Renal denervation in hypertensive patients not on blood pressure lowering drugs.
BACKGROUND
Studies on the blood pressure lowering effect of renal denervation (RDN) in resistant hypertensive patients have produced conflicting results. Change in medication usage during the studies may be responsible for this inconsistency. To eliminate the effect of medication usage on blood pressure we focused on unmedicated hypertensive patients who underwent RDN.


RESULTS
Our study reports on a cohort of patients, who were not on blood pressure lowering drugs at baseline and during follow-up, from eight tertiary centers. Data of patients were used when they were treated with RDN and had a baseline office systolic blood pressure (SBP) ≥140 mmHg and/or 24-h ambulatory SBP ≥130 mmHg. Our primary outcome was defined as change in office and 24-h SBP at 12 months after RDN, compared to baseline. Fifty-three patients were included. There were three different reasons for not using blood pressure lowering drugs: (1) documented intolerance or allergic reaction (57 %); (2) temporary cessation of medication for study purposes (28 %); and (3) reluctance to take antihypertensive drugs (15 %). Mean change in 24-h SBP was -5.7 mmHg [95 % confidence interval (CI) -11.0 to -0.4; p = 0.04]. Mean change in office SBP was -13.1 mmHg (95 % CI -20.4 to -5.7; p = 0.001). No changes were observed in other variables, such as eGFR, body-mass-index and urinary sodium excretion.


CONCLUSIONS
This explorative study in hypertensive patients, who are not on blood pressure lowering drugs, suggests that at least in some patients RDN lowers blood pressure.
Department of Nephrology and Hypertension, University Medical Center Utrecht, Room F03.220, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Rosa L
RL
De Jager
Department of Nephrology and Hypertension, University Medical Center Utrecht, Room F03.220, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Margreet F
MF
Sanders
The Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Michiel L
ML
Bots
William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.
Melvin D
MD
Lobo
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Sebastian
S
Ewen
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Martine M A
MM
Beeftink
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Michael
M
Böhm
Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Joost
J
Daemen
Department of Cardiology, University of Giessen, Giessen, Germany.
Oliver
O
Dörr
School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Perth, Australia.|Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
Dagmara
D
Hering
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Felix
F
Mahfoud
Department of Cardiology, University of Giessen, Giessen, Germany.
Holger
H
Nef
Department of Nephrology and Hypertension, University Hospital of Erlangen, Erlangen, Germany.
Christian
C
Ott
William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.
Manish
M
Saxena
Department of Nephrology and Hypertension, University Hospital of Erlangen, Erlangen, Germany.
Roland E
RE
Schmieder
School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Perth, Australia.|Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
Markus P
MP
Schlaich
Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Wilko
W
Spiering
Department of Cardiology, Heartcenter Catharina Hospital, Eindhoven, The Netherlands.
Pim A L
PA
Tonino
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Willemien L
WL
Verloop
Department of Nephrology and Hypertension, University Medical Center Utrecht, Room F03.220, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Eva E
EE
Vink
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Evert-Jan
EJ
Vonken
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Michiel
M
Voskuil
Cardiovascular Research Centre, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia.
Stephen G
SG
Worthley
Department of Nephrology and Hypertension, University Medical Center Utrecht, Room F03.220, PO Box 85500, 3508 GA, Utrecht, The Netherlands. p.j.blankestijn@umcutrecht.nl.
Peter J
PJ
Blankestijn
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D005060:Europe; D005260:Female; 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*; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D013564:Sympathetic Nervous System / Q000503:physiopathology / Q000601:surgery*; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
Blood pressure reduction; Drug naive; Hypertension; Medication adherence; Renal denervation; Sympathetic activity