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Retinal microperfusion after renal denervation in treatment-resistant hypertensive patients

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Abstract

Background

High pulsatile pressure and flow in the arteries causes microvascular damage, and hence increased cardio-, and cerebrovascular complications. With advanced stages of hypertensive disease, an exaggerated pulsatile retinal capillary flow (RCF) has been shown, but data about interventional effect are missing.

Methods

Fifty-one patients with true treatment-resistant hypertension (TRH) underwent renal denervation (RDN) using the Symplicity Flex™ catheter and were followed for 12 months. RCF was assessed non-invasively using Scanning laser Doppler flowmetry (SLDF) before, 6 (6 M), and 12 (12 M) months after RDN. RCF was measured in systole and diastole and pulsed RCF (difference of RCF in systole minus diastole) was calculated. In addition, flicker light-induced vasodilation (representing vasodilatory capacity) was assessed.

Results

Systolic and diastolic office blood pressure (BP) as well as 24-h ABPM decreased significantly 6 M and 12 M after RDN, compared to baseline values (all p < 0.001). There was a significant reduction of pulsed RCF 6 M (231 ± 81 versus 208 ± 68 AU, p = 0.046) and 12 M (194 ± 72 AU, p = 0.001) after RDN, whereas the mean RCF was unchanged. Moreover, there was a significant increase of flicker light-induced vasodilation after RDN (p = 0.043).

Conclusion

In hypertensive patients with TRH, we observed a decrease of pulsed RCF 6 M and 12 M after RDN and an increase of vasodilatory capacity, in parallel to decreases in BP and heart rate. The reduction of pulsed RCF after RDN implies a decrease of shear stress on the vascular wall by the pulsed blood flow. This and the increment of vasodilatory capacity suggest an improvement of retinal (and potentially cerebral) microcirculation.

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Acknowledgments

The authors thank the study nurses (CRC), as well as the assistant personal of the angiography lab for invaluable support with patient management.

Conflict of interest

AS has received speaker fees from Medtronic. RES has received travel support, speaker and consultancy fees and institutional grants from Medtronic.

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Author notes

    Authors and Affiliations

    1. Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany

      Christian Ott, Joanna M. Harazny, Tilmann Ditting, Roland Veelken & Roland E. Schmieder

    2. Department of Pathophysiology, University of Warmia and Masury, Olsztyn, Poland

      Joanna M. Harazny & Marek Bladowski

    3. Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany

      Axel Schmid & Michael Uder

    4. Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany

      Georg Michelson

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    Correspondence to Roland E. Schmieder.

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    C. Ott and J. M. Harazny contributed equally to this manuscript.

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    Ott, C., Harazny, J.M., Schmid, A. et al. Retinal microperfusion after renal denervation in treatment-resistant hypertensive patients. Clin Res Cardiol 104, 782–789 (2015). https://doi.org/10.1007/s00392-015-0845-0

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