Key result
Renal sympathetic denervation significantly reduced office systolic blood pressure by 24.3 mm Hg (P<0.001) and decreased serum biomarkers of cardiac extracellular matrix turnover (P<0.01) at 6 months.
Why the study?
Does renal sympathetic denervation reduce serum biomarkers of cardiac extracellular matrix turnover in patients with resistant arterial hypertension?
Cohort (n=100)
Does renal sympathetic denervation reduce serum biomarkers of cardiac extracellular matrix turnover in patients with resistant arterial hypertension?
p-value: p=<0.01
Renal sympathetic denervation in patients with resistant hypertension significantly reduces blood pressure and biomarkers of cardiac extracellular matrix turnover at 6 months, suggesting a beneficial effect on cardiovascular fibrosis.
May indicate reduced cardiac fibrosis beyond BP lowering; hypothesis-generating and should not change practice without RCTs.
BACKGROUND: Renal sympathetic denervation (RSD) represents an effective treatment option for patients with resistant arterial hypertension (HT). Extracellular matrix (ECM) turnover and deposition are essential processes in HT-related cardiovascular remodeling, fibrosis, and cardiac hypertrophy and contribute to hypertensive heart disease. OBJECTIVES: The primary aim of the present study was to examine the effect of RSD on increased collagen turnover as reflected by serum levels of amino-terminal pro-peptides (PINP, PIIINP) and a carboxyl-terminal pro-peptide (PICP), specific biomarkers for cardiac ECM turnover and cardiovascular fibrosis. METHODS: A total of 100 consecutive patients (mean age: 65.9±10.1 years) undergoing RSD were included in this study. A therapeutic response was defined as an office systolic blood pressure (SBP) reduction of >10mm Hg 6 months after RSD. Venous serum samples for measurement of PICP, PINP, and PIIINP were collected prior to and 6 months after RSD. RESULTS: A significant reduction in the office SBP of 24.3 mm Hg (SBP baseline: 166.9±14.3 mm Hg (P < 0.001) was documented 6 months after RSD. At this time point, the serum levels of PICP, PINP, and PIIINP (P < 0.01) were significantly decreased compared to baseline values in patients with an increased collagen turnover, showing significant differences comparing BP responders and nonresponders. CONCLUSION: In addition to the effective blood pressure reduction in response to RSD, this study demonstrates a positive effect of RSD on biomarkers reflecting cardiovascular ECM turnover and deposition. These results suggest a beneficial effect of RSD on cardiovascular fibrosis, hypertensive heart disease, and end-organ damage in high-risk patients.
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Dörr et al. (2015) conducted a cohort in resistant arterial hypertension (n=100). Renal sympathetic denervation vs. Baseline was evaluated on Serum levels of PICP, PINP, and PIIINP (biomarkers for cardiac extracellular matrix turnover) (p=<0.01). Renal sympathetic denervation significantly reduced office systolic blood pressure by 24.3 mm Hg (P<0.001) and decreased serum biomarkers of cardiac extracellular matrix turnover (P<0.01) at 6 months.
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