Blood pressure changes after renal denervation at 10 European expert centers.
We did a subject-level meta-analysis of the changes (Δ) in blood pressure (BP) observed 3 and 6 months after renal denervation (RDN) at 10 European centers. Recruited patients (n=109; 46.8% women; mean age 58.2 years) had essential hypertension confirmed by ambulatory BP. From baseline to 6 months, treatment score declined slightly from 4.7 to 4.4 drugs per day. Systolic/diastolic BP fell by 17.6/7.1 mm Hg for office BP, and by 5.9/3.5, 6.2/3.4, and 4.4/2.5 mm Hg for 24-h, daytime and nighttime BP (P0.03 for all). In 47 patients with 3- and 6-month ambulatory measurements, systolic BP did not change between these two time points (P0.08). Normalization was a systolic BP of <140 mm Hg on office measurement or <130 mm Hg on 24-h monitoring and improvement was a fall of 10 mm Hg, irrespective of measurement technique. For office BP, at 6 months, normalization, improvement or no decrease occurred in 22.9, 59.6 and 22.9% of patients, respectively; for 24-h BP, these proportions were 14.7, 31.2 and 34.9%, respectively. Higher baseline BP predicted greater BP fall at follow-up; higher baseline serum creatinine was associated with lower probability of improvement of 24-h BP (odds ratio for 20-μmol l(-1) increase, 0.60; P=0.05) and higher probability of experiencing no BP decrease (OR, 1.66; P=0.01). In conclusion, BP responses to RDN include regression-to-the-mean and remain to be consolidated in randomized trials based on ambulatory BP monitoring. For now, RDN should remain the last resort in patients in whom all other ways to control BP failed, and it must be cautiously used in patients with renal impairment.
1] Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium [2] Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
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Persu
Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
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Jin
Faculté de Médecine, Université Paris Descartes, Paris, France.
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Azizi
1] Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium [2] Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
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Baelen
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Völz
Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
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Elvan
Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
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Severino
Third Department of Internal Medicine, General Faculty Hospital, Prague, Czech Republic.
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Rosa
Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
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Adiyaman
Department of Cardiology, Ullevål University Hospital, University of Oslo, Oslo, Norway.
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Fadl Elmula
BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
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Taylor
Hypertension Unit, Geneva University Hospital, Geneva, Switzerland.
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Pechère-Bertschi
Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland.
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Wuerzner
Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
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Jokhaji
Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
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Kahan
Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
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Renkin
Faculté de Médecine, Université Paris Descartes, Paris, France.
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Monge
Third Department of Internal Medicine, General Faculty Hospital, Prague, Czech Republic.
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Widimský
Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
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Jacobs
Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland.
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Burnier
BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
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Mark
Department of Cardiology, Ullevål University Hospital, University of Oslo, Oslo, Norway.
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Kjeldsen
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Andersson
Faculté de Médecine, Université Paris Descartes, Paris, France.
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Sapoval
1] Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium [2] Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
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Staessen
D000959:Antihypertensive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory; D003131:Combined Modality Therapy; D003714:Denervation; D000075222:Essential Hypertension; D005060:Europe; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000601:surgery*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D000959:Antihypertensive Agents