Renal hemodynamics and renal function after catheter-based renal sympathetic denervation in patients with resistant hypertension.
Increased renal resistive index and urinary albumin excretion are markers of hypertensive end-organ damage and renal vasoconstriction involving increased sympathetic activity. Catheter-based sympathetic renal denervation (RD) offers a new approach to reduce renal sympathetic activity and blood pressure in resistant hypertension. The influence of RD on renal hemodynamics, renal function, and urinary albumin excretion has not been studied. One hundred consecutive patients with resistant hypertension were included in the study; 88 underwent interventional RD and 12 served as controls. Systolic, diastolic, and pulse pressure, as well renal resistive index in interlobar arteries, renal function, and urinary albumin excretion, were measured before and at 3 and 6 months of follow-up. RD reduced systolic, diastolic, and pulse pressure at 3 and 6 months by 22.7/26.6 mm Hg, 7.7/9.7 mm Hg, and 15.1/17.5 mm Hg (P for all <0.001), respectively, without significant changes in the control group. SBP reduction after 6 months correlated with SBP baseline values (r=-0.46; P<0.001). There were no renal artery stenoses, dissections, or aneurysms during 6 months of follow-up. Renal resistive index decreased from 0.691±0.01 at baseline to 0.674±0.01 and 0.670±0.01 (P=0.037/0.017) at 3- and 6-month follow-up. Mean cystatin C glomerular filtration rate and urinary albumin excretion remained unchanged after RD; however, the number of patients with microalbuminuria or macroalbuminuria decreased. RD reduced blood pressure, renal resistive index, and incidence of albuminuria without adversely affecting glomerular filtration rate or renal artery structure within 6 months and appears to be a safe and effective therapeutic approach to lower blood pressure in patients with resistant hypertension.
Klinik für Innere Medizin III, Kardiologie, Angiologie, und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str, Geb 40, 66421 Homburg/Saar, Germany. Felix.Mahfoud@uks.eu
Felix
F
Mahfoud
Bodo
B
Cremers
Julia
J
Janker
Britta
B
Link
Oliver
O
Vonend
Christian
C
Ukena
Dominik
D
Linz
Roland
R
Schmieder
Lars Christian
LC
Rump
Ingrid
I
Kindermann
Paul Andrew
PA
Sobotka
Henry
H
Krum
Bruno
B
Scheller
Markus
M
Schlaich
Ulrich
U
Laufs
Michael
M
Böhm
D000419:Albuminuria / Q000453:epidemiology; D001794:Blood Pressure / Q000502:physiology; D057785:Catheters; D055316:Cystatin C / Q000652:urine; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D015994:Incidence; D007668:Kidney / Q000098:blood supply* / Q000294:innervation* / Q000502:physiology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D013562:Sympathectomy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
D055316:Cystatin C