title: Renal nerve ablation reduces augmentation index in patients with resistant hypertension.
abstract: OBJECTIVE
  Renal denervation (RDN) has been demonstrated to reduce muscle sympathetic nerve activity (MSNA) and blood pressure (BP) in patients with resistant hypertension. Whether alterations of arterial stiffness may contribute to BP-lowering effects of RDN is unknown.
  
  
  METHODS
  We measured office BP and arterial stiffness using fingertip tonometry-derived augmentation index (EndoPAT2000) at baseline and at 3-month follow-up in 50 consecutive patients with resistant hypertension. Forty patients received RDN and 10 patients served as controls. MSNA was obtained in 20 RDN and 10 non-RDN patients.
  
  
  RESULTS
  Baseline BP averaged 170/92 ± 19/15 mmHg (RDN) and 171/93 ± 14/8 mmHg (non-RDN) despite the use of 4.9 ± 1.9 and 4.4 ± 2.0 antihypertensive drugs, respectively. RDN significantly reduced SBP (170  ± 19 vs. 154 ± 25 mmHg; P < 0.001) and DBP (92 ± 15 vs. 84 ± 16 mmHg; P<0.001), augmentation index (30.6  ± 23.8 vs. 22.7 ± 22.4%; P=0.002), AI@75 corrected for heart rate (22.4 ± 21.6 vs. 14.4 ± 20.7; P=0.002) and MSNA (80 ± 15 vs. 71 ± 18  bursts/100 heartbeats; P<0.01). Changes in AI@75 with RDN were unrelated to SBP (r=0.043; P = 0.79), and DBP (r = 0.092; P = 0.57) and MSNA changes (r = -0.17; P = 0.49). No changes in BP, augmentation index, AI@75 or MSNA were observed in the non-RDN group.
  
  
  CONCLUSIONS
  RDN results in a substantial and rapid reduction in augmentation index, which appears to be independent of BP and MSNA changes. These findings are indicative of a beneficial effect of RDN on arterial stiffness in patients with resistant hypertension and may contribute to the sustained BP-lowering effect of RDN.
authors.affiliation: aNeurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia bDepartment of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland cHeart Centre Alfred Hospital dDepartment of Epidemiology & Preventive Medicine eFaculty of Medicine, Nursing and Health Sciences and Department of Physiology, Monash University, Melbourne, Victoria, Australia fDepartment of Medicine and Cardiology, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota gMedtronic ARDIAN Inc., Mountain View, California, USA hUniversitätsklinikum des Saarlandes, Homburg/Saar, Germany.
authors.forename: Dagmara
authors.initials: D
authors.lastname: Hering
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Lambert
authors.forename: Petra
authors.initials: P
authors.lastname: Marusic
authors.forename: Carolina
authors.initials: C
authors.lastname: Ika-Sari
authors.forename: Antony S
authors.initials: AS
authors.lastname: Walton
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sobotka
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Lambert
authors.forename: Murray D
authors.initials: MD
authors.lastname: Esler
authors.forename: Markus P
authors.initials: MP
authors.lastname: Schlaich
mesh_terms: D000368:Aged; D000792:Angiography; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001158:Arteries / Q000473:pathology; D001794:Blood Pressure; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory; D015992:Body Mass Index; D003714:Denervation / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000601:surgery* / Q000628:therapy*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D059289:Vascular Stiffness
chemical_list: D000959:Antihypertensive Agents