title: Renal artery sympathetic denervation: observations from the UK experience.
abstract: BACKGROUND
  Renal denervation (RDN) may lower blood pressure (BP); however, it is unclear whether medication changes may be confounding results. Furthermore, limited data exist on pattern of ambulatory blood pressure (ABP) response-particularly in those prescribed aldosterone antagonists at the time of RDN.
  
  
  METHODS
  We examined all patients treated with RDN for treatment-resistant hypertension in 18 UK centres.
  
  
  RESULTS
  Results from 253 patients treated with five technologies are shown. Pre-procedural mean office BP (OBP) was 185/102 mmHg (SD 26/19; n = 253) and mean daytime ABP was 170/98 mmHg (SD 22/16; n = 186). Median number of antihypertensive drugs was 5.0: 96 % ACEi/ARB; 86 % thiazide/loop diuretic and 55 % aldosterone antagonist. OBP, available in 90 % at 11 months follow-up, was 163/93 mmHg (reduction of 22/9 mmHg). ABP, available in 70 % at 8.5 months follow-up, was 158/91 mmHg (fall of 12/7 mmHg). Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn. Dose changes appeared neutral. Quartile analysis by starting ABP showed mean reductions in systolic ABP after RDN of: 0.4; 6.5; 14.5 and 22.1 mmHg, respectively (p < 0.001 for trend). Use of aldosterone antagonist did not predict response (p > 0.2).
  
  
  CONCLUSIONS
  In 253 patients treated with RDN, office BP fell by 22/9 mmHg. Ambulatory BP fell by 12/7 mmHg, though little response was seen in the lowermost quartile of starting blood pressure. Fall in BP was not explained by medication changes and aldosterone antagonist use did not affect response.
authors.affiliation: Department of Cardiology, Royal Devon and Exeter NHS Foundation Trust, University of Exeter, Barrack Road, Exeter, EX2 5DW, UK. drandrewsharp@gmail.com.
authors.forename: Andrew S P
authors.initials: AS
authors.lastname: Sharp
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Justin E
authors.initials: JE
authors.lastname: Davies
authors.affiliation: Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London, EC1A 7BE, UK.|William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, E1 4NS, UK.
authors.forename: Melvin D
authors.initials: MD
authors.lastname: Lobo
authors.affiliation: Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, UK.
authors.forename: Clare L
authors.initials: CL
authors.lastname: Bent
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA, UK.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Mark
authors.affiliation: University of Bristol, Bristol, UK.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Burchell
authors.affiliation: Hull and East Yorkshire Hospitals NHS Trust, Hull York Medical School, Castle Road, Hull, HU16 5JQ, UK.
authors.forename: Simon D
authors.initials: SD
authors.lastname: Thackray
authors.affiliation: Department of Clinical Pharmacology, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.
authors.forename: Una
authors.initials: U
authors.lastname: Martin
authors.affiliation: Sheffield Kidney Institute, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
authors.forename: William S
authors.initials: WS
authors.lastname: McKane
authors.affiliation: East Sussex Healthcare NHS Trust, Eastbourne, East Sussex, UK.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Gerber
authors.affiliation: University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.
authors.forename: James R
authors.initials: JR
authors.lastname: Wilkinson
authors.affiliation: St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK.
authors.forename: Tarek F
authors.initials: TF
authors.lastname: Antonios
authors.affiliation: East Kent Hospitals NHS Foundation Trust, Kent and Canterbury Hospital, Ethelbert Road, Canterbury, CT1 3NG, UK.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Doulton
authors.affiliation: Cardiovascular Division, Rayne Institute, BHF Centre of Research Excellence, Kings College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Patterson
authors.affiliation: Buckinghamshire Healthcare NHS Trust, Queen Alexandra Road, High Wycombe, Bucks, HP11 2TT, UK.
authors.forename: Piers C
authors.initials: PC
authors.lastname: Clifford
authors.affiliation: NIHR Cardiovascular BRU Royal Brompton & Harefield NHS Foundation Trust, London, SW3 6NP, UK.
authors.forename: Alistair
authors.initials: A
authors.lastname: Lindsay
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, UK.
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Houston
authors.affiliation: Department of Interventional Radiology, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Freedman
authors.affiliation: East Kent Hospitals NHS Foundation Trust, Kent and Canterbury Hospital, Ethelbert Road, Canterbury, CT1 3NG, UK.
authors.forename: Neelan
authors.initials: N
authors.lastname: Das
authors.affiliation: St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Belli
authors.affiliation: East Sussex Healthcare NHS Trust, Eastbourne, East Sussex, UK.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Faris
authors.affiliation: Sheffield Vascular Institute, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Cleveland
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA, UK.
authors.forename: Angus K
authors.initials: AK
authors.lastname: Nightingale
authors.affiliation: University of Birmingham, Birmingham, UK.
authors.forename: Awais
authors.initials: A
authors.lastname: Hameed
authors.affiliation: University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.
authors.forename: Kalaivani
authors.initials: K
authors.lastname: Mahadevan
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Finegold
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK.
authors.forename: Adam N
authors.initials: AN
authors.lastname: Mather
authors.affiliation: Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, UK.
authors.forename: Terry
authors.initials: T
authors.lastname: Levy
authors.affiliation: Department of Renal Medicine, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: D'Souza
authors.affiliation: Radiology Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, B15 2TH, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Riley
authors.affiliation: Queen Elizabeth University Hospital, Glasgow, G11 6NT, UK.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Moss
authors.affiliation: NIHR Cardiovascular BRU Royal Brompton & Harefield NHS Foundation Trust, London, SW3 6NP, UK.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.affiliation: Cardiovascular Division, Rayne Institute, BHF Centre of Research Excellence, Kings College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
authors.forename: Simon R
authors.initials: SR
authors.lastname: Redwood
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA, UK.
authors.forename: Andreas
authors.initials: A
authors.lastname: Baumbach
authors.affiliation: Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London, EC1A 7BE, UK.|William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, E1 4NS, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Caulfield
authors.affiliation: Renal Unit, Birmingham Heartlands Hospital, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.
authors.forename: Indranil
authors.initials: I
authors.lastname: Dasgupta
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists; D009819:Office Visits; D012042:Registries; D012077:Renal Artery / Q000294:innervation*; D012189:Retrospective Studies; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D013564:Sympathetic Nervous System / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000959:Antihypertensive Agents; D000451:Mineralocorticoid Receptor Antagonists
keywords: Aldosterone; Catheter ablation; Hypertension; Sympathetic nervous system