Comparison of renal sympathetic denervation with spironolactone in patients with still a high blood pressure despite the use of 3 different antihypertensive agents.

Renal sympathetic denervation is not superior to add-on therapy with spironolactone in treatment-resistant hypertension.

Ambulatory blood pressure will be measured 6 months after intervention.

1. Endovascular renal sympathetic denervation;

2. Addition of spironolactone to existing antihypertensive treatment.



The intervention consists either of endovascular renal sympathetic denervation or the addition of spironolactone to existing antihypertensive treatment.



Endovascular renal sympathetic denervation is a recently introduced technique. With the technique a catheter is introduced via a groin artery in the left and right renal artery.



Using radiofrequency energy the nerves surrounding the renal arteries are ablated. This a once a time procedure lasting about 1 hour. With this technique blood pressure potentially falls and this effect is compared with the addition of spironolactone in a maximal once daily dose of 50 mg.



Patients with treatment-resistant hypertension are included. They will be randomised for endovascular renal sympathetic denervation or treatment with spironolactone.



Spironolactone is used for 6 months. The primary endpoint of this study is the difference in 24-hour ambulatory blood pressure response between the group of patients treated with endovascular denervation and the group of patients treated with spironolactone after 6 months of follow-up.