title: Impact of multi-electrode renal sympathetic denervation on short-term blood pressure variability in patients with drug-resistant hypertension. Insights from the EnligHTN I study.
abstract: BACKGROUND
  Transluminal renal sympathetic denervation (RDN) has been shown to reduce blood pressure (BP) in patients with treatment-resistant hypertension.
  
  
  METHODS
  We assessed the effect of multi-electrode RDN on short-term BP variability indexes in resistant hypertensives. Thirty-one patients with drug-resistant uncontrolled hypertension, participants in the EnligHTN I study, underwent ambulatory BP measurements at baseline and 6months after RDN using the EnligHTN ablation catheter (St. Jude Medical). Twelve resistant hypertensives matched for office BP served as control group.
  
  
  RESULTS
  At 6months post-RDN, office BP and 24-hour BP were reduced by 25.6/10.3mmHg and by 10.2/6mmHg (p<0.001 for all cases), respectively. No significant changes were observed 6months post-RDN in standard short-term BP variability indexes including 24-hour systolic and diastolic average real variability. The rates of systolic and diastolic 24-hour BP variation were decreased 6months after RDN, (from 0.40/0.30 to 0.34/0.24, p=0.030/0.006, respectively), especially in the responders group (n=23, 74.2%). No significant differences in BP and BP variability parameters in the control group were detected. ROC analysis revealed an area under the curve for prediction of response to RDN by systolic time rate of 66.8% (95% CI: 46.7% to 87%; p=0.16) and by diastolic time rate of 76.1% (95% CI: 58.2% to 93.9%; p=0.030).
  
  
  CONCLUSIONS
  Although standard BP variability indexes remained unchanged, the rate of systolic and diastolic BP variation was significantly decreased 6months after RDN in patients with drug-resistant hypertension. These novel indexes might also be useful as predictors of response.
authors.affiliation: First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece. Electronic address: ktsioufis@hippocratio.gr.
authors.forename: Costas
authors.initials: C
authors.lastname: Tsioufis
authors.affiliation: VA and Georgetown University Medical Centers, Washington, DC, USA.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papademetriou
authors.affiliation: First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tsiachris
authors.affiliation: First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Kasiakogias
authors.affiliation: First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Kordalis
authors.affiliation: First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece.
authors.forename: Costas
authors.initials: C
authors.lastname: Thomopoulos
authors.affiliation: First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Dimitriadis
authors.affiliation: First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
authors.affiliation: First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece.
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.affiliation: Dept of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
authors.affiliation: Cardiovascular Research Centre, University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Worthley
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D004351:Drug Resistance; D004566:Electrodes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D013562:Sympathectomy / Q000295:instrumentation*; D013564:Sympathetic Nervous System / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: Blood pressure variability; Hypertension; Renal denervation; Resistant hypertension