MyRDN publishes consensus paper on renal denervation | Đa khoa

A consensus paper detailing the recommendations and guidelines for healthcare professionals on the use of renal denervation in the treatment of people with hypertension has been published in Hypertension Research.[https://doi.org/10.1038/s41440-022-00937-w]

The paper was developed by the Malaysian Renal Nerve Denervation Working Group (MyRDN), a collaborative entity comprising the Malaysian Society of Hypertension (MSH) and the National Heart Association of Malaysia (NHAM).

Dr Alan Fong, NHAM’s president, said: “We are proud that our consensus paper, which was wholly produced by Malaysian specialists, has been published by the Hypertension Research Journal, which is the official journal of the Japanese Society of Hypertension. This journal publishes high quality original research specifically in the area of hypertension, or high blood pressure, and other related heart diseases.”

Fong highlighted a study conducted in Sarawak where around one-in-four participants who were suspected of having resistant hypertension were later confirmed to have resistant hypertension. On that basis, Fong anticipated that approximately 200,000 Malaysian adults would have genuine resistant hypertension in 2021. The purpose of the study, which was presented at the NHAM Congress 2022, was to fill in data gaps about the prevalence and epidemiology of genuine resistant hypertension in Malaysia.

“It is important to have more accurate numbers related to resistant hypertension in Malaysia as patients with this form of hypertension face an even higher risk of heart and kidney disease than those with regular hypertension. Patients with resistant hypertension have the option of undergoing renal denervation as an adjunct treatment to help them lower their blood pressure, and thus, also decrease their risk of serious heart and kidney issues,” added Fong.

Professor Datin Dr Chia Yook Chin, co-chair of MyRDN and immediate past president of MSH who was also present at the launch, said: “It is important that both the healthcare professionals and members of the public have access to these recommendations and guidelines for the use of renal denervation. The doctors and patients can discuss the suitability of this procedure on an individual basis and come to a decision together. This is particularly important as the consensus paper states that patient preference is one of the considerations in the decision to proceed with this procedure.”

According to data from the first 80 participants in the ongoing SPYRAL HTN-ON MED clinical trial, patients who previously had uncontrolled hypertension despite taking antihypertensive medications experienced an 18.7 mmHg decrease in systolic blood pressure as measured continuously over 24 hours via ambulatory monitoring and a 20.9 mmHg decrease when measured in the office 3 years after undergoing renal denervation. In contrast, patients in the control group saw a drop in systolic blood pressure of 8.6 mmHg when monitored continuously over 24 hours via ambulatory monitoring and 12.5 mmHg when tested in the office. SPYRAL HTN-ON MED is an international, multicentre, blinded, randomized, sham-controlled, proof-of-concept trial in which patients with uncontrolled hypertension were enrolled from the US, Germany, Japan, UK, Australia, Austria, and Greece. This study’s objective is to evaluate the hypothesis that renal denervation reduces blood pressure and is safe in the presence of up to three antihypertensive medicines.

About renal denervation
Renal denervation is a minimally invasive procedure in which radiofrequency waves are directed towards the sympathetic renal nerves to diminish their activities, which contribute to hypertension. Patients with resistant hypertension who experience elevated blood pressure despite taking the optimal combination of antihypertensive medications, those who consistently fail to take their medications regularly despite counselling, and those who are unwilling to be on long-term medication are recommended to undergo renal denervation.

Also present at the launch were Dr Ong Tiong Kiam, MyRDN co-chair, Dato’ Seri Dr Azhari Rosman, senior consultant cardiologist, National Heart Institute (IJN), and Professor Dr Wan Azman Wan Ahmad, immediate past president of NHAM.

Ed: According to the 2020 International Society of Hypertension Global Hypertension Practice guidelines [Available at https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.15026 Accessed on 12 June 2022]:

- Resistant hypertension is defined as seated office BP >140/90 mm Hg in a patient treated with three or more antihypertensive medications at optimal (or maximally tolerated) doses including a diuretic.

- ‘Pseudoresistance’ (poor BP measurement technique, white coat effect, nonadherence and suboptimal choices in antihypertensive therapy)as well as the substance/drug-induced hypertension and secondary hypertension – must be first, excluded.

- Resistant hypertension affects around 10% of hypertensive individuals, has a negative impact on well-beingand increases the risk of coronary artery disease, chronic HF, stroke, end-stage renal disease, and all-cause mortality.

- Approximately 50% of patients diagnosed with resistant hypertension have ‘pseudoresistance’ rather than true resistant hypertension.