Evaluating Veterans' Preferences for Renal Denervation for Treatment of Difficult-to-Control Hypertension: A Single-Center Survey Study

Abstract

Background and Aims

Catheter-based renal denervation (RDN) is a safe and effective alternative treatment for hypertension. However, data on patient preferences are limited. This study sought to delineate preferences for RDN among Veterans with difficult-to-control hypertension at an urban VA Medical Center with the goal of optimizing management and referral practices in hypertensive Veterans.

Methods

Patients on 3+ antihypertensive medications and a measured creatinine < 2.5 mg/dL were identified from the pharmacy database. A total of 100 randomly selected patients were telephoned for the administration of a survey assessing patient preferences for RDN, expectations for RDN, as well as medication adherence using the Medication Adherence Report Scale (MARS-5). Additional chart review was performed to gather demographic and clinical data of survey respondents.

Results

A total of 51 Veterans completed the survey. While 29 (56.9%) Veterans indicated a preference against RDN, 22 (43.1%) indicated a preference for this procedure, and 33 (64.7%) expressed that if their blood pressure were uncontrolled, they would prefer RDN over additional medication. A history of congestive heart failure (p = 0.017) and lower MARS-5 score (p = 0.007) were associated with a preference for RDN. Age, reported medication side effects, and hypertension treatment satisfaction ratings were not associated with preference for or against RDN.

Conclusions

A considerable portion of Veterans with difficult-to-control hypertension at an urban VA Medical Center expressed a preference for RDN if their blood pressure were to be uncontrolled or if recommended by their doctor. These survey results should be considered in shared decision-making discussions for hypertension management in this population.