Key result
Renal sympathetic denervation reduces sympathetic activity and cuts adrenaline by ~17% vs drug adjustment.
Why the study?
Renal sympathetic denervation possibly lowers blood pressure in treatment-resistant hypertension, but its effect compared to drug adjustment on sympathetic nervous system activity needed assessment.
Does renal sympathetic denervation reduce sympathetic nervous system activity compared to drug adjustment in patients with treatment-resistant hypertension?
RCT (n=19)
randomised
Does renal sympathetic denervation reduce sympathetic nervous system activity compared to drug adjustment in patients with treatment-resistant hypertension?
Renal sympathetic denervation may reduce sympathetic nervous system activity at six months in patients with treatment-resistant hypertension compared to drug adjustment.
Supports RDN for sympathetic modulation in resistant hypertension; confirms mechanistic effect versus drug adjustment in this RCT.
Purpose Sympathetic nervous system (SNS) over-activity is associated with essential hypertension. Renal sympathetic denervation (RDN) possibly lowers office- and ambulatory blood pressure (BP) in patients with treatment-resistant hypertension (TRH). We aimed to assess the effect of RDN compared to drug adjustment on SNS activity among patients with TRH by measuring plasma catecholamines and heart rate variability (HRV) during stress tests.Materials and methods Patients with TRH were randomised to RDN (n = 9) or Drug Adjustment (DA) (n = 10). We measured continuous HRV and beat-to-beat-BP using FinaPres® and obtained plasma catecholamines during standardised orthostatic- and cold-pressor stress tests (CPT) before- and six months after randomisation.Results CPT revealed no differences between groups at baseline in peak adrenaline concentration (69.3 pg/mL in the DA group vs. 70.0 pg/mL in the RDN group, p = 0.38) or adrenaline reactivity (Δ23.1 pg/mL in the DA group vs. Δ29.3 pg/mL in the RDN group, p = 0.40). After six months, adrenaline concentrations were statistically different between groups after one minute (66.9 pg/mL in the DA group vs. 55.3 pg/mL in the RDN group, p = 0.03), and six minutes (62.4 pg/mL in the DA group vs. 50.1 pg/mL in the RDN group, p = 0.03). There was a tendency of reduction in adrenaline reactivity after six months in the RDN group (Δ26.3 pg/mL at baseline vs. Δ12.8 pg/ml after six months, p = 0.08), while it increased in the DA group (Δ13.6 pg/mL at baseline vs. Δ19.9 pg/mL after six months, p = 0.53). We also found a difference in the Low Frequency band at baseline following the CPT (667µs2 in the DA group vs. 1628µs2 in the RDN group, p = 0.03) with a clear tendency of reduction in the RDN group to 743µs2 after six months (p = 0.07), compared to no change in the DA group (1052µs2, p = 0.39).Conclusion Our data suggest that RDN reduces SNS activity after six months. This finding warrants investigation in a larger study. Clinical Trial Number registered at www.clinicaltrials.gov: NCT01673516
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Bergland et al. (2021) conducted an RCT in treatment-resistant hypertension (TRH) (n=19). Renal sympathetic denervation (RDN) vs. Drug Adjustment (DA) was evaluated on adrenaline concentration after one minute during cold-pressor stress test (p=0.03). Renal sympathetic denervation reduced sympathetic nervous system activity compared to drug adjustment, with lower adrenaline concentrations at one minute (55.3 vs 66.9 pg/mL, p=0.03) at 6 months.
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