The effect of two different renal denervation strategies on blood pressure in resistant hypertension: Comparison of full‐length versus proximal renal artery ablation

Background Renal denervation (RDN) is used to manage blood pressure (BP) in patients with resistant hypertension (rHT), but effectiveness is still a concern, and key arterial portion for successful RDN is not clear. Objective The aim of this study was to investigate the efficacy and safety of proximal versus full‐length renal artery ablation in patients with resistant hypertension (rHT). Methods Forty‐seven patients with rHT were randomly assigned to receive full‐length ablation ( n  = 23) or proximal ablation ( n  = 24) of the renal arteries. All lesions were treated with radiofrequency energy via a saline‐irrigated catheter. Office BP was measured during 12 months of follow‐up and ambulatory BP at baseline and 6 months ( n  = 15 in each group). Results Compared with full‐length ablation, proximal ablation reduced the number of ablation points in both the right (6.1 ± 0.7 vs. 3.3 ± 0.6, P  < 0.001) and the left renal arteries (6.2 ± 0.7 vs. 3.3 ± 0.8, P  < 0.001), with significantly shorter RF delivery time ( P  < 0.001), but higher RF power ( P  = 0.011). Baseline office BPs was 179.4 ± 13.7/102.8 ± 9.4 mm Hg in the full‐length group and 181.9 ± 12.8/103.5 ± 8.9 mm Hg in the proximal group ( P  > 0.5). Similar office BPs was reduced by −39.4 ± 11.5/−20.9 ± 7.1 mm Hg at 6 months and −38.2 ± 10.3/−21.5 ± 5.8 mm Hg at 12 months in the full‐length group ( P  < 0.001), −42.0 ± 11.6/−21.4 ± 7.9 mm Hg at 6 months and −40.9 ± 10.3/−22.1 ± 5.6 mm Hg at 12 months in the proximal group ( P  < 0.001), and progressive BP reductions were observed over the 6 months ( P  < 0.001) in both groups. The drop in ambulatory 24‐hr SBP and DBP were significantly less than the drop in office BP ( P  < 0.001). No renovascular or other adverse complications were observed. Conclusions The results indicate that proximal RDN has a similar efficacy and safety profile compared with full‐length RDN, and propose the proximal artery as the key portion for RDN. © 2016 Wiley Periodicals, Inc.