Blood pressure variability after catheter-based renal sympathetic denervation in patients with resistant hypertension.

Abstract

BACKGROUND:

Renal denervation (RDN) reduces sympathetic activity and blood pressure (BP) in patients with resistant hypertension. Increased 24-h BP variability is associated with adverse cardiovascular outcomes and related to sympathetic activation.

METHODS AND RESULTS:

This multicenter study investigated the effect of RDN on BP variability in 84 patients with uncontrolled hypertension (office systolic BP ≥140 mmHg) despite treatment with greater than three antihypertensive agents. BP variability was assessed by means of standard deviation, coefficient of variation (standard deviation/mean), and average real variability of 24-h ambulatory SBP at 3-month and 6-month follow-up. RDN significantly reduced office BP by 17/6 mmHg at 3-month and 19/7 mmHg at 6-month follow-up (P < 0.001 for all) and 24-h ambulatory BP by 9/5 mmHg (P < 0.001/P = 0.001) after 3 months and 12/7 mmHg (P < 0.001/P < 0.001) after 6 months. Standard deviation significantly decreased from 17.1 to 14.9 mmHg (P = 0.008) and 15.3 mmHg (P = 0.037), consistent with a reduction of coefficient of variation from 0.116 to 0.103 (P = 0.035) and 0.104 (P = 0.071) and average real variability from 12.3 to 10.9 (P = 0.029) and 11.0 (P = 0.054) after 3-month and 6-month, respectively. Interestingly, also BP nonresponders (change in office systolic BP < 10 mmHg after 6 months) showed a significant reduction of standard deviation after 3 months (P = 0.041, n = 26) and a borderline significant reduction at 6-month (P = 0.057, n = 28).

CONCLUSIONS:

RDN reduces office and ambulatory BP and BP variability in patients with resistant hypertension. Improvement in BP variability was also documented in patients characterized as office BP nonresponders after 6 months.

• Authors: Sebastian Ewen, Oliver Dörr, Christian Ukena, Dominik Linz, Bodo Cremers, Ulrich Laufs, Christian Hamm, Holger Nef, Axel Bauer, Giuseppe Mancia, Michael Böhm, Felix Mahfoud
• Journal: Journal of hypertension (J Hypertens) Vol. 33 Issue 12 Pg. 2512-8 (Dec 2015) ISSN: 1473-5598 [Electronic] England
• PMID: 26485461 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Blood Pressure (physiology)
• Blood Pressure Monitoring, Ambulatory
• Catheter Ablation
• Coronary Vasospasm (physiopathology, surgery)
• Female
• Humans
• Hypertension (physiopathology, surgery)
• Male
• Middle Aged
• Prospective Studies
• Renal Artery (innervation, surgery)
• Sympathectomy
• Time Factors
• Treatment Outcome