title: Renal denervation in moderate treatment-resistant hypertension.
abstract: OBJECTIVE
  This study sought to investigate the effect of renal denervation (RDN) in patients with treatment-resistant hypertension according to the established definition (Joint National Committee VII and European Society of Hypertension/European Society of Cardiology guidelines), that is, office blood pressure (BP) ≥140/90 mm Hg (with at least three antihypertensive drugs, including a diuretic, in adequate doses) and confirmed by 24-h ambulatory BP monitoring (ABPM).
  
  
  BACKGROUND
  RDN emerged as an innovative interventional antihypertensive therapy. However, so far, only patients with severe hypertension (systolic BP ≥160 mm Hg or ≥150 mm Hg for patients with type 2 diabetes) have been investigated.
  
  
  METHODS
  In this study, there were 54 patients with moderate treatment-resistant hypertension (office BP ≥140/90 mm Hg and <160/100 mm Hg and diagnosis confirmed by 24-h ABPM of ≥130/80 mm Hg) who underwent catheter-based RDN using the Symplicity catheter (Medtronic Inc., Mountain View, California).
  
  
  RESULTS
  Patients were treated with 5.1 ± 1.4 antihypertensive drugs on average. Office BP was significantly reduced by 13/7 mm Hg 6 months after RDN (systolic: 151 ± 6 mm Hg vs. 138 ± 21 mm Hg, p < 0.001; diastolic: 83 ± 11 mm Hg vs. 75 ± 11 mm Hg, p < 0.001). In patients (n = 36) who underwent ABPM 6 months after treatment, there was a reduction in average 24-h ABPM by 14/7 mm Hg (systolic: 150 ± 16 mm Hg vs. 136 ± 16 mm Hg, p < 0.001; diastolic: 83 ± 10 mm Hg vs. 76 ± 10 mm Hg, p < 0.001). In 51% of patients, office BP was controlled below 140/90 mm Hg after RDN. In addition, heart rate decreased from 67 ± 11 to 63 ± 10 beats/min (p = 0.006).
  
  
  CONCLUSIONS
  Our data indicate that RDN may reduce office and 24-h ambulatory BP substantially in patients with moderate treatment-resistant hypertension. (Renal Denervation in Treatment Resistant Hypertension; NCT01687725).
authors.affiliation: Department of Nephrology and Hypertension, University Hospital at the University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ott
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
authors.forename: Axel
authors.initials: A
authors.lastname: Schmid
authors.forename: Tilmann
authors.initials: T
authors.lastname: Ditting
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sobotka
authors.forename: Roland
authors.initials: R
authors.lastname: Veelken
authors.forename: Aline
authors.initials: A
authors.lastname: Spies
authors.forename: Christian
authors.initials: C
authors.lastname: Ukena
authors.forename: Ulrich
authors.initials: U
authors.lastname: Laufs
authors.forename: Michael
authors.initials: M
authors.lastname: Uder
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D017115:Catheter Ablation; D003714:Denervation; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000601:surgery*; D007668:Kidney / Q000294:innervation; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012077:Renal Artery / Q000294:innervation / Q000601:surgery*; D017211:Treatment Failure
chemical_list: D000959:Antihypertensive Agents
keywords: 24-h ambulatory blood pressure; ABPM; BP; CV; ESC; ESH; European Society of Cardiology; European Society of Hypertension; HR; JNC; Joint National Committee; RDN; SBP; TRH; ambulatory blood pressure monitoring; blood pressure; cardiovascular; heart rate; renal denervation; systolic blood pressure; treatment-resistant hypertension