Details

Autor(en) / Beteiligte

• Azizi, Michel
• Pereira, Helena
• Hamdidouche, Idir
• Gosse, Philippe
• Monge, Matthieu
• Bobrie, Guillaume
• Delsart, Pascal
• Mounier-Véhier, Claire
• Courand, Pierre-Yves
• Lantelme, Pierre
• Denolle, Thierry
• Dourmap-Collas, Caroline
• Girerd, Xavier
• Michel Halimi, Jean
• Zannad, Faiez
• Ormezzano, Olivier
• Vaïsse, Bernard
• Herpin, Daniel
• Ribstein, Jean
• Chamontin, Bernard
• Mourad, Jean-Jacques
• Ferrari, Emile
• Plouin, Pierre-François
• Jullien, Vincent
• Sapoval, Marc
• Chatellier, Gilles

Titel

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

Ist Teil von

• Circulation (New York, N.Y.), 2016-09, Vol.134 (12), p.847-857

Ort / Verlag

United States: by the American College of Cardiology Foundation and the American Heart Association, Inc

Erscheinungsjahr

2016

Quelle

MEDLINE

Beschreibungen/Notizen

• 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:URLhttp://www.clinicaltrials.gov. Unique identifierNCT01570777.