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

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 trea...

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Published in:Circulation (New York, N.Y.) N.Y.), 2016-09, Vol.134 (12), p.847-857
Main Authors: 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
Format: Article
Language:English
Subjects:
Antihypertensive Agents - therapeutic use
Blood Pressure - drug effects
Blood Pressure - physiology
Blood Pressure Determination - methods
Blood Pressure Monitoring, Ambulatory - methods
Female
Humans
Hypertension - drug therapy
Hypertension - physiopathology
Kidney - drug effects
Life Sciences
Male
Medication Adherence
Middle Aged
Prospective Studies
Treatment Outcome
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Summary: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.
ISSN:0009-7322
1524-4539
DOI:10.1161/CIRCULATIONAHA.116.022922