title: Accessory renal arteries: Prevalence in resistant hypertension and an important role in nonresponse to radiofrequency renal denervation.
abstract: OBJECTIVE
  The aim of this study was to understand the role of accessory renal arteries in resistant hypertension, and to establish their role in nonresponse to radiofrequency renal denervation (RDN) procedures.
  
  
  BACKGROUND
  Prior studies suggest a role for accessory renal arteries in hypertensive syndromes, and recent clinical trials of renal denervation report that these anomalies are highly prevalent in resistant hypertension. This study evaluated the relationships among resistant hypertension, accessory renal arteries, and the response to radiofrequency (RF) renal denervation.
  
  
  METHODS
  Computed Tomography Angiography (CTA) and magnetic resonance imaging (MRI) scans from 58 patients with resistant hypertension undergoing RF renal denervation (RDN) were evaluated. Results were compared with CT scans in 57 healthy, normotensive subjects undergoing screening as possible renal transplant donors. All scans were carefully studied for accessory renal arteries, and were correlated with long term blood pressure reduction.
  
  
  RESULTS
  Accessory renal arteries were markedly more prevalent in the hypertensive patients than normotensive renal donors (59% vs 32% respectively, p=0.004). RDN had an overall nonresponse rate of 29% (response rate 71%). Patients without accessory vessels had a borderline higher response rate to RDN than those with at least one accessory vessel (83% vs 62% respectively, p=0.076) and a higher RDN response than patients with untreated accessory arteries (83% vs 55%; p=0.040). For accessory renal arteries and nonresponse, the sensitivity was 76%, specificity 49%, with positive and negative predictive values 38% and 83% respectively.
  
  
  CONCLUSIONS
  Accessory renal arteries were markedly over-represented in resistant hypertensives compared with healthy controls. While not all patients with accessory arteries were nonresponders, nonresponse was related to both the presence and non-treatment of accessory arteries. Addressing accessory renal arteries in future clinical trials may improve RDN therapeutic efficacy.
authors: Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, MN.
authors: Paige
authors: P
authors: VonAchen
authors: Boston Scientific Corporation, Maple Grove, MN.
authors: Jason
authors: J
authors: Hamann
authors: Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, MN.
authors: Thomas
authors: T
authors: Houghland
authors: Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, MN.
authors: John R
authors: JR
authors: Lesser
authors: Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, MN.
authors: Yale
authors: Y
authors: Wang
authors: Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, MN.
authors: David
authors: D
authors: Caye
authors: Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, MN.
authors: Kristi
authors: K
authors: Rosenthal
authors: Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, MN.
authors: Ross F
authors: RF
authors: Garberich
authors: Vital Images/Toshiba, Minnetonka, MN.
authors: Mary
authors: M
authors: Daniels
authors: Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, MN. Electronic address: rss@rsschwartz.com.
authors: Robert S
authors: RS
authors: Schwartz
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D017115:Catheter Ablation; D002986:Clinical Trials as Topic; D000072226:Computed Tomography Angiography; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D015994:Incidence; D007668:Kidney / Q000098:blood supply*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000002:abnormalities* / Q000294:innervation*; D012189:Retrospective Studies; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000000981:diagnostic imaging / Q000453:epidemiology*
chemical_list: D000959:Antihypertensive Agents
keywords: Hypertension; Renal denervation