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Renal Nerve Stimulation as Procedural End Point for Renal Sympathetic Denervation

  • Annemiek F. Hoogerwaard
  • Mark R. de Jong
  • Arif Elvan
Secondary Hypertension: Nervous System Mechanisms (M Wyss, Section Editor)
  • 196 Downloads
Part of the following topical collections:
  1. Topical Collection on Secondary Hypertension: Nervous System Mechanisms

Abstract

Purpose of Review

Renal sympathetic denervation (RDN) as treatment option for hypertension has a strong rationale; however, variable effects on blood pressure (BP) have been reported ranging from non-response to marked reductions in BP. The absence of a procedural end point for RDN is one of the potential factors associated with the variable response. Studies have suggested the use of renal nerve stimulation (RNS) to adequately address this issue. This review aims to provide an overview of the clinical and experimental data available regarding the effects of RNS in the setting of RDN.

Recent Findings

Animal studies have shown that high-frequency electrical stimulation of the sympathetic nerves in the adventitia of the renal arteries elicits an increase in BP and leads to an increased norepinephrine spillover as a marker of increased sympathetic activity and these effects of stimulation were attenuated or blunted after RDN. In a human feasibility study using RNS both before and after RDN, similar BP responses were observed. Moreover, in patients with resistant hypertension, RNS-induced changes in BP appeared to be correlated with 24-h BP response after RDN. These data suggest that RNS is a useful tool to identify renal sympathetic nerve fibers in patients with treatment-resistant hypertension undergoing RDN, and to predict the likely effectiveness of RDN treatments.

Summary

In acute procedural settings both in animal and human models, RNS elicits increase in BP and HR before RDN and these effects are blunted after RDN. Up to now, there is preliminary evidence that the RNS-induced BP changes predict 24-h ABPM outcome at follow-up in patients with resistant hypertension. Of note, studies are small sized and results of large trials comparing conventional RDN to RNS-guided RDN are warranted.

Keywords

Renal nerve stimulation Renal nerve denervation Drug-resistant hypertension 

Abbreviations

ABPM

Ambulatory blood pressure measurements

BP

Blood pressure

DBP

Diastolic blood pressure

HR

Heart rate

RDN

Renal nerve denervation

RNS

Renal nerve stimulation

SBP

Systolic blood pressure

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

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.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Annemiek F. Hoogerwaard
    • 1
  • Mark R. de Jong
    • 1
  • Arif Elvan
    • 1
  1. 1.Department of CardiologyIsala HospitalZwolleThe Netherlands

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