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Renal denervation improves exercise blood pressure: insights from a randomized, sham-controlled trial

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Abstract

Introduction

Despite the ongoing debate on the role of renal sympathetic denervation (RSD) in the management of therapy-resistant hypertension, little is known about its possible effects on exercise blood pressure (BP), a known predictor for future cardiovascular events. We sought to evaluate the effect of RSD on exercise BP in a randomized, sham-controlled trial in patients with mild hypertension.

Methods and results

Patients with therapy-resistant mild hypertension (defined by mean daytime systolic BP between 135 and 149 mmHg or mean daytime diastolic BP between 90 and 94 mmHg on 24-h ambulatory BP measurement) were randomized to either radiofrequency-based RSD or a sham procedure. Patients underwent cardiopulmonary exercise testing at baseline and after 6 months. Of the 71 patients randomized, data from cardiopulmonary exercise testing were available for 48 patients (22 in the RSD group, 26 in the sham group). After 6 months, patients undergoing RSD had a significantly lower systolic BP at maximum exercise workload compared to baseline (−14.2 ± 26.1 mmHg, p = 0.009). In contrast, no change was observed in the sham group (0.6 ± 22.9 mmHg, p = 0.45, p = 0.04 for between-group comparison). When analyzing patients with exaggerated baseline exercise BP only, the effect was even more pronounced (RSD vs. sham −29.5 ± 23.4 vs. 0.1 ± 25.3 mmHg, p = 0.008).

Conclusion

Exercise systolic BP values in patients with mild therapy-resistant hypertension are reduced after RSD as compared to a sham-procedure.

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Abbreviations

BP:

Blood pressure

RSD:

Renal sympathetic denervation

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Author notes

    Authors and Affiliations

    1. Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany

      Karl Fengler, Diana Heinemann, Thomas Okon, Karoline Röhnert, Thomas Stiermaier, Maximilian von Röder, Christian Besler, Ulrike Müller, Robert Höllriegel, Gerhard Schuler & Philipp Lurz

    2. Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany

      Steffen Desch

    3. German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Luebeck, Germany

      Steffen Desch

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    1. Karl Fengler
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    2. Diana Heinemann
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    3. Thomas Okon
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    Correspondence to Philipp Lurz.

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    Conflict of interest

    PL received speaker fees from Medtronic. No other conflict of interest has been reported.

    Ethical standards

    All patients provided written informed consent for participation in this trial. The study was approved by the local Institutional Review Board and conducted in accordance with the principles of the Declaration of Helsinki.

    Additional information

    S. Desch and P. Lurz, both the senior authors, contributed equally to this work.

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    Fengler, K., Heinemann, D., Okon, T. et al. Renal denervation improves exercise blood pressure: insights from a randomized, sham-controlled trial. Clin Res Cardiol 105, 592–600 (2016). https://doi.org/10.1007/s00392-015-0955-8

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    • DOI: https://doi.org/10.1007/s00392-015-0955-8

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