Patient nonadherence to prescribed antihypertensive medications remains a major contributor to the low rate of hypertension control worldwide. Recent studies have shown nonadherence due to antihypertension medication side effects highly influences patient preference toward alternative, interventional strategies to control hypertension. It is unclear what factors influence physician preferences in recommending renal denervation (RDN) as an interventional therapy to control hypertension. Recent consensus reports from the ESH and from SCAI and NKF highlight the importance of a shared decision-making process between the patient and physician to determine strategies for controlling hypertension. This analysis evaluates which reasons for patient nonadherence to prescribed medications most influence physician preferences to recommend RDN.

General and interventional cardiologists from Europe and the United States completed an online survey that assessed their willingness to recommend RDN to their patients as an interventional therapy to control hypertension. Physicians were asked to score their likelihood to recommend RDN due to medication nonadherence for three different reasons: 1) patient preference to not take medications, 2) medication side effects, and 3) non-specific nonadherence. Surveys followed the highest industry standards from ISO 20252. Results were compared using two-tailed Z-tests.

Two-thirds of the 501 physicians surveyed stated they would recommend RDN for uncontrolled hypertension regardless of the reason for medication nonadherence. Physicians were significantly more likely to recommend RDN due to patient nonadherence from medication side effects compared to patient preference to not take medications and non-specific reasons for nonadherence (p<0.001).

Physicians were most likely to recommend RDN to patients experiencing medication side effects than for other reasons of medication nonadherence. These findings underscore how provider recommendations are influenced by patient preferences in the shared decision-making process between the patient and physician in developing a joint hypertension control strategy.