Skip to main content

Advertisement

SpringerLink
Log in

Renal sympathetic denervation therapy in the real world: results from the Heidelberg registry

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Introduction

Renal sympathetic denervation (RDN) is a novel treatment option in patients with treatment-resistant arterial hypertension. A subset of recently published randomized and non-randomized trials indicates that RDN leads to sustained lowering of blood pressure (BP) under controlled study conditions. However, registry data that allow evaluation of safety and efficacy in a real-world setting are largely missing.

Methods

Sixty-three consecutive patients with treatment-resistant hypertension underwent RDN with the radiofrequency-based Symplicity™ catheter. As part of our prospective registry, treatment efficacy and safety were monitored after 3, 6, and 12 months.

Results

At 6 months follow-up, office systolic BP significantly improved by 19 + 23 mmHg as compared to baseline, while diastolic BP values reduced by 6 + 13 mmHg (p < 0.05). One year after RDN, office BP levels further improved (26 + 25 mmHg in systolic BP and 9 + 13 mmHg in diastolic BP, respectively), even though 19 patients had reduced the number and/or dosage of antihypertensive agents. The response rate, defined as reduction of office systolic BP of ≥10 mmHg, was 73 % after 6 months. Baseline BP was the only significant predictor of blood pressure response, whereas no correlation was found between the number of ablation points and the individual changes in office blood pressure. Interestingly, patients with challenging renal anatomy profited somewhat less from the procedure than those with “normal” renal anatomy. Procedure related adverse events occurred in three patients (4.7 %) and were limited to vascular access complications.

Conclusions

RDN with the Symplicity™ system is safe and effective in patients with treatment-resistant hypertension also in a real-world setting.

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
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wolf-Maier K, Cooper RS, Kramer H, Banegas JR, Giampaoli S, Joffres MR, Poulter N, Primatesta P, Stegmayr B, Thamm M (2004) Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension 43(1):10–17. doi:10.1161/01.HYP.0000103630.72812.10

    Article  CAS  PubMed  Google Scholar 

  2. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies C (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360(9349):1903–1913

    Article  PubMed  Google Scholar 

  3. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ, Joint National Committee on Prevention DE, Treatment of High Blood Pressure, National Heart L, Blood I, National High Blood Pressure Education Program Coordinating C (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42(6):1206–1252. doi:10.1161/01.HYP.0000107251.49515.c2

    Article  CAS  PubMed  Google Scholar 

  4. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Stafford R, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J, American Heart Association Statistics C, Stroke Statistics S (2010) Executive summary: heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation 121(7):948–954. doi:10.1161/CIRCULATIONAHA.109.192666

    Article  PubMed  Google Scholar 

  5. WHO (2009) Global health risks: mortality and burden of disease attributable to selected major risks. World Health Organization, Geneva

    Google Scholar 

  6. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J (2005) Global burden of hypertension: analysis of worldwide data. Lancet 365(9455):217–223. doi:10.1016/S0140-6736(05)17741-1

    PubMed  Google Scholar 

  7. Sarafidis PA, Bakris GL (2008) Resistant hypertension: an overview of evaluation and treatment. J Am Coll Cardiol 52(22):1749–1757. doi:10.1016/j.jacc.2008.08.036

    Article  PubMed  Google Scholar 

  8. Sobotka PA, Mahfoud F, Schlaich MP, Hoppe UC, Bohm M, Krum H (2011) Sympatho-renal axis in chronic disease. Clin Res Cardiol Off J Ger Card Soc 100(12):1049–1057. doi:10.1007/s00392-011-0335-y

    Article  Google Scholar 

  9. Schlaich MP, Sobotka PA, Krum H, Lambert E, Esler MD (2009) Renal sympathetic-nerve ablation for uncontrolled hypertension. New Engl J Med 361(9):932–934. doi:10.1056/NEJMc0904179

    Article  CAS  PubMed  Google Scholar 

  10. Rippy MK, Zarins D, Barman NC, Wu A, Duncan KL, Zarins CK (2011) Catheter-based renal sympathetic denervation: chronic preclinical evidence for renal artery safety. Clin Res Cardiol Off J Ger Card Soc 100(12):1095–1101. doi:10.1007/s00392-011-0346-8

    Article  Google Scholar 

  11. Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K, Kapelak B, Walton A, Sievert H, Thambar S, Abraham WT, Esler M (2009) Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 373(9671):1275–1281. doi:10.1016/S0140-6736(09)60566-3

    Article  PubMed  Google Scholar 

  12. Symplicity HTNI (2011) Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months. Hypertension 57(5):911–917. doi:10.1161/HYPERTENSIONAHA.110.163014

    Article  Google Scholar 

  13. Symplicity HTNI, Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Bohm M (2010) Renal sympathetic denervation in patients with treatment-resistant hypertension (the Symplicity HTN-2 trial): a randomised controlled trial. Lancet 376(9756):1903–1909. doi:10.1016/S0140-6736(10)62039-9

    Article  Google Scholar 

  14. Krum HSM, Sobotka P, Esler M, Mahfoud F, Boehm M, Dunlap M, Rocha-Singh K, Katholi R (2012) Long-term follow up of catheter-based renal denervation for resistant hypertension confirms durable blood pressure reduction. J Am Coll Cardiol 60(17):B3

    Article  Google Scholar 

  15. Esler MDKH, Schlaich MP, Schmieder RE, Boehm M, Sobotka P (2012) Catheter-based renal sympathetic denervation in patients with resistant hypertension: 18 months follow up of the Symplicity HTN-2 trial. Eur Heart J 33:181

    Google Scholar 

  16. Kandzari DE, Bhatt DL, Sobotka PA, O’Neill WW, Esler M, Flack JM, Katzen BT, Leon MB, Massaro JM, Negoita M, Oparil S, Rocha-Singh K, Straley C, Townsend RR, Bakris G (2012) Catheter-based renal denervation for resistant hypertension: rationale and design of the SYMPLICITY HTN-3 Trial. Clin Cardiol 35(9):528–535. doi:10.1002/clc.22008

    Article  PubMed  Google Scholar 

  17. Mahfoud F, Schlaich M, Kindermann I, Ukena C, Cremers B, Brandt MC, Hoppe UC, Vonend O, Rump LC, Sobotka PA, Krum H, Esler M, Bohm M (2011) Effect of renal sympathetic denervation on glucose metabolism in patients with resistant hypertension: a pilot study. Circulation 123(18):1940–1946. doi:10.1161/CIRCULATIONAHA.110.991869

    Article  CAS  PubMed  Google Scholar 

  18. Witkowski A, Prejbisz A, Florczak E, Kadziela J, Sliwinski P, Bielen P, Michalowska I, Kabat M, Warchol E, Januszewicz M, Narkiewicz K, Somers VK, Sobotka PA, Januszewicz A (2011) Effects of renal sympathetic denervation on blood pressure, sleep apnea course, and glycemic control in patients with resistant hypertension and sleep apnea. Hypertension 58(4):559–565. doi:10.1161/HYPERTENSIONAHA.111.173799

    Article  CAS  PubMed  Google Scholar 

  19. Schlaich MP, Straznicky N, Grima M, Ika-Sari C, Dawood T, Mahfoud F, Lambert E, Chopra R, Socratous F, Hennebry S, Eikelis N, Bohm M, Krum H, Lambert G, Esler MD, Sobotka PA (2011) Renal denervation: a potential new treatment modality for polycystic ovary syndrome? J Hypertens 29(5):991–996. doi:10.1097/HJH.0b013e328344db3a

    Article  CAS  PubMed  Google Scholar 

  20. Ukena C, Bauer A, Mahfoud F, Schreieck J, Neuberger HR, Eick C, Sobotka PA, Gawaz M, Bohm M (2012) Renal sympathetic denervation for treatment of electrical storm: first-in-man experience. Clin Res Cardiol Off J Ger Card Soc 101(1):63–67. doi:10.1007/s00392-011-0365-5

    Article  Google Scholar 

  21. Linz D, Mahfoud F, Schotten U, Ukena C, Neuberger HR, Wirth K, Bohm M (2012) Renal sympathetic denervation suppresses postapneic blood pressure rises and atrial fibrillation in a model for sleep apnea. Hypertension 60(1):172–178. doi:10.1161/HYPERTENSIONAHA.112.191965

    Article  CAS  PubMed  Google Scholar 

  22. Zhao Q, Yu S, Zou M, Dai Z, Wang X, Xiao J, Huang C (2012) Effect of renal sympathetic denervation on the inducibility of atrial fibrillation during rapid atrial pacing. J Interv Card Electrophysiol Int J Arrhythm Pacing 35(2):119–125. doi:10.1007/s10840-012-9717-y

    Article  Google Scholar 

  23. Linz D, Mahfoud F, Schotten U, Ukena C, Hohl M, Neuberger HR, Wirth K, Bohm M (2013) Renal sympathetic denervation provides ventricular rate control but does not prevent atrial electrical remodeling during atrial fibrillation. Hypertension 61(1):225–231. doi:10.1161/HYPERTENSIONAHA.111.00182

    Article  CAS  PubMed  Google Scholar 

  24. Brandt MC, Mahfoud F, Reda S, Schirmer SH, Erdmann E, Bohm M, Hoppe UC (2012) Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol 59(10):901–909. doi:10.1016/j.jacc.2011.11.034

    Article  PubMed  Google Scholar 

  25. Task Force M, Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Council ESHS, Redon J, Dominiczak A, Narkiewicz K, Nilsson PM, Burnier M, Viigimaa M, Ambrosioni E, Caufield M, Coca A, Olsen MH, Schmieder RE, Tsioufis C, van de Borne P, Guidelines ESCCfP, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document R, Clement DL, Coca A, Gillebert TC, Tendera M, Rosei EA, Ambrosioni E, Anker SD, Bauersachs J, Hitij JB, Caulfield M, De Buyzere M, De Geest S, Derumeaux GA, Erdine S, Farsang C, Funck-Brentano C, Gerc V, Germano G, Gielen S, Haller H, Hoes AW, Jordan J, Kahan T, Komajda M, Lovic D, Mahrholdt H, Olsen MH, Ostergren J, Parati G, Perk J, Polonia J, Popescu BA, Reiner Z, Ryden L, Sirenko Y, Stanton A, Struijker-Boudier H, Tsioufis C, van de Borne P, Vlachopoulos C, Volpe M, Wood DA (2013) 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). Eur Heart J 34(28):2159–2219. doi:10.1093/eurheartj/eht151

    Article  PubMed  Google Scholar 

  26. Mahfoud F, Luscher TF, Andersson B, Baumgartner I, Cifkova R, Dimario C, Doevendans P, Fagard R, Fajadet J, Komajda M, Lefevre T, Lotan C, Sievert H, Volpe M, Widimsky P, Wijns W, Williams B, Windecker S, Witkowski A, Zeller T, Bohm M (2013) Expert consensus document from the European Society of Cardiology on catheter-based renal denervation. Eur Heart J 34(28):2149–2157. doi:10.1093/eurheartj/eht154

    Article  PubMed  Google Scholar 

  27. Schmieder RE, Redon J, Grassi G, Kjeldsen SE, Mancia G, Narkiewicz K, Parati G, Ruilope L, van de Borne P, Tsioufis C (2013) Updated ESH position paper on interventional therapy of resistant hypertension. EuroIntervention J EuroPCR Collab Work Group Interv Cardiol Eur Soc Cardiol 9(Suppl R):R58–R66. doi:10.4244/EIJV9SRA11

    Google Scholar 

  28. Mahfoud F, Cremers B, Janker J, Link B, Vonend O, Ukena C, Linz D, Schmieder R, Rump LC, Kindermann I, Sobotka PA, Krum H, Scheller B, Schlaich M, Laufs U, Bohm M (2012) Renal hemodynamics and renal function after catheter-based renal sympathetic denervation in patients with resistant hypertension. Hypertension 60(2):419–424. doi:10.1161/HYPERTENSIONAHA.112.193870

    Article  CAS  PubMed  Google Scholar 

  29. Mahfoud F, Ukena C, Schmieder RE, Cremers B, Rump LC, Vonend O, Weil J, Schmidt M, Hoppe UC, Zeller T, Bauer A, Ott C, Blessing E, Sobotka PA, Krum H, Schlaich M, Esler M, Bohm M (2013) Ambulatory blood pressure changes after renal sympathetic denervation in patients with resistant hypertension. Circulation 128(2):132–140. doi:10.1161/CIRCULATIONAHA.112.000949

    Article  CAS  PubMed  Google Scholar 

  30. Kaltenbach B, Franke J, Bertog SC, Steinberg DH, Hofmann I, Sievert H (2012) Renal sympathetic denervation as second-line therapy in mild resistant hypertension: a pilot study. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. doi:10.1002/ccd.24557

    Google Scholar 

Download references

Acknowledgments

We thank Ilka Buss for excellent technical assistance.

Conflict of interest

Dr. med. Britta Vogel and Prof. Dr. med. Erwin Blessing occasionally receive speakers honoraria from Medtronic. Prof. Blessing is also receiving research grants from Medtronic.

Author information

Authors and Affiliations

  1. Medical Clinic III, University of Heidelberg, INF 410, 69120, Heidelberg, Germany

    Britta Vogel, Michael Kirchberger, Felicitas Stoll, Benjamin Meder, Martin Andrassy, Oliver J. Mueller, Stefan Hardt, Anna Strothmeyer, Hugo A. Katus & Erwin Blessing

  2. Medical Clinic I, University of Heidelberg, Heidelberg, Germany

    Martin Zeier & Vedat Schwenger

  3. Department of Medical Biometry, University of Heidelberg, Heidelberg, Germany

    Daniel Saure

Authors
  1. Britta Vogel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Kirchberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Zeier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Felicitas Stoll
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Benjamin Meder
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel Saure
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Martin Andrassy
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Oliver J. Mueller
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Stefan Hardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Vedat Schwenger
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Anna Strothmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hugo A. Katus
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Erwin Blessing
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Britta Vogel.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 27 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vogel, B., Kirchberger, M., Zeier, M. et al. Renal sympathetic denervation therapy in the real world: results from the Heidelberg registry. Clin Res Cardiol 103, 117–124 (2014). https://doi.org/10.1007/s00392-013-0627-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-013-0627-5

Keywords

Search

Navigation