title: Central pulse pressure predicts BP reduction after renal denervation in patients with treatment-resistant hypertension.
abstract: OBJECTIVE
  Enhanced vascular ageing is associated with elevated central pulse pressure (cPP), an independent predictor of cardiovascular (CV) events. Although antihypertensive treatment strategies are effective, high residual CV risk remains indicative of advanced and largely irreversible vascular damage. Renal denervation (RDN) has been shown to reduce blood pressure (BP) to various extents in patients with treatment-resistant hypertension (TRH). We hypothesised that cPP predicts BP reduction after RDN.
  
  
  RESULTS
  Sixty-three patients with true TRH underwent catheter-based RDN using the Symplicity Flex™ catheter and were followed for six months. At baseline, cPP was assessed by pulse wave analysis (SphygmoCor™). Patients were stratified according to their median cPP (55 mmHg), and called "low cPP" (below the median) or "high cPP" (above the median). Office BP reduction six months after RDN was greater (-22±19/-13±11 vs. -12±20/-5±13 mmHg, p=0.038/0.014) and 24-hr ambulatory blood pressure (ABP) reduction tended to be greater (-11±13/-8±10 vs. -3±18/-4±10 mmHg, p=0.070/0.112) in patients with low cPP compared to those with high cPP. Only cPP (β=0.687, p=0.001) and baseline systolic BP (β=-0.564, p<0.001) were independent determinants of office systolic BP reduction after RDN.
  
  
  CONCLUSIONS
  Our data suggest that cPP, indicative of the degree of large arterial stiffening, may be helpful to identify responders to RDN.
authors.affiliation: Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ott
authors.forename: Axel
authors.initials: A
authors.lastname: Schmid
authors.forename: Stefan W
authors.initials: SW
authors.lastname: Toennes
authors.forename: Tilmann
authors.initials: T
authors.lastname: Ditting
authors.forename: Roland
authors.initials: R
authors.lastname: Veelken
authors.forename: Michael
authors.initials: M
authors.lastname: Uder
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D017763:Autonomic Denervation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016009:Chi-Square Distribution; D004351:Drug Resistance; D004566:Electrodes; D004867:Equipment Design; D005260:Female; D005858:Germany; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000098:blood supply*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D063177:Pulse Wave Analysis; D012077:Renal Artery / Q000294:innervation*; D013997:Time Factors; D016896:Treatment Outcome; D059289:Vascular Stiffness
chemical_list: D000959:Antihypertensive Agents