title: Effects of renal sympathetic denervation on urinary sodium excretion in patients with resistant hypertension.
abstract: BACKGROUND
  Sympathetic overactivity increases sodium retention and contributes to the pathophysiology of hypertension. Renal sympathetic denervation lowers blood pressure and reduces sympathetic activity in certain patients with resistant hypertension.
  
  
  RESULTS
  This study aimed to assess the effect of renal denervation on urinary sodium excretion. 24-h urinary sodium excretion was estimated at baseline and after 6 months using the Kawasaki formula in 137 patients with resistant hypertension undergoing renal denervation. Sodium excretion was adjusted for cystatin C GFR and fractional sodium excretion was assessed. Mean office systolic blood pressure at baseline was 171 ± 2 mmHg despite an intake of 5.2 ± 0.1 antihypertensive drugs. Six months after renal denervation, systolic and diastolic BP decreased by 18 ± 2 mmHg (p < 0.0001) and 10 ± 1 mmHg (p < 0.001). 90 patients (65.7%) had SBP reductions ≥ 10 mmHg (responders). After 6 months, 24-h UNa increased by 13% compared to baseline (236 ± 9 vs. 268 ± 9 mmol/day, p < 0.003). This increase was most pronounced in patients with less response in BP. These findings were paralleled by a significant increase in fractional sodium excretion (1.19 ± 0.11 vs. 1.64 ± 0.14%, p < 0.0001) and were observed independently of the intake of antihypertensive drugs affecting sodium balance, such as mineralocorticoid receptor antagonists or diuretics.
  
  
  CONCLUSIONS
  RDN lowered BP and increased estimated UNa and fractional sodium excretion in patients with resistant hypertension independently of renal function and antihypertensive therapy.
authors.affiliation: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Germany, janine.poess@uksh.de.
authors.forename: Janine
authors.initials: J
authors.lastname: Pöss
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ewen
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
authors.forename: Sonja
authors.initials: S
authors.lastname: Muhler
authors.forename: Oliver
authors.initials: O
authors.lastname: Vonend
authors.forename: Christian
authors.initials: C
authors.lastname: Ott
authors.forename: Dominik
authors.initials: D
authors.lastname: Linz
authors.forename: Jürgen
authors.initials: J
authors.lastname: Geisel
authors.forename: Lars C
authors.initials: LC
authors.lastname: Rump
authors.forename: Markus
authors.initials: M
authors.lastname: Schlaich
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000652:urine; D001794:Blood Pressure / Q000187:drug effects; D017115:Catheter Ablation / Q000009:adverse effects; D004351:Drug Resistance; D005260:Female; D005858:Germany; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D009318:Natriuresis; D011446:Prospective Studies; D065667:Renal Elimination; D012964:Sodium / Q000652:urine*; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D012964:Sodium