title: Intraprocedural reduction of the veno-arterial norepinephrine gradient correlates with blood pressure response after renal denervation.
abstract: OBJECTIVE
  No intraprocedural assessment is currently available to evaluate the extent of nerve ablation by renal denervation (RDN). We prospectively evaluated the association of intraprocedural reduction of renal veno-arterial norepinephrine gradient with blood pressure (BP) response after RDN.
  
  
  RESULTS
  In 46 consecutive RDN patients, the periprocedural norepinephrine veno-arterial difference was defined as veno-arterial norepinephrine gradient. We observed a reduction of the office systolic BP from 176±19 mmHg to 165±24 mmHg (p=0.02) at three months and 163±22 mmHg (p=0.02) at six months. The mean and maximum systolic ABP decreased by 5 mmHg (p=0.03) and 9 mmHg (p=0.02), respectively. There was a decrease of the norepinephrine RV-RA difference from pre- to post-procedural levels (median 186 pg/ml [54;466] vs. 81 pg/ml [0;182], p=0.02). OBP responders (office systolic BP reduction ≥10 mmHg) showed a greater reduction of the norepinephrine gradient compared to non-responders (-290±450 pg/ml vs. -4±106 pg/ml, p=0.01). Patients with a reduction of norepinephrine gradient in both kidneys showed the most pronounced decrease of the systolic OBP (-24±14 mmHg) compared to patients with a reduction of norepinephrine gradient in only one kidney (-7±15 mmHg) or patients without a norepinephrine reduction (-3±19 mmHg, p=0.03 vs. bilateral reduction).
  
  
  CONCLUSIONS
  Measuring renal norepinephrine gradient during RDN may be a method to gauge the extent of renal nerve ablation.
authors.affiliation: HELIOS Klinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Tiroch
authors.forename: Armin
authors.initials: A
authors.lastname: Sause
authors.forename: Jacek
authors.initials: J
authors.lastname: Szymanski
authors.forename: Ina
authors.initials: I
authors.lastname: Nover
authors.forename: Roman
authors.initials: R
authors.lastname: Leischik
authors.forename: Johannes F E
authors.initials: JF
authors.lastname: Mann
authors.forename: Marc
authors.initials: M
authors.lastname: Vorpahl
authors.forename: Melchior
authors.initials: M
authors.lastname: Seyfarth
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D017763:Autonomic Denervation / Q000379:methods*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000098:blood supply / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood*; D009819:Office Visits; D010690:Phlebography; D011446:Prospective Studies; D012077:Renal Artery / Q000000981:diagnostic imaging; D012082:Renal Veins / Q000000981:diagnostic imaging; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D009638:Norepinephrine