title: Plasma endothelin-1 levels in patients with resistant hypertension: effects of renal sympathetic denervation.
abstract: Resistant arterial hypertension (RHT) is defined as poor controlled blood pressure (BP) despite optimal doses of three or more antihypertensive agents, including a diuretic. In the development of RHT, hyperactivity of sympathetic (SNS) and renin-angiotensin-aldosterone (SRAA) systems are involved, and SNS is a potent stimulator of vasoactive endothelin-1 (ET-1) peptide. Renal sympathetic denervation (RSD) through disrupting renal afferent and efferent nerves attenuates SNS activity.
  
  
  
  We carried out pilot study investigating the effect of RSD on BP and plasma ET-1 levels in consecutive 9 RHT patients (7 male and 2 female, mean age of 56 ± 13.3).
  
  
  
  After 12 months of the RSD, we observed a significant reduction of BP office, 24-h ambulatory BP monitoring (ABPM) (p < 0.05, respectively), and "non-dipping" pattern (from 55% to 35%) (p < 0.05). Moreover, RSD significantly decreased plasma ET-1 levels in both renal artery (at right from 21.8 ± 4.1 to 16.8 ± 2.9 pg/ml; p = 0.004; at left from 22.1 ± 3.7 to 18.9 ± 3.3 pg/ml; p = 0.02). We observed positive correlations between plasma renal arteries ET-1 levels and systolic BP values at ABPM [Global-SBP (r = 0.58; p < 0.01), Diurnal-SBP (r = 0.51; p < 0.03) and Nocturnal-SBP (r = 0.58; p < 0.01), respectively].
  
  
  
  Our data confirmed the positive effects of RSD on BP values in patients with RHT, and showed a possible physio-pathological role of ET-1. KEY MESSAGES RSD is associated to a significant reduction of plasma ET-1 levels, representing an useful tool into reduction of BP in RHT patients.
authors.affiliation: a Department of Internal Medicine and Medical Specialties , Specialized Center of Secondary Hypertension, University of Rome "Sapienza" , Rome , Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Petramala
authors.affiliation: a Department of Internal Medicine and Medical Specialties , Specialized Center of Secondary Hypertension, University of Rome "Sapienza" , Rome , Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Olmati
authors.affiliation: b Department of Cardiovascular, Respiratory, Nephrology, Anestesiology and Geriatric Sciences , University of Rome "Sapienza" , Rome , Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Mancone
authors.affiliation: a Department of Internal Medicine and Medical Specialties , Specialized Center of Secondary Hypertension, University of Rome "Sapienza" , Rome , Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Concistré
authors.affiliation: a Department of Internal Medicine and Medical Specialties , Specialized Center of Secondary Hypertension, University of Rome "Sapienza" , Rome , Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Galassi
authors.affiliation: a Department of Internal Medicine and Medical Specialties , Specialized Center of Secondary Hypertension, University of Rome "Sapienza" , Rome , Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Marinelli
authors.affiliation: a Department of Internal Medicine and Medical Specialties , Specialized Center of Secondary Hypertension, University of Rome "Sapienza" , Rome , Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Tonnarini
authors.affiliation: a Department of Internal Medicine and Medical Specialties , Specialized Center of Secondary Hypertension, University of Rome "Sapienza" , Rome , Italy.
authors.forename: Piernatale
authors.initials: P
authors.lastname: Lucia
authors.affiliation: c Department of Surgery "P. Valdoni", Policlinico "Umberto I" , University of Rome "Sapienza" , Rome , Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Costi
authors.affiliation: a Department of Internal Medicine and Medical Specialties , Specialized Center of Secondary Hypertension, University of Rome "Sapienza" , Rome , Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Iannucci
authors.affiliation: b Department of Cardiovascular, Respiratory, Nephrology, Anestesiology and Geriatric Sciences , University of Rome "Sapienza" , Rome , Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sardella
authors.affiliation: a Department of Internal Medicine and Medical Specialties , Specialized Center of Secondary Hypertension, University of Rome "Sapienza" , Rome , Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Letizia
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000601:surgery; D007668:Kidney / Q000294:innervation* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D019332:Endothelin-1
keywords: Ambulatory blood pressure monitoring; endothelin-1; office blood pressure; renal sympathetic denervation; resistant arterial hypertension