title: Influence of pseudo-resistance on the effect of renal denervation on 24-hour ambulatory blood pressure levels.
abstract: BACKGROUND
  Renal denervation (RDN) is a promising treatment option in addition to medical antihypertensive treatment in patients suffering from resistant hypertension. Despite the growing interest in RDN, the negative result of the Symplicity HTN-3 trial led to a debate on the efficacy of RDN.
  
  
  METHODS
  We systematically investigated the effects of RDN, evaluated by 24-hr ambulatory blood pressure measurements (ABPM), in a consecutive series of patients with resistant hypertension, which was defined by a mean office systolic blood pressure (SBP) >160 mm Hg (>150 mm Hg in patients with diabetes). Patients with a mean 24-hr SBP of less than 130 mm Hg at baseline were classified as pseudo-resistant, while all other patients were classified as true-resistant. After six months, we analyzed the response rates in true-resistant and in pseudo-resistant patients, respectively, by the means of 24-hr ABPM. Thereby, patients with a reduction of more than 5 mm Hg in 24-hr SBP were classified as responders.
  
  
  RESULTS
  RDN was performed in 106 patients. By 24-hr ABPM, 20 patients (18.9%) were classified as pseudo-resistant patients. In this cohort, we only found two responders (response rate 10%) six months after RDN. By contrast, in true-resistant patients, the response rate was almost 60% and the mean BP reduction was -18.6/-9 mm Hg in 24-hr ABPM.
  
  
  CONCLUSIONS
  We found a significant BP reduction in almost 60% of patients with true-resistant hypertension, but only in 10% in patients with pseudo-resistant hypertension. According to our results, patient selection seems to be crucial for acceptable response rates after RDN.
authors.affiliation: 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lambert
authors.affiliation: 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Nahler
authors.affiliation: 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Reiter
authors.affiliation: 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria.
authors.forename: Verena
authors.initials: V
authors.lastname: Gammer
authors.affiliation: 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria.
authors.forename: Hermann
authors.initials: H
authors.lastname: Blessberger
authors.affiliation: 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Kammler
authors.affiliation: 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Grund
authors.affiliation: 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria.
authors.forename: Karim
authors.initials: K
authors.lastname: Saleh
authors.affiliation: 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwarz
authors.affiliation: 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria.
authors.forename: Clemens
authors.initials: C
authors.lastname: Steinwender
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery*; D007668:Kidney / Q000294:innervation*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D013562:Sympathectomy; D014655:Vascular Resistance / Q000502:physiology*
chemical_list: D000959:Antihypertensive Agents
keywords: endovascular intervention; hypertension; sympathetic denervation