Individual-patient visit-by-visit office and ambulatory blood pressure measurements over 24months in patients undergoing renal denervation for hypertension.

BACKGROUND: Renal denervation (RDN) is a promising treatment option in addition to medical antihypertensive treatment in patients suffering from resistant hypertension. Despite the growing interest in RDN, only few long-term results are published so far. METHODS: We systematically investigated the effects of RDN on ABPM in a consecutive series of patients with resistant hypertension out to 24 months. Office BP measurements and ABPM assessment were offered at 3, 6, 12 and 24 months. The patients with an average systolic BP reduction of more than 10 mmHg in office BP 6months after RDN were classified as responders. Additional to this classical responder concept, we categorized response to RDN by an individual-patient visit-by-visit evaluation of office BP and 24-hour-BP, separately. RESULTS: We included 32 patients. In 21 patients (65.6%) we found a mean systolic BP reduction >10 mmHg in office BP six months after RDN. These patients were classified as responders. In responders, mean office BP dropped from 175.3 ± 15.9/96 ± 14.2 mmHg to 164.8 ± 24.4/93.2 ± 10.4 mmHg (p=0.040/p=0.323) and mean 24-h BP in ABPM decreased from 146.8 ± 17.0/89.1 ± 11 mmHg to 136.8 ± 15.0/83.2 ± 10.7 mmHg after 24 months (p=0.034/p=0.014). Additionally, we performed a visit-by-visit evaluation of all patients and results were divided in larger-than-median and smaller-than-median response. By this evaluation, we found a high variation of office BP reductions and the 24-hour BP results demonstrated a significant BP reduction in patients with larger-than-median response, which sustained over the 24 months of follow-up. CONCLUSIONS: In contrast to the observed variation of office BP measurements, ABPM demonstrated a reproducible and sustained significant BP reduction in patients with larger-than-median response to RDN.

Effects of renal denervation on ambulatory blood pressure measurements in patients with resistant arterial hypertension.

BACKGROUND: The sympathetic nervous system is an important factor in hypertension. In patients suffering from resistant hypertension, transfemoral renal sympathetic denervation (RDN) reduces office blood pressure (BP) values. HYPOTHESIS: Ambulatory BP measurement (ABPM) is a better predictor than office BP of cardiovascular morbidity and mortality. We thus believe that ABPM should be added to the systematic evaluation and follow-up protocol when treating patients with resistant hypertension with RDN. Therefore, we evaluated the effect of RDN on mean 24-hour BP by the use of ABPM. METHODS: Patients with resistant hypertension (office systolic BP >160 mm Hg, or >150 mm Hg in patients with diabetes) have been treated with RDN. Ambulatory BP measurement was performed at baseline and at 3 and 6 months after RDN. Patients with a 24-hour systolic BP reduction of ≥5 mm Hg were classified as responders. RESULTS: Of 86 patients initially enrolled in the study, 5 had to be excluded from the analysis because of <70% valid ABPM recordings. Out of the 81 studied patients, we found 49 responders (60.5%). In all patients, office BP decreased from 169.9/87.8 mm Hg to 153.5/86.3 mm Hg (P < 0.001/P = not significant [NS]) and 24-hour BP decreased from 144.3/86.0 mm Hg to 139.9/84.0 mm Hg (P = 0.025/P = NS) 6 months after RDN. In responders, office BP decreased from 169.6/90.3 mm Hg to 143.7/79.7 mm Hg (P < 0.001/P < 0.001). The ABPM levels started at 144.3/84.7 mm Hg and decreased to 138.3/81.5 mm Hg (P = 0.025/P = 0.045). In nonresponders, office BP was 150.2/84.0 mm Hg and 24-hour BP was 144.5/84.7 mm Hg at baseline; at 6 months, office BP was 168.7/96.4 mm Hg (P < 0.001/P = NS) and 24-hour BP was 142.2/81.5 mm Hg (P = NS/P = NS). CONCLUSIONS: Office BP and AMBP levels can be significantly lowered by RDN in patients with resistant hypertension.