title: Renal artery anatomy affects the blood pressure response to renal denervation in patients with resistant hypertension.
abstract: BACKGROUND
  Renal denervation (RDN) has been shown to reduce blood pressure (BP), muscle sympathetic nerve activity (MSNA) and target organ damage in patients with resistant hypertension (RH) and bilateral single renal arteries. The safety and efficacy of RDN in patients with multiple renal arteries remains unclear.
  
  
  METHODS
  We measured office and 24-hour BP at baseline, 3 and 6 months following RDN in 91 patients with RH, including 65 patients with single renal arteries bilaterally (group 1), 16 patients with dual renal arteries on either one or both sides (group 2) and 10 patients with other anatomical constellations or structural abnormalities (group 3). Thirty nine out of 91 patients completed MSNA at baseline and follow-up.
  
  
  RESULTS
  RDN significantly reduced office and daytime SBP in group 1 at both 3 and 6 months follow-up (P<0.001) but not in groups 2 and 3. Similarly, a significant reduction in resting baseline MSNA was only observed in group 1 (P<0.05). There was no deterioration in kidney function in any group.
  
  
  CONCLUSIONS
  While RDN can be performed safely irrespective of the underlying renal anatomy, the presence of single renal arteries with or without structural abnormalities is associated with a more pronounced BP and MSNA lowering effect than the presence of dual renal arteries in patients with RH. However, when patients with dual renal arteries received renal nerve ablation in all arteries there was trend towards a greater BP reduction. Insufficient renal sympathetic nerve ablation may account for these differences.
authors.affiliation: Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia; School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of WA, Perth, Australia.
authors.forename: Dagmara
authors.initials: D
authors.lastname: Hering
authors.affiliation: Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia; School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of WA, Perth, Australia.
authors.forename: Petra
authors.initials: P
authors.lastname: Marusic
authors.affiliation: Heart Centre Alfred Hospital, Melbourne, Australia.
authors.forename: Antony S
authors.initials: AS
authors.lastname: Walton
authors.affiliation: Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Duval
authors.affiliation: Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lee
authors.affiliation: Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Sata
authors.affiliation: Heart Centre Alfred Hospital, Melbourne, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.affiliation: Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lambert
authors.affiliation: Heart Centre Alfred Hospital, Melbourne, Australia; Atherosclerosis & Vascular Biology Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Peter
authors.affiliation: Neuropharmacology Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
authors.forename: Geoff
authors.initials: G
authors.lastname: Head
authors.affiliation: Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
authors.forename: Gavin
authors.initials: G
authors.lastname: Lambert
authors.affiliation: Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia; Heart Centre Alfred Hospital, Melbourne, Australia.
authors.forename: Murray D
authors.initials: MD
authors.lastname: Esler
authors.affiliation: Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia; School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of WA, Perth, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences and Department of Physiology, Monash University, Melbourne, Australia. Electronic address: markus.schlaich@uwa.edu.au.
authors.forename: Markus P
authors.initials: MP
authors.lastname: Schlaich
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000098:blood supply* / Q000294:innervation* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000033:anatomy & histology* / Q000294:innervation / Q000601:surgery; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D013564:Sympathetic Nervous System / Q000601:surgery*; D016896:Treatment Outcome
keywords: Renal artery anatomy; Renal denervation; Resistant hypertension