Skip to main content
SpringerLink
Log in

The effect of renal sympathetic denervation on nocturnal dipping in patients with resistant hypertension; observational data from a tertiary referral centre in the Republic of Ireland

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Objective

Renal sympathetic denervation (RSD) is an emerging device based treatment for patients with resistant hypertension. Nocturnal dipping (ND) is defined as a decrease in BP of 10–20 % during sleep, and has been shown to be protective against cardiovascular disease. This study examined the effect of RSD on the 24 h BP profile of patients with resistant hypertension.

Methods and results

The first 23 consecutive patients with resistant hypertension scheduled for renal denervation in a single centre were included. 24 h ambulatory blood pressure monitors (ABPM) were given to patients pre-procedure and 9 months post-procedure. RSD led to a statistically non-significant reduction in overall 24 h ABPM BP (150/85 ± 12/9 vs. 143/84 ± 15/11 mmHg; P > 0.05) despite a reduction in the number of antihypertensive medications (4.9 ± 1.2 vs. 4.3 ± 1.2; P = 0.001). There were improvements in systolic ND 1.7 ± 8 vs. 5.2 ± 8 %; P < 0.05), diastolic ND (5.2 ± 8 vs. 10.2 ± 9 %; P < 0.05) and mean arterial pressure (MAP) ND (4.2 ± 8 vs. 8.0 ± 8 %; P < 0.05). Non-significant changes in ND status were observed in systolic (17 vs. 43 % of participants; P > 0.05), diastolic (30 vs. 43 % of participants; P > 0.05) and MAP (22 vs. 39 % of participants; P > 0.05) measurements.

Conclusions

These data suggest that RSD may lead to an improvement in nocturnal dipping in selected patients with resistant hypertension. This may have cardiovascular benefits even if reduction in BP is not achieved with RSD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

BP:

Blood pressure

RSD:

Renal sympathetic denervation

ND:

Nocturnal dipping

ABPM:

Ambulatory blood pressure monitoring

HR:

Heart rate

BPM:

Beats per minute

mmHg:

Millimetres of mercury

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

MAP:

Mean arterial pressure

SD:

Standard deviation

References

  1. Okamoto LE, Gamboa A, Shibao C, Black BK, Diedrich A, Raj SR et al (2009) Nocturnal blood pressure dipping in the hypertension of autonomic failure. Hypertension 53(2):363–369

    Article  CAS  PubMed  Google Scholar 

  2. Friedman O, Logan AG (2009) Nocturnal blood pressure profiles among normotensive, controlled hypertensive and refractory hypertensive subjects. Can J Cardiol 25(9):e312–e316

    Article  PubMed  PubMed Central  Google Scholar 

  3. O’Brien E, Sheridan J, O’Malley K (1988) Dippers and non-dippers. Lancet 2:397

    Article  PubMed  Google Scholar 

  4. Henskens LH, Kroon AA, van Oostenbrugge RJ, Haest RJ, Lodder J, de Leeuw PW (2008) Different classifications of nocturnal blood pressure dipping affect the prevalence of dippers and nondippers and the relation with target-organ damage. J Hypertens 26:691–698

    Article  CAS  PubMed  Google Scholar 

  5. Verdecchia P, Schillaci G, Gatteschi C, Zampi I, Battistelli M, Bartoccini C et al (1993) Blunted nocturnal fall in blood pressure in hypertensive women with future cardiovascular morbid events. Circulation 88(3):986–992

    Article  CAS  PubMed  Google Scholar 

  6. Grassi G, Seravalle G, Quarti-Trevano F, Dell’Oro R, Bombelli M et al (2008) Adrenergic metabolic, and reflex abnormalities in reverse and extreme dipper hypertensives. Hypertension 52:925–931

    Article  CAS  PubMed  Google Scholar 

  7. Sherwood A, Steffen PR, Blumenthal JA, Kuhn C, Hinderliter AL (2002) Nighttime blood pressure dipping: the role of the sympathetic nervous system. Am J Hypertens 15:111–118

    Article  PubMed  Google Scholar 

  8. Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmeider RE, Bohm M (2010) Renal sympathetic denervation in patients with treatment-resistant hypertension (the Symplicity HTN-2 trial): a randomised controlled trial. Lancet 376:1903–1909

    Article  PubMed  Google Scholar 

  9. Katayama T, Sueta D, Kataoka K, Hasegawa Y, Koibuchi N, Toyama K et al (2013) Long-term renal denervation normalizes disrupted blood pressure circadian rhythm and ameliorates cardiovascular injury in a rat model of metabolic syndrome. J Am Heart Assoc 2(4):e000197. doi:10.1161/JAHA.113.000197

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kohara K, Nishida W, Maguchi M, Hiwada K (1995) Autonomic nervous function in non-dipper essential hypertensive subjects. Hypertension 26:808–814

    Article  CAS  PubMed  Google Scholar 

  11. Krum H, Sobotka P, Mahfoud F, Böhm M, Esler M, Schlaich M (2011) Device based antihypertensive therapy: therapeutic modulation of the autonomic nervous system. Circulation 123:209–215

    Article  PubMed  Google Scholar 

  12. Schlaich MP, Sobotka PA, Krum H, Lambert E, Esler MD (2009) Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med 361:932–934

    Article  CAS  PubMed  Google Scholar 

  13. Schlaich MP, Lambert E, Kaye DM, Krozowski Z, Campbell DJ, Lambert G et al (2004) Sympathetic augmentation in hypertension: role of nerve firing, norepinephrine reuptake, and angiotensin neuromodulation. Hypertension 43:169–175

    Article  CAS  PubMed  Google Scholar 

  14. Hering D, Lambert EA, Marusic P, Ika-Sari C, Walton AS, Sabotka PA et al (2013) Renal nerve ablation reduces augmentation index in patients with resistant hypertension. J Hypertens 31(9):1893–1900

    Article  CAS  PubMed  Google Scholar 

  15. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al (2007) Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 25:1105–1187

    Article  CAS  PubMed  Google Scholar 

  16. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD et al (2008) Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for high blood pressure research. Hypertension 51:1403–1419

    Article  CAS  PubMed  Google Scholar 

  17. Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K et al (2009) Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 373:1275–1281

    Article  PubMed  Google Scholar 

  18. Grassi G, Bombelli M, Seravalle G, Dell’Oro R, Quarti-Trevano F (2010) Diurnal blood pressure variation and sympathetic activity. Hypertens Res 33:381–385

    Article  PubMed  Google Scholar 

  19. Mahfoud F, Ukena C, Schmieder RE, Cremers B, Rump LC, Vonend O et al (2013) Ambulatory blood pressure changes after renal sympathetic denervation in patients with resistant hypertension. Circulation 128(2):132–140

    Article  CAS  PubMed  Google Scholar 

  20. Howard J, Cole G, Sievert H, Bhatt D, Papademetriou V, Kandzari D, Davies J, Francis D (2014) Unintentional overestimation of an expected antihypertensive effect in drug and device trials: mechanisms and solutions. Int J Cardiol 172(1):29–35

    Article  PubMed  Google Scholar 

  21. Patel H, Hayward C, Ozdemir B, Rosen S, Krum H, Lyon A, Francis D, Di Mario C (2015) Magnitude of blood pressure reduction in the placebo arms of modern hypertension trials: implications for trials of renal denervation. Hypertension 65(2):401–406

    Article  CAS  PubMed  Google Scholar 

  22. Bhatt DL, Kandzari DE, O’Neill WW, D’Agostino R, Flack JM, Katzen BT et al (2014) A controlled trial of renal denervation for resistant hypertension. N Engl J Med 370(15):1393–1401

    Article  CAS  PubMed  Google Scholar 

  23. Patel H, Hayward C, Di Mario C (2014) SYMPLICITY HTN 3: the death knell for renal denervation in hypertension? Glob Cardiol Sci Pract 2014(1):94–98

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Galway University Hospital, Galway, Republic of Ireland

    S. T. Tuohy, S.-M. G. Kyvelou, P. J. Gleeson, F. B. Daniels, L. A. Ryan, M. J. O’Donnell & F. Sharif

  2. Department of Nephrology, Galway University Hospital, Galway, Republic of Ireland

    D. W. Lappin

  3. Clinical Research Facility, National University of Ireland, Galway, Republic of Ireland

    M. J. O’Donnell & F. Sharif

Authors
  1. S. T. Tuohy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S.-M. G. Kyvelou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. J. Gleeson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. B. Daniels
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L. A. Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. W. Lappin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. J. O’Donnell
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F. Sharif
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. T. Tuohy.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tuohy, S.T., Kyvelou, SM.G., Gleeson, P.J. et al. The effect of renal sympathetic denervation on nocturnal dipping in patients with resistant hypertension; observational data from a tertiary referral centre in the Republic of Ireland. Ir J Med Sci 185, 635–641 (2016). https://doi.org/10.1007/s11845-015-1324-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-015-1324-3

Keywords

Search

Navigation