title: Renal sympathetic denervation in uncontrolled arterial hypertension after successful repair for aortic coarctation.
abstract: BACKGROUND
  Uncontrolled arterial hypertension is a frequent problem after successful repair of CoA and has been attributed to increased central sympathetic drive as well as a blunted baroreceptor reflex. RSD is a promising therapy to reduce central sympathetic drive and improve baroreflex sensitivity.
  
  
  METHODS
  8 patients (age: 27±6 years) with previous surgical and/or percutaneous repair of CoA, absence of any relevant restenosis (invasive gradient across the site of previous treatment 3±4 mmHg) and resistant arterial hypertension (daytime SBP≥140 mmHg on 24 hour ambulatory blood pressure measurements [ABPM] in spite of the concurrent use of 3 antihypertensive agents of different classes or intolerance to BP medications) were included. Bilateral RSD was performed using the Symplicity Flex™ catheter (Medtronic, MN, USA).
  
  
  RESULTS
  RSD was successful in all patients with no procedural complications and no evidence for renal artery stenosis 6 months post procedure. From baseline to 6 month follow-up, RSD was followed by a significant reduction in average daytime systolic BP (150.4±7.8 to 143.1±8.0 mmHg; p=0.0117) as well as systolic BP throughout 24 h (146.8±7.3 vs. 140.5±7.8, p=0.04).
  
  
  CONCLUSIONS
  The BP reductions observed in these patients justify engaging in a larger clinical trial on the efficacy of RSD in this specific type of secondary hypertension and bares the hope that RSD might extend the currently very limited armory against arterial hypertension in young adults with previous repair of CoA.
authors.affiliation: Dept. of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany. Electronic address: Philipp.Lurz@gmx.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lurz
authors.affiliation: Dept. of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Okon
authors.affiliation: Dept. of Paediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Riede
authors.affiliation: Dept. of Paediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Wagner
authors.affiliation: Dept. of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: Dept. of Paediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Daehnert
authors.affiliation: Medical Clinic II, University Heart Center Luebeck, Luebeck, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001017:Aortic Coarctation / Q000601:surgery*; D003714:Denervation; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery*; D007668:Kidney / Q000294:innervation*; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: Arterial hypertension; Coarctation of the aorta; Congenital heart disease; Renal nerves; Renal sympathetic denervation