Cardiorespiratory Response to Exercise After Renal Sympathetic Denervation in Patients With Resistant Hypertension
Key result
Renal sympathetic denervation reduces resting systolic blood pressure by ~31 mm Hg at three months.
- P<0.0001
- n=46
Why the study?
Renal sympathetic denervation reduces resting blood pressure in patients with resistant hypertension, but its effects on the cardiorespiratory response to exercise were unclear.
Population
46 patients with therapy-resistant hypertension
Comparison
Bilateral renal sympathetic denervation vs control
Design
Extended investigation of the Symplicity HTN-2 trial
Follow-up
3 months
Authors
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our study showed for the first time that renal nerve ablation significantly reduces blood pressure during exercise with improvements in heart rate recovery without blood pressure dysregulation, ventilator effects, or chronotropic incompetence. Our results support the efficacy and safety of renal denervation in the treatment of resistant hypertension.”
Implication
May support safe exercise hemodynamics after renal denervation in resistant hypertension; hypothesis-generating pending randomized trials.
Key Points
- To determine the effects of catheter-based renal sympathetic denervation on cardiorespiratory response, hemodynamic performance, and chronotropic competence during exercise in patients with resistant hypertension.
- Prospective controlled study assessing 46 patients with resistant hypertension who underwent symptom-limited exercise testing before and 3 months after bilateral renal sympathetic denervation (n=37) or medical therapy alone (control group, n=9).
- Measured rest and exercise blood pressure, workload, peak oxygen uptake, and post-exercise heart rate recovery at baseline and 3-month follow-up.
- Renal denervation significantly reduced resting blood pressure from 175/93 mm Hg to 154/83 mm Hg (p<0.001) and peak exercise systolic blood pressure from 217 mm Hg to 202 mm Hg (p=0.003).
- Workload and peak oxygen consumption were preserved after denervation, while resting heart rate decreased, peak exercise heart rate was maintained, and heart rate recovery improved significantly (p=0.015).
- Control patients receiving medical therapy alone exhibited no significant changes in blood pressure, heart rate, or exercise capacity at 3 months.
Study Design
Type
RCT (n=46)
PICO
P
Population
46 patients with therapy-resistant hypertension evaluated at baseline and 3-month follow-up.
I
Intervention / Comparator
Renal sympathetic denervation vs Control group
O
Primary Outcome
Blood pressure at rest and at maximum exercise after 3 months, p=<0.0001
Main Result
p-value: p=<0.0001
Cite This Study
Ukena et al. (2011) conducted an RCT in Resistant hypertension (n=46). Renal sympathetic denervation vs. Control group was evaluated on Blood pressure at rest and at maximum exercise after 3 months (p=<0.0001). Renal sympathetic denervation significantly reduced resting blood pressure by 31/9 mm Hg and maximum exercise blood pressure by 21/5 mm Hg at 3 months (p<0.0001).