• George L Bakris, Raymond R Townsend, Minglei Liu, Sidney A Cohen, Ralph D'Agostino, John M Flack, David E Kandzari, Barry T Katzen, Martin B Leon, Laura Mauri, Manuela Negoita, William W O'Neill, Suzanne Oparil, Krishna Rocha-Singh, Deepak L Bhatt, and SYMPLICITY HTN-3 Investigators.
• ASH Comprehensive Hypertension Center, University of Chicago Medicine, Chicago, Illinois. Electronic address: gbakris@medicine.bsd.uchicago.edu.
• J. Am. Coll. Cardiol. 2014 Sep 16;64(11):1071-8.

BackgroundPrior studies of catheter-based renal artery denervation have not systematically performed ambulatory blood pressure monitoring (ABPM) to assess the efficacy of the procedure.ObjectivesSYMPLICITY HTN-3 (Renal Denervation in Patients With Uncontrolled Hypertension) was a prospective, blinded, randomized, sham-controlled trial. The current analysis details the effect of renal denervation or a sham procedure on ABPM measurements 6 months post-randomization.MethodsPatients with resistant hypertension were randomized 2:1 to renal denervation or sham control. Patients were on a stable antihypertensive regimen including maximally tolerated doses of at least 3 drugs including a diuretic before randomization. The powered secondary efficacy endpoint was a change in mean 24-h ambulatory systolic blood pressure (SBP). Nondipper to dipper (nighttime blood pressure [BP] 10% to 20% lower than daytime BP) conversion was calculated at 6 months.ResultsThe 24-h ambulatory SBP changed -6.8 ± 15.1 mm Hg in the denervation group and -4.8 ± 17.3 mm Hg in the sham group: difference of -2.0 mm Hg (95% confidence interval [CI]: -5.0 to 1.1; p = 0.98 with a 2 mm Hg superiority margin). The daytime ambulatory SBP change difference between groups was -1.1 (95% CI: -4.3 to 2.2; p = 0.52). The nocturnal ambulatory SBP change difference between groups was -3.3 (95 CI: -6.7 to 0.1; p = 0.06). The percent of nondippers converted to dippers was 21.2% in the denervation group and 15.0% in the sham group (95% CI: -3.8% to 16.2%; p = 0.30). Change in 24-h heart rate was -1.4 ± 7.4 in the denervation group and -1.3 ± 7.3 in the sham group; (95% CI: -1.5 to 1.4; p = 0.94).ConclusionsThis trial did not demonstrate a benefit of renal artery denervation on reduction in ambulatory BP in either the 24-h or day and night periods compared with sham (Renal Denervation in Patients With Uncontrolled Hypertension [SYMPLICITY HTN-3]; NCT01418261).Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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