Effects of multielectrode renal denervation on cardiac and neurohumoral adaptations in resistant hypertension with cardiac hypertrophy: an EnligHTN I substudy.
OBJECTIVE
This EnligHTN I nonrandomized substudy investigated the effect of multielectrode renal denervation (RDN) on cardiac and neurohumoral adaptations.


METHODS
Eighteen patients with true drug-resistant hypertension [age: 56 ± 10 years, 12 men, BMI: 33.6 ± 5.4 kg/m, office blood pressure (BP) by automatic device (Omron): 182 ± 19/97 ± 18 mmHg and ambulatory BP (Spacelabs): 153 ± 16/87 ± 15 mmHg receiving 4.5 antihypertensive drugs/day] and left ventricular hypertrophy underwent multielectrode RDN (EnligHTN system; St. Jude Medical), whereas 10 patients served as controls. Both groups were followed-up for 6 months.


RESULTS
Demographic data were homogenous between both patient groups. In addition to reduction of office (-42/-17 mmHg, P < 0.001) and ambulatory (-19/-9 mmHg, P < 0.001) BP, RDN contributed to attenuation of left ventricular mass index from 140.0 ± 17.0 g/m (57.9 ± 7.9 g/m) to 126.7 ± 19.2 g/m (52.6 ± 8.4 g/m) (P < 0.01 for both) and left atrial diameter from 42.4 ± 4.3 to 40.6 ± 3.6 mm (P = 0.004) at 6 months. Up to 56% of the RDN-group patients achieved a target of less than 140/90 mmHg in the office BP; proportion of RDN-group patients with concentric left ventricular hypertrophy had decreased by 39%; mitral lateral E/E' ratio decreased from 14.8 ± 6.1 to 12.0 ± 3.2 (P = 0.016); isovolumic relaxation time shortened from 109.8 ± 16.2 to 100.8 ± 17.1 ms (P = 0.003); and N-terminal pro B-type natriuretic peptide levels reduced from 84.9 ± 35.9 to 57.2 ± 38.8 pg/ml (P < 0.001) significantly at 6 months post-RDN. Control patients exhibited no significant changes in all the above parameters (P > 0.05) at 6 months.


CONCLUSIONS
Multielectrode RDN contributes to improvement of diastolic dysfunction, reduction of left ventricular mass and attenuation of NT-proBNP, suggesting additional cardiovascular benefits in drug-resistant hypertension associated with left ventricular hypertrophy.
aFirst Cardiology Clinic, University of Athens, Hippocration Hospital, Athens, Greece bVeterans Affairs and Georgetown University Medical Centers, Washington, District of Columbia cSt. Jude Medical, Inc., Irvine, California, USA dClinica Medica, University of Milano-Bicocca, Monza eIstituto di Ricerche a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni Milan, Italy.
Costas
C
Tsioufis
Vasilios
V
Papademetriou
Kyriakos
K
Dimitriadis
Dimitris
D
Tsiachris
Costas
C
Thomopoulos
Alexandros
A
Kasiakogias
Athanasios
A
Kordalis
Anna
A
Kefala
Evagelia
E
Koutra
Elizabeth Oi-Yan
EO
Lau
Guido
G
Grassi
Christodoulos
C
Stefanadis
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D003714:Denervation / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography
D000959:Antihypertensive Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain