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Circulation. 2016 Sep 20;134(12):847-57. doi: 10.1161/CIRCULATIONAHA.116.022922. Epub 2016 Aug 30.

Adherence to Antihypertensive Treatment and the Blood Pressure-Lowering Effects of Renal Denervation in the Renal Denervation for Hypertension (DENERHTN) Trial.

Author information

1
From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Cardiology/Hypertension Department, France (P.G.); Institut Mutualiste Montsouris, Paris, France (M.M.); Centre Hospitalier Régional Universitaire de Lille, Hôpital Cardiologique, Médecine Vasculaire et HTA, France (P.D., C.M.-V.); Hôpital Croix-Rousse, Cardiology Department, European Society of Hypertension Excellence Centre, Hospices Civils de Lyon, and Université de Lyon, CREATIS UMR5220; INSERM U1044; INSA-Lyon; Université Claude Bernard Lyon 1; Hospices Civils de Lyon, France (P.-Y.C., P.L.); Hôpital Arthur Gardiner, Centre d'excellence en HTA Rennes-Dinard, France (T.D.); Centre Hospitalier Universitaire de Rennes, Service de Cardiologie et Maladies Vasculaires, France (C.D.-C.); Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié Salpétrière, France (X.G.); Hôpital Bretonneau, Tours, France (J.M.H.); CHU Nancy-Brabois, Nancy, France (F.Z.); CHU de Grenoble, France (O.O.); CHU de la Timone, Marseille, France (B.V.); CHU de Poitiers, Cardiologie, France (D.H.); CHRU Montpellier, France (J.R.); CHU Rangueil, Toulouse, France (B.C.); Hôpital Avicenne, Bobigny, France (J.-J.M.); Hôpital Pasteur, Nice, France (E.F.); INSERM, UMR 1129, Paris, France (V.J.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Vascular and Oncological Interventional Radiology Department, France (M.S.). michel.azizi@aphp.fr.
2
From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Cardiology/Hypertension Department, France (P.G.); Institut Mutualiste Montsouris, Paris, France (M.M.); Centre Hospitalier Régional Universitaire de Lille, Hôpital Cardiologique, Médecine Vasculaire et HTA, France (P.D., C.M.-V.); Hôpital Croix-Rousse, Cardiology Department, European Society of Hypertension Excellence Centre, Hospices Civils de Lyon, and Université de Lyon, CREATIS UMR5220; INSERM U1044; INSA-Lyon; Université Claude Bernard Lyon 1; Hospices Civils de Lyon, France (P.-Y.C., P.L.); Hôpital Arthur Gardiner, Centre d'excellence en HTA Rennes-Dinard, France (T.D.); Centre Hospitalier Universitaire de Rennes, Service de Cardiologie et Maladies Vasculaires, France (C.D.-C.); Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié Salpétrière, France (X.G.); Hôpital Bretonneau, Tours, France (J.M.H.); CHU Nancy-Brabois, Nancy, France (F.Z.); CHU de Grenoble, France (O.O.); CHU de la Timone, Marseille, France (B.V.); CHU de Poitiers, Cardiologie, France (D.H.); CHRU Montpellier, France (J.R.); CHU Rangueil, Toulouse, France (B.C.); Hôpital Avicenne, Bobigny, France (J.-J.M.); Hôpital Pasteur, Nice, France (E.F.); INSERM, UMR 1129, Paris, France (V.J.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Vascular and Oncological Interventional Radiology Department, France (M.S.).

Abstract

BACKGROUND:

The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure-lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report the influence of adherence to antihypertensive treatment on blood pressure control.

METHODS:

One hundred six patients with hypertension resistant to 4 weeks of treatment with indapamide 1.5 mg/d, ramipril 10 mg/d (or irbesartan 300 mg/d), and amlodipine 10 mg/d were randomly assigned to renal denervation plus standardized stepped-care antihypertensive treatment, or the same antihypertensive treatment alone. For standardized stepped-care antihypertensive treatment, spironolactone 25 mg/d, bisoprolol 10 mg/d, prazosin 5 mg/d, and rilmenidine 1 mg/d were sequentially added at monthly visits if home blood pressure was ≥135/85 mm Hg after randomization. We assessed adherence to antihypertensive treatment at 6 months by drug screening in urine/plasma samples from 85 patients.

RESULTS:

The numbers of fully adherent (20/40 versus 21/45), partially nonadherent (13/40 versus 20/45), or completely nonadherent patients (7/40 versus 4/45) to antihypertensive treatment were not different in the renal denervation and the control groups, respectively (P=0.3605). The difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the 2 groups was -6.7 mm Hg (P=0.0461) in fully adherent and -7.8 mm Hg (P=0.0996) in nonadherent (partially nonadherent plus completely nonadherent) patients. The between-patient variability of daytime ambulatory systolic blood pressure was greater for nonadherent than for fully adherent patients.

CONCLUSIONS:

In the DENERHTN trial, the prevalence of nonadherence to antihypertensive drugs at 6 months was high (≈50%) but not different in the renal denervation and control groups. Regardless of adherence to treatment, renal denervation plus standardized stepped-care antihypertensive treatment resulted in a greater decrease in blood pressure than standardized stepped-care antihypertensive treatment alone.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01570777.

KEYWORDS:

ablation techniques; hypertension; kidney; medications; nervous system; sympathetic nervous system

[Indexed for MEDLINE]

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