title: Renal denervation improves exercise blood pressure: insights from a randomized, sham-controlled trial.
abstract: BACKGROUND
  Despite the ongoing debate on the role of renal sympathetic denervation (RSD) in the management of therapy-resistant hypertension, little is known about its possible effects on exercise blood pressure (BP), a known predictor for future cardiovascular events. We sought to evaluate the effect of RSD on exercise BP in a randomized, sham-controlled trial in patients with mild hypertension.
  
  
  RESULTS
  Patients with therapy-resistant mild hypertension (defined by mean daytime systolic BP between 135 and 149 mmHg or mean daytime diastolic BP between 90 and 94 mmHg on 24-h ambulatory BP measurement) were randomized to either radiofrequency-based RSD or a sham procedure. Patients underwent cardiopulmonary exercise testing at baseline and after 6 months. Of the 71 patients randomized, data from cardiopulmonary exercise testing were available for 48 patients (22 in the RSD group, 26 in the sham group). After 6 months, patients undergoing RSD had a significantly lower systolic BP at maximum exercise workload compared to baseline (-14.2 ± 26.1 mmHg, p = 0.009). In contrast, no change was observed in the sham group (0.6 ± 22.9 mmHg, p = 0.45, p = 0.04 for between-group comparison). When analyzing patients with exaggerated baseline exercise BP only, the effect was even more pronounced (RSD vs. sham -29.5 ± 23.4 vs. 0.1 ± 25.3 mmHg, p = 0.008).
  
  
  CONCLUSIONS
  Exercise systolic BP values in patients with mild therapy-resistant hypertension are reduced after RSD as compared to a sham-procedure.
authors.affiliation: Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Fengler
authors.affiliation: Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
authors.forename: Diana
authors.initials: D
authors.lastname: Heinemann
authors.affiliation: Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Okon
authors.affiliation: Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
authors.forename: Karoline
authors.initials: K
authors.lastname: Röhnert
authors.affiliation: Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Stiermaier
authors.affiliation: Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: von Röder
authors.affiliation: Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Besler
authors.affiliation: Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Müller
authors.affiliation: Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Höllriegel
authors.affiliation: Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany.|German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Luebeck, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.affiliation: Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany. Philipp.Lurz@gmx.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lurz
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D017115:Catheter Ablation / Q000009:adverse effects; D004351:Drug Resistance; D015444:Exercise; D005080:Exercise Test; D005260:Female; D005858:Germany; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000294:innervation* / Q000601:surgery*; D012720:Severity of Illness Index; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: Exercise blood pressure; Renal sympathetic denervation; Sham controlled; Therapy-resistant hypertension