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The bipolar radiofrequency Vessix Renal Denervation System (Boston Scientific, Marlborough, MA) can be used in small arteries, allowing resistant hypertension patients with accessory renal arteries to be included in the REDUCE-HTN study.
Accessory renal arteries were identified and treated in 24 patients during study procedures. Another 19 patients had accessory arteries that were later identified in core lab angiographic analysis (ie, untreated accessory arteries). In post hoc analyses, BP changes were compared between patients with treated vs untreated accessory arteries, and between patients with accessory arteries (according to the core lab) vs without.
At both 6 and 12 months, all 4 patient subgroups had significant office systolic BP reductions (p≤0.0004). For patients with treated accessory arteries, mean office BP decreased from 178.0±16.1/99.1±11.2 mmHg at baseline to 157.0±26.3/86.8±14.5 mmHg at 6 months, and for patients with core lab-identified but untreated accessory arteries, office BP decreased from 188.8±17.5/103.8±13.2 mmHg to 155.2±28.0/88.0±11.8 mmHg. None of the 6- or 12-month pairwise comparisons of systolic BP for patients with treated vs untreated accessory arteries, or for those with accessory arteries vs without, reached statistical significance (Table). In linear regression models, neither presence nor treatment of accessory arteries was significantly associated with the change in office systolic BP.
Presence of accessory renal arteries does not prevent significant BP reductions following renal denervation treatment. Due to the small sample sizes, these unpowered post hoc analyses do not conclusively address the degree to which accessory renal artery denervation may affect BP-lowering efficacy.