The effect of renal denervation in moderate treatment-resistant hypertension with confirmed medication adherence.
Data on the blood pressure (BP)-lowering effect of renal denervation (RDN) in moderate treatment-resistant hypertension (TRH) are limited. Moreover, change of adherence to medication, as one potential confounder of BP response, has never been analyzed rigorously in this group of patients. We analyzed the effect of RDN on BP in patients with moderate TRH who were retrospectively found to be completely adherent to their antihypertensive medication.



Our study cohort comprised 40 patients with moderate TRH [office BP ≥ 140/90 but <160/100 mmHg and 24-h ambulatory BP monitoring (ABPM) ≥130/80 mmHg] who underwent catheter-based RDN. Further major inclusion criterion was complete adherence to their medication (≥80% intake of their prescribed antihypertensive drugs) at baseline (assessed by retrospective toxicological analysis).



Six months after RDN, office BP was reduced by -10/-6 mmHg (SBP: 149 ± 6 vs. 139 ± 15 mmHg; DBP: 81 ± 12 vs. 75 ± 10 mmHg; both P < 0.001) and 24-h ABPM by -7/-4 mmHg (SBP: 150 ± 14 vs. 143 ± 16 mmHg, P = 0.005; DBP: 82 ± 10 vs. 78 ± 9 mmHg, P = 0.009). Number of prescribed antihypertensive medication [6.0 (5.0-6.0) vs. 5.5 (5.0-6.0), P = 0.013] and adherence rate (95.2 ± 7.6 vs. 91.7 ± 13.9%, P = 0.065) was slightly reduced 6 months after RDN, both likely to underestimate the true BP reduction.



Thus, our data indicate that even after given full respect to drug adherence as potential confounder of BP response after RDN, both office and 24-h ABPM were substantially reduced in patients with moderate TRH.
aDepartment of Nephrology and Hypertension, University Hospital of the Friedrich-Alexander University Erlangen-Nümburg, Erlangen bKlinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar cDepartment of Radiology, University Hospital of the Friedrich-Alexander University Erlangen-Nürnberg, Erlangen dInstitute of Legal Medicine, Forensic Toxicology Department, Goethe University, Frankfurt/Main eAbteilung für Experimentelle und Klinische Pharmakologie, Universität des Saarlandes, Homburg/Saar, Germany.
Christian
C
Ott
Felix
F
Mahfoud
Axel
A
Schmid
Sebastian
S
Ewen
Stefan W
SW
Toennes
Markus R
MR
Meyer
Andreas G
AG
Helfer
Hans H
HH
Maurer
Tilmann
T
Ditting
Roland
R
Veelken
Ina
I
Zivanovic
Michael
M
Uder
Michael
M
Böhm
Roland E
RE
Schmieder
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D003329:Coronary Vasospasm / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000294:innervation; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies; D013562:Sympathectomy; D016896:Treatment Outcome
D000959:Antihypertensive Agents