A Pseudo-Quality Assurance Fig Leaf
The review article draws impressive conclusions on renal denervation and also suggests that this might soon become almost standard procedure.
However, equally impressive is the frenzied speed with which this procedure is becoming widespread after only one controlled trial in Germany (1), and one with a limited number of patients, despite the fact that this trial on high blood pressure, a disorder strongly affected by psychological factors (white-coat hypertension), involved no placebo control, and that the current standard diagnostic procedure for hypertension was never followed: instead, normal office blood pressure readings were used. The authors’ conclusion is therefore incorrect: at the current time a register would be a pseudo-quality assurance fig leaf. Much more beneficial would be further controlled trials with placebo treatments in a comparator population and appropriate standards for reading blood pressure, before this procedure is used in the huge population of up to 22% of cases of treatment-refractory hypertension (2). Unfortunately, we cannot put the genie back in the bottle.
Dr. med. Akhil Chandra, Lüneburg, AChandra@t-online.de
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Böhm M: Renal sympathetic denervation in patients with treatment-resistant hypertension (the Symplicity HTN-2 Trial): a randomised con-trolled trial. Lancet 2010; 376: 1903–9. CrossRef MEDLINE|
|2.||Lowel H, Meisinger C, Heier M, Hymer H, Alte D, Volzke H: Epidemiology of hypertension in Germany. Selected results of population-representative cross-sectional studies. Dtsch Med Wochenschr 2006; 131: 2586–91. MEDLINE|
|3.||Mahfoud F, Himmel F, Ukena C, Schunkert H, Böhm M, Weil J: Treatment strategies for resistant arterial hypertension. Dtsch Arztebl Int 2011; 108(43): 725–31. VOLLTEXT|