Blood pressure changes after catheter-based renal denervation are related to reductions in total peripheral resistance.
BACKGROUND
Renal denervation (RDN) can reduce sympathetic activity and blood pressure (BP) in patients with uncontrolled hypertension. The exact mechanisms by which RDN results in BP reductions are yet not fully established.


RESULTS
This study investigated the effects of RDN on office BP, 24-h ambulatory BP, noninvasive 10-min beat-to-beat digital pulse wave analysis, total peripheral resistance (TPR), cardiac output, and plasma renin and aldosterone serum concentrations in 30 patients with resistant hypertension. Adherence to antihypertensive drugs was assessed by liquid chromatography high-resolution tandem mass spectrometry analysis in plasma and urine at baseline and at 6 month. RDN significantly reduced office BP, beat-to-beat BP, and 24-h ambulatory BP by 19/6 (P = 0.021/P = 0.012), 12/7 (P = 0.005/P = 0.005), and 10/5  mmHg (P = 0.001/P = 0.049) at 6 months, respectively. TPR decreased from 1696 to 1377  dyn × s/cm (-19%; P = 0.027). This reduction was not associated with significant changes in cardiac output. The changes in office, ambulatory, and beat-to-beat BP correlated with the reductions of TPR. Adherence to antihypertensive treatment remained unchanged during the study period (84.7% at baseline, 83.6% at 6 months, P = 0.782).


CONCLUSIONS
RDN reduced office BP, beat-to-beat BP, and 24-h ambulatory BP in patients with resistant hypertension after 6 months. The BP changes were associated with reductions in peripheral resistance, whereas cardiac output, plasma renin, and aldosterone levels remained unchanged. The observed effects were not explained by an increased intake of antihypertensive medications.
aKlinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes bAbteilung Experimentelle und Klinische Pharmakologie, Universität des Saarlandes, Homburg/Saar, Germany cClinica Medica, Università Milano-Bicocca dIstituto di Ricerca e Cura a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
Sebastian
S
Ewen
Bodo
B
Cremers
Markus R
MR
Meyer
Luca
L
Donazzan
Ingrid
I
Kindermann
Christian
C
Ukena
Andreas G
AG
Helfer
Hans H
HH
Maurer
Ulrich
U
Laufs
Guido
G
Grassi
Michael
M
Böhm
Felix
F
Mahfoud
D000368:Aged; D000450:Aldosterone / Q000097:blood; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002302:Cardiac Output; D017115:Catheter Ablation; D003329:Coronary Vasospasm / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D012077:Renal Artery / Q000294:innervation / Q000601:surgery; D012083:Renin / Q000097:blood; D013562:Sympathectomy; D014655:Vascular Resistance / Q000502:physiology*
D000959:Antihypertensive Agents; D000450:Aldosterone; D012083:Renin