Effects of renal sympathetic denervation on arterial stiffness and central hemodynamics in patients with resistant hypertension.
OBJECTIVE
This study investigated the effect of catheter-based renal sympathetic denervation (RD) on central hemodynamics in patients with resistant hypertension.


BACKGROUND
High central blood pressure (BP) increases cardiovascular events and mortality independently of peripheral BP. The effect of RD on central BP is unclear.


METHODS
A total of 110 patients underwent bilateral RD. Radial artery applanation tonometry and pulse wave analysis were used to derive central aortic pressure and hemodynamic indices at baseline and 1, 3, and 6 months after ablation. Ten patients with resistant hypertension not undergoing RD served as controls.


RESULTS
RD significantly reduced mean central aortic BP from 167/92 mm Hg to 149/88 mm Hg, 147/85 mm Hg, and 141/85 mm Hg at 1, 3, and 6 months (p < 0.001), respectively. Aortic pulse pressure decreased from 76.2 ± 23.3 mm Hg to 61.5 ± 17.5 mm Hg, 62.7 ± 18.1 mm Hg, and 54.5 ± 15.7 mm Hg 1, 3, and 6 months after RD (p < 0.001), respectively. Six months after RD aortic augmentation and augmentation index were significantly reduced by -11 mm Hg (p < 0.001) and -5.3% (p < 0.001), respectively. Carotid to femoral pulse wave velocity showed a significant reduction from 11.6 ± 3.2 m/s to 9.6 ± 3.1 m/s at 6 months (p < 0.001). Consistently, ejection duration and aortic systolic pressure load were significantly diminished, indicating improvement of cardiac work load by RD. No significant changes were obtained in control patients.


CONCLUSIONS
Besides the known effect of RD on brachial blood pressure, the study showed for the first time that this novel approach significantly improves arterial stiffness and central hemodynamics, which might have important prognostic implications in patients with resistant hypertension at high cardiovascular risk.
Department of Internal Medicine II, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48,Salzburg, Austria.
Mathias C
MC
Brandt
Sara
S
Reda
Felix
F
Mahfoud
Matthias
M
Lenski
Michael
M
Böhm
Uta C
UC
Hoppe
D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000294:innervation / Q000502:physiology*; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome; D059289:Vascular Stiffness / Q000502:physiology*