Response to Is It Ethical to Perform Irreversible Renal Denervation Before a Trial of Low Sodium Intake for Treatment-Resistant Hypertension?
We thank the authors of the letter1 for their timely reminder of the importance of maximizing nonpharmacological strategies in addition to use of multiple antihypertensive drug therapy in the treatment of patients with resistant hypertension. In the specific case of our proof-of-concept trial (Symplicity HTN-1),2 we took patients, largely derived from hypertension centers of excellence, who were refractory to the best efforts of their treating physicians to minimize blood pressure elevations. Although not mandated by the protocol, those efforts included dietary sodium restriction. However, urinary sodium excretion was not measured in this study, nor in the randomized Symplicity HTN-23 Study, to ascertain dietary compliance. Our study of renal denervation was therefore a pragmatic one, asking the question of whether this novel procedure offered a blood pressure–lowering benefit additional to the care provided by the patient's treating doctor and continued during follow-up postprocedure. Treatments with low sodium intake and renal denervation are of course not mutually exclusive; indeed, it would be interesting to speculate whether reduced dietary sodium may lead to an enhanced responsiveness to the denervation procedure, but this remains to be formally tested in future studies.
Centre of Cardiovascular Research and Education in
Department of Epidemiology and Preventive Medicine
Melbourne, Victoria, Australia
H.K. received research funds to conduct the Symplicity studies.
- © 2011 American Heart Association, Inc.
- Turner MJ,
- van Schalkwyk JM
Symplicity HTN-1 Investigators. Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months. Hypertension. 2011;57:911–917.