in lowering blood pressure for adults with uncontrolled hypertension who may be inadequately responsive to, or who are intolerant of, antihypertensive medications.
The device is intended to be used in renal arteries with diameters of 3.0 to 8.0 mm.
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After hearing data from three trials, RADIANCE-HTN SOLO, RADIANCE II, and RADIANCE-HTN TRIO, the 12-member panel unanimously agreed that there was “reasonable assurance” that the ReCor Paradise Ultrasound Renal Denervation System (ReCor Medical) was safe.
However, while most of the panel felt the device was effective, a few disagreed.
Keith Allen, MD, director of surgical research for the Mid-America Heart and Lung Surgeons, Kansas City, Mo., who was one of the three panel members who voted no regarding efficacy, stated that he had concerns about the duration and the degree of efficacy shown in the trials.
Mark Lockhart, MD, University of Alabama, Birmingham, also voted no. “I do think there was an effect for 2 months, but the duration of that positive effect appears to decline after that period of time.”
Benjamin Saville, PhD, echoed Dr. Lockhart’s concern: “The benefit is more short term, it is unclear what the long term benefit would be.”
Data from all three trials showed a significant drop in blood pressure with the device compared with pharmacologic therapy, but after 2 months of follow-up, that advantage disappeared.
The FDA highlighted data from the trials that showed that at 2 months, uRDN patients experienced significant reductions in systolic blood pressure compared with those treated with a sham device; however, by 6 months, there was a difference of only 1 mm Hg between the two groups.
“It seems when I look at 6 months and 12 months, the benefit is very tiny. We know the safety is fine, but a benefit of less than 1 mm Hg difference would not make me want to have an intervention,” said statistician Janet Wittes, PhD.
“I think the device is efficacious, even though there is not much difference between sham and treatment, but a big issue is the fact that half of our patients are not compliant. That will make the benefits over sham more clear,” noted Jim Blankenship, MD, professor of medicine and director of the division of cardiology at the University of New Mexico in Albuquerque.
John Hirshfeld Jr., MD, professor emeritus of medicine at the University of Pennsylvania, Philadelphia, said he voted yes on safety and efficacy but admitted he had some misgivings. “The sample size was small, but it is a novel tool to add to our tool box, and hopefully it will be used responsibly,” he said.
John Somberg, MD, professor emeritus of medicine, cardiology, and pharmacology, Rush University, Chicago, said the data on this procedure show “that antihypertensive medication works. Denervation is not superior to medications. It lowers blood pressure and is persistent, but when you can take the sham group to almost as good control as you get in the denervation group, that shows it can also be done with medicines.”
The panel wants to see results from additional studies in important subpopulations who are affected by hypertension, including Black people, women, the elderly, and people who already have cardiovascular risk factors, such as diabetes and heart failure.
Deneen Hesser, RN, the panel’s patient representative, called for any postmarketing studies that may be conducted by ReCor to include a good patient education program and also a way of documenting patient-reported outcomes.
“This would help us ascertain how happy people were if they were able to reduce their medication burden by, for example, one drug, or if they were willing to undergo a procedure to be able to stop taking so many antihypertensive medications,” she said.
The panel will meet again to review data on Medtronic’s Simplicity Spyral Renal Denervation System, which is also for patients with uncontrolled hypertension.
A version of this article appeared on Medscape.com.