Key result
Renal denervation significantly reduced peripheral office systolic blood pressure from 158 mmHg to 142 mmHg at 6 months, while renal perfusion and function remained unchanged.
Why the study?
Does renal denervation improve renal perfusion, renal vascular resistance, and central hemodynamics in patients with treatment-resistant hypertension?
Observational (n=19)
Open-label
None
No
Does renal denervation improve renal perfusion, renal vascular resistance, and central hemodynamics in patients with treatment-resistant hypertension?
Absolute Event Rate: 142% vs 158%
p-value: p=0.002
Renal denervation significantly reduces peripheral and central blood pressure as well as renal vascular resistance without compromising renal perfusion or function in patients with treatment-resistant hypertension.
Renal denervation may safely lower BP in resistant hypertension without renal compromise; leaves open randomized confirmation of perfusion effects.
BACKGROUND AND OBJECTIVES: Renal denervation (RDN) has been shown to be effective in reducing BP in treatment-resistant hypertension. Measurement of the renal and sympathetic activity revealed a decrease in sympathetic drive to the kidney and small resistance vessels after RDN. However, the consequences on renal perfusion and renal vascular resistance (RVR), as well as central hemodynamics, are unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Nineteen patients with treatment-resistant hypertension (office BP≥140/90 mmHg, despite at least three antihypertensive drugs [including a diuretic], and diagnosis confirmed by 24-hour ambulatory BP monitoring) underwent RDN between January and October 2011. Renal perfusion and RVR were noninvasively assessed by magnetic resonance imaging with arterial spin labeling, and renal function was assessed by estimating GFR before (day -1), after (day +1), and again after 3 months of RDN. Central hemodynamics was assessed using pulse wave analysis at day -1 and after 6 months of RDN. RESULTS: Peripheral office BP (systolic, 158±26 versus 142±23 mmHg, P=0.002; diastolic, 83±13 versus 76±9 mmHg, P=0.02) and mean systolic 24-hour ambulatory BP (159±17 versus 152±17 mmHg, P=0.02) were significantly reduced 6 months after RDN. Renal perfusion was not statistically different between day -1 and day +1 (256.8 [interquartile range (IQR), 241-278] versus 263.4 [IQR, 252-277] ml/min per 100 g; P=0.17) as well as after 3 months (256.8 [IQR, 241-278] versus 261.2 [IQR, 240-285] ml/min per 100 g; P=0.27) after RDN. RVR dropped (432.1 [IQR, 359-525] versus 390.6 [IQR, 338-461] AU; P=0.02), whereas renal function was not statistically different at any time point. Central systolic BP (145±31 versus 131±28 mmHg; P=0.009), diastolic BP (85±18 versus 80±14 mmHg; P=0.03), and central pulse pressure (61±18 versus 52±18 mmHg; P=0.02) were significantly reduced 6 months after RDN. Central augmentation index (24±8 versus 20±8%; P=0.02) was decreased 6 months after RDN. CONCLUSION: The data indicate that RDN significantly reduced peripheral and central BP. Despite reduced systemic BP, renal perfusion and function did not change after RDN.
No takes yet. Share an insight, caveat, or question.
Ott et al. (2013) conducted an observational in Treatment-resistant hypertension (n=19). Renal denervation vs. Baseline was evaluated on Peripheral office systolic blood pressure at 6 months (p=0.002). Renal denervation significantly reduced peripheral office systolic blood pressure from 158 mmHg to 142 mmHg at 6 months, while renal perfusion and function remained unchanged.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: