title: Ambulatory blood pressure changes after renal sympathetic denervation in patients with resistant hypertension.
abstract: BACKGROUND
  Catheter-based renal sympathetic denervation (RDN) reduces office blood pressure (BP) in patients with resistant hypertension according to office BP. Less is known about the effect of RDN on 24-hour BP measured by ambulatory BP monitoring and correlates of response in individuals with true or pseudoresistant hypertension.
  
  
  RESULTS
  A total of 346 uncontrolled hypertensive patients, separated according to daytime ambulatory BP monitoring into 303 with true resistant (office systolic BP [SBP] 172.2±22 mm Hg; 24-hour SBP 154±16.2 mm Hg) and 43 with pseudoresistant hypertension (office SBP 161.2±20.3 mm Hg; 24-hour SBP 121.1±19.6 mm Hg), from 10 centers were studied. At 3, 6, and 12 months follow-up, office SBP was reduced by 21.5/23.7/27.3 mm Hg, office diastolic BP by 8.9/9.5/11.7 mm Hg, and pulse pressure by 13.4/14.2/14.9 mm Hg (n=245/236/90; P for all <0.001), respectively. In patients with true treatment resistance there was a significant reduction with RDN in 24-hour SBP (-10.1/-10.2/-11.7 mm Hg, P<0.001), diastolic BP (-4.8/-4.9/-7.4 mm Hg, P<0.001), maximum SBP (-11.7/-10.0/-6.1 mm Hg, P<0.001) and minimum SBP (-6.0/-9.4/-13.1 mm Hg, P<0.001) at 3, 6, and 12 months, respectively. There was no effect on ambulatory BP monitoring in pseudoresistant patients, whereas office BP was reduced to a similar extent. RDN was equally effective in reducing BP in different subgroups of patients. Office SBP at baseline was the only independent correlate of BP response.
  
  
  CONCLUSIONS
  RDN reduced office BP and improved relevant aspects of ambulatory BP monitoring, commonly linked to high cardiovascular risk, in patients with true-treatment resistant hypertension, whereas it only affected office BP in pseudoresistant hypertension.
authors.affiliation: 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
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
authors.forename: Christian
authors.initials: C
authors.lastname: Ukena
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
authors.forename: Bodo
authors.initials: B
authors.lastname: Cremers
authors.forename: Lars C
authors.initials: LC
authors.lastname: Rump
authors.forename: Oliver
authors.initials: O
authors.lastname: Vonend
authors.forename: Joachim
authors.initials: J
authors.lastname: Weil
authors.forename: Martin
authors.initials: M
authors.lastname: Schmidt
authors.forename: Uta C
authors.initials: UC
authors.lastname: Hoppe
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeller
authors.forename: Axel
authors.initials: A
authors.lastname: Bauer
authors.forename: Christian
authors.initials: C
authors.lastname: Ott
authors.forename: Erwin
authors.initials: E
authors.lastname: Blessing
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sobotka
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.forename: Markus
authors.initials: M
authors.lastname: Schlaich
authors.forename: Murray
authors.initials: M
authors.lastname: Esler
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000503:physiopathology* / Q000601:surgery*; D007668:Kidney / Q000294:innervation* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013562:Sympathectomy / Q000379:methods / Q000639:trends*
keywords: ambulatory blood pressure monitoring; hypertension resistant to conventional therapy; sympathectomy