title: The effect of two different renal denervation strategies on blood pressure in resistant hypertension: Comparison of full-length versus proximal renal artery ablation.
abstract: BACKGROUND
  Renal denervation (RDN) is used to manage blood pressure (BP) in patients with resistant hypertension (rHT), but effectiveness is still a concern, and key arterial portion for successful RDN is not clear.
  
  
  OBJECTIVE
  The aim of this study was to investigate the efficacy and safety of proximal versus full-length renal artery ablation in patients with resistant hypertension (rHT).
  
  
  METHODS
  Forty-seven patients with rHT were randomly assigned to receive full-length ablation (n = 23) or proximal ablation (n = 24) of the renal arteries. All lesions were treated with radiofrequency energy via a saline-irrigated catheter. Office BP was measured during 12 months of follow-up and ambulatory BP at baseline and 6 months (n = 15 in each group).
  
  
  RESULTS
  Compared with full-length ablation, proximal ablation reduced the number of ablation points in both the right (6.1 ± 0.7 vs. 3.3 ± 0.6, P < 0.001) and the left renal arteries (6.2 ± 0.7 vs. 3.3 ± 0.8, P < 0.001), with significantly shorter RF delivery time (P < 0.001), but higher RF power (P = 0.011). Baseline office BPs was 179.4 ± 13.7/102.8 ± 9.4 mm Hg in the full-length group and 181.9 ± 12.8/103.5 ± 8.9 mm Hg in the proximal group (P > 0.5). Similar office BPs was reduced by -39.4 ± 11.5/-20.9 ± 7.1 mm Hg at 6 months and -38.2 ± 10.3/-21.5 ± 5.8 mm Hg at 12 months in the full-length group (P < 0.001), -42.0 ± 11.6/-21.4 ± 7.9 mm Hg at 6 months and -40.9 ± 10.3/-22.1 ± 5.6 mm Hg at 12 months in the proximal group (P < 0.001), and progressive BP reductions were observed over the 6 months (P < 0.001) in both groups. The drop in ambulatory 24-hr SBP and DBP were significantly less than the drop in office BP (P < 0.001). No renovascular or other adverse complications were observed.
  
  
  CONCLUSIONS
  The results indicate that proximal RDN has a similar efficacy and safety profile compared with full-length RDN, and propose the proximal artery as the key portion for RDN. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Weijie
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Zhiyu
authors.initials: Z
authors.lastname: Ling
authors.affiliation: Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Huaan
authors.initials: H
authors.lastname: Du
authors.affiliation: Department of Cardiology, Chongqing Dazu District People's Hospital, Chongqing, China.
authors.forename: Wenxin
authors.initials: W
authors.lastname: Song
authors.affiliation: Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Zengzhang
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Su
authors.affiliation: Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Peilin
authors.initials: P
authors.lastname: Xiao
authors.affiliation: Department of Cardiology, Chongqing Yongchuan District People's Hospital, Chongqing, China.
authors.forename: Yuelong
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Jiayi
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of Cardiology, Chongqing Tongliang, Chinese Traditional Medicine Hospital, Chongqing, China.
authors.forename: Jianhong
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, the Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Zhifeng
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Cardiology, Chongqing Three Gorges Central Hospital, Chongqing, China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Shao
authors.affiliation: Department of Cardiology, Chongqing Fifth People's Hospital, Chongqing, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhong
authors.affiliation: Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Bei
authors.initials: B
authors.lastname: Zhou
authors.affiliation: School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Kamsang
authors.initials: K
authors.lastname: Woo
authors.affiliation: Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Yuehui
authors.initials: Y
authors.lastname: Yin
mesh_terms: D000792:Angiography; D001794:Blood Pressure / Q000502:physiology*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D013562:Sympathectomy / Q000379:methods; D016896:Treatment Outcome
keywords: full-length ablation; proximal ablation; renal denervation; resistant hypertension