Persistent Increase in Blood Pressure After Renal Nerve Stimulation in Accessory Renal Arteries After Sympathetic Renal Denervation.
Blood pressure response to renal denervation is highly variable, and the proportion of responders is disappointing. This may be partly because of accessory renal arteries too small for denervation, causing incomplete ablation. Renal nerve stimulation before and after renal denervation is a promising approach to assess completeness of renal denervation and may predict blood pressure response to renal denervation. The objective of the current study was to assess renal nerve stimulation-induced blood pressure increase before and after renal sympathetic denervation in main and accessory renal arteries of anaesthetized patients with drug-resistant hypertension. The study included 21 patients. Nine patients had at least 1 accessory renal artery in which renal denervation was not feasible. Renal nerve stimulation was performed in the main arteries of all patients and in accessory renal arteries of 6 of 9 patients with accessory arteries, both before and after renal sympathetic denervation. Renal nerve stimulation before renal denervation elicited a substantial increase in systolic blood pressure, both in main (25.6±2.9 mm Hg; P<0.001) and accessory (24.3±7.4 mm Hg; P=0.047) renal arteries. After renal denervation, renal nerve stimulation-induced systolic blood pressure increase was blunted in the main renal arteries (Δ systolic blood pressure, 8.6±3.7 mm Hg; P=0.020), but not in the nondenervated renal accessory renal arteries (Δ systolic blood pressure, 27.1±7.6 mm Hg; P=0.917). This residual source of renal sympathetic tone may result in persistent hypertension after ablation and partly account for the large response variability.
From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for Innovation and Strategic Collaboration, St. Jude Medical, Inc., Irvine, CA (E.O.Y.L.); The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Mark R
MR
de Jong
From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for Innovation and Strategic Collaboration, St. Jude Medical, Inc., Irvine, CA (E.O.Y.L.); The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Annemiek F
AF
Hoogerwaard
From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for Innovation and Strategic Collaboration, St. Jude Medical, Inc., Irvine, CA (E.O.Y.L.); The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Pim
P
Gal
From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for Innovation and Strategic Collaboration, St. Jude Medical, Inc., Irvine, CA (E.O.Y.L.); The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Ahmet
A
Adiyaman
From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for Innovation and Strategic Collaboration, St. Jude Medical, Inc., Irvine, CA (E.O.Y.L.); The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Jaap Jan J
JJ
Smit
From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for Innovation and Strategic Collaboration, St. Jude Medical, Inc., Irvine, CA (E.O.Y.L.); The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Peter Paul H M
PP
Delnoy
From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for Innovation and Strategic Collaboration, St. Jude Medical, Inc., Irvine, CA (E.O.Y.L.); The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Anand R
AR
Ramdat Misier
From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for Innovation and Strategic Collaboration, St. Jude Medical, Inc., Irvine, CA (E.O.Y.L.); The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Boudewijn A A M
BA
van Hasselt
From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for Innovation and Strategic Collaboration, St. Jude Medical, Inc., Irvine, CA (E.O.Y.L.); The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Jan-Evert
JE
Heeg
From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for Innovation and Strategic Collaboration, St. Jude Medical, Inc., Irvine, CA (E.O.Y.L.); The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Jean-Benoit
JB
le Polain de Waroux
From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for Innovation and Strategic Collaboration, St. Jude Medical, Inc., Irvine, CA (E.O.Y.L.); The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Elizabeth O Y
EO
Lau
From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for Innovation and Strategic Collaboration, St. Jude Medical, Inc., Irvine, CA (E.O.Y.L.); The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Jan A
JA
Staessen
From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for Innovation and Strategic Collaboration, St. Jude Medical, Inc., Irvine, CA (E.O.Y.L.); The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Alexandre
A
Persu
From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for Innovation and Strategic Collaboration, St. Jude Medical, Inc., Irvine, CA (E.O.Y.L.); The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.). v.r.c.derks@isala.nl.
Arif
A
Elvan
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination; D017115:Catheter Ablation / Q000379:methods*; D004351:Drug Resistance; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012077:Renal Artery / Q000000981:diagnostic imaging* / Q000294:innervation; D018570:Risk Assessment; D012720:Severity of Illness Index; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome
D000959:Antihypertensive Agents
accessory renal artery; blood pressure; denervation; hypertension; hypertension resistant to conventional therapy; renal artery; renal nerve stimulation