Predictors of Renal Denervation Efficacy in the Treatment of Resistant Hypertension
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The aims of the study were to evaluate the effects of renal sympathetic denervation (RSD) on the heart and to identify the predictors of RSD efficacy in patients with resistant arterial hypertension. The study comprised 60 RSD patients (54.6 ± 9.5 years) who received full-dose antihypertensive therapy (4.1 drugs) including diuretics. Initially, 58.6 % of patients had abnormal left ventricular (LV) diastolic function. All patients received echocardiography before and 24 weeks after RSD. Renal sympathetic denervation was achieved through the endovascular radiofrequency ablation (RFA) of the renal arteries. Drug therapy continued for the entire period of observation. After RSD, all patients were retrospectively assigned to two groups: group 1 comprised patients (n = 22; 36.7 %) in whom the myocardial mass (MM) of the left ventricle decreased by more than 10 g after RSD; group 2 comprised patients (n = 38; 63.3 %) in whom LV MM increased or decreased by less than 10 g. Anthropometry, arterial blood pressure, heart rate, therapy, and LV end-diastolic dimensions (EDD) were comparable in these groups. After RSD, the values of office blood pressure significantly decreased and MM regressed by more than 10 g in 36.7 % of patients; LV diastolic function normalized in 31 % of patients, and diastolic dysfunction improved in 14 % of patients. The study found the associations between the initial LV wall dimensions and LV MM changes. Unlike LV EDD, arterial blood pressure, or heart rate, the initial values of LV wall thickness predicted LV MM regress. Trial registration: #NCT01499810 https://clinicaltrials.gov/ct2/show/NCT01499810.
KeywordsHypertension Renal denervation RSD Heart Left ventricular hypertrophy Diastolic function Echocardiography
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Conflict of Interest
The authors declare that they have no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
- 1.Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. 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. Circulation. 2008;117(25):e510–26. doi: 10.1161/CIRCULATIONAHA.108.189141.CrossRefPubMedGoogle Scholar
- 2.Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC 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. 2013;31(7):1281–357. doi: 10.1097/01.hjh.0000431740.32696.cc.CrossRefPubMedGoogle Scholar
- 3.Urban D, Ewen S, Ukena C, Linz D, Böhm M, Mahfoud F. Treating resistant hypertension: role of renal denervation. Integr Blood Press Control. 2007;6:119–28.Google Scholar
- 9.Bombelli M, Facchetti R, Carugo S, Madotto F, Arenare F, Quarti-Trevano F, et al. Left ventricular hypertrophy increases cardiovascular risk independently of in-office and out-of-office blood pressure values. J Hypertens. 2009;27(12):2458–64. doi: 10.1097/HJH.0b013e328330b845.CrossRefPubMedGoogle Scholar
- 11.Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet. 2009;373(9671):1275–81. doi: 10.1016/S0140-6736(09)60566-3.CrossRefPubMedGoogle Scholar
- 12.Symplicity HTN-2 Investigators, Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, et al. Renal sympathetic denervation in patients with treatment-resistant hypertension (the Symplicity HTN-2 trial): a randomised controlled trial. Lancet. 2010;376(9756):1903–9. doi: 10.1016/S0140-6736(10)62039-9.CrossRefGoogle Scholar
- 17.Brandt MC, Mahfoud F, Reda S, Schirmer SH, Erdmann E, Böhm M, et al. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol. 2012;59(10):901–9. doi: 10.1016/j.jacc.2011.11.034.CrossRefPubMedGoogle Scholar
- 23.Schirmer SH, Sayed MM, Reil JC, Ukena C, Linz D, Kindermann M, et al. Improvements in left ventricular hypertrophy and diastolic function following renal denervation: effects beyond blood pressure and heart rate reduction. J Am Coll Cardiol. 2014;63(18):1916–23. doi: 10.1016/j.jacc.2013.10.073.CrossRefPubMedGoogle Scholar