subarachnoid haemorrhage was seen in clinic, secondary causes having been excluded. Symptoms included epistaxis, headaches, dizziness, palpitations and syncope. Despite six antihypertensive agents, ambulatory blood pressure monitoring (ABPM) showed a 24 h average of 174/89 mm Hg. Medication adherence was checked via direct observation.

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Authors and Affiliations

  1. School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK,

    T E Purvis

  2. Department of Clinical Chemistry, Heart of England NHS Foundation Trust, Birmingham, UK,

    K E Shipman

  3. Department of Cardiology, Heart of England NHS Foundation Trust, Birmingham, UK,

    R Watkin

  4. Department of Radiology, Heart of England NHS Foundation Trust, Birmingham, UK,

    J Freedman & P Crowe

  5. Department of Renal Medicine, Heart of England NHS Foundation Trust, Birmingham, UK,

    I Dasgupta

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  1. T E Purvis
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  2. K E Shipman
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  4. J Freedman
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Correspondence to I Dasgupta.

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Purvis, T., Shipman, K., Watkin, R. et al. Renal sympathetic denervation for resistant hypertension: a transiently sustained placebo effect?. J Hum Hypertens 29, 396–397 (2015). https://doi.org/10.1038/jhh.2014.102

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