Effects of renal sympathetic denervation on arterial stiffness and central hemodynamics in patients with resistant hypertension.

This study investigated the effect of catheter-based renal sympathetic denervation (RD) on central hemodynamics in patients with resistant hypertension. High central blood pressure (BP) increases cardiovascular events and mortality independently of peripheral BP. The effect of RD on central BP is unclear. A total of 110 patients underwent bilateral RD. Radial artery applanation tonometry and pulse wave analysis were used to derive central aortic pressure and hemodynamic indices at baseline and 1, 3, and 6 months after ablation. Ten patients with resistant hypertension not undergoing RD served as controls. RD significantly reduced mean central aortic BP from 167/92 mm Hg to 149/88 mm Hg, 147/85 mm Hg, and 141/85 mm Hg at 1, 3, and 6 months (p < 0.001), respectively. Aortic pulse pressure decreased from 76.2 ± 23.3 mm Hg to 61.5 ± 17.5 mm Hg, 62.7 ± 18.1 mm Hg, and 54.5 ± 15.7 mm Hg 1, 3, and 6 months after RD (p < 0.001), respectively. Six months after RD aortic augmentation and augmentation index were significantly reduced by -11 mm Hg (p < 0.001) and -5.3% (p < 0.001), respectively. Carotid to femoral pulse wave velocity showed a significant reduction from 11.6 ± 3.2 m/s to 9.6 ± 3.1 m/s at 6 months (p < 0.001). Consistently, ejection duration and aortic systolic pressure load were significantly diminished, indicating improvement of cardiac work load by RD. No significant changes were obtained in control patients. Besides the known effect of RD on brachial blood pressure, the study showed for the first time that this novel approach significantly improves arterial stiffness and central hemodynamics, which might have important prognostic implications in patients with resistant hypertension at high cardiovascular risk.

Brandt MC ，Reda S ，Mahfoud F ，Lenski M ，Böhm M ，Hoppe UC ... -  《-》

Effects of low-dose atorvastatin on arterial stiffness and central aortic pressure augmentation in patients with hypertension and hypercholesterolemia.

Kanaki AI ，Sarafidis PA ，Georgianos PI ，Kanavos K ，Tziolas IM ，Zebekakis PE ，Lasaridis AN ... -  《-》

Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension.

This study investigated the effect of catheter-based renal sympathetic denervation (RD) on left ventricular hypertrophy (LVH) and systolic and diastolic function in patients with resistant hypertension. LVH and diastolic dysfunction are associated with elevated sympathetic activity and increased morbidity and mortality. The effect of RD on LVH and LV function is unclear. Forty-six patients underwent bilateral RD, and 18 patients served as controls. Transthoracic echocardiography was performed at baseline, and after 1 month and 6 months. Besides reduction of systolic and diastolic blood pressure (-22.5/-7.2 mm Hg at 1 month and -27.8/-8.8 mm Hg at 6 months, p < 0.001 at each time point), RD significantly reduced mean interventricular septum thickness from 14.1 ± 1.9 mm to 13.4 ± 2.1 mm and 12.5 ± 1.4 mm (p = 0.007), and LV mass index from 53.9 ± 15.6 g/m(2.7) (112.4 ± 33.9 g/m(2)) to 47.0 ± 14.2 g/m(2.7) (103.6 ± 30.5 g/m(2)) and 44.7 ± 14.9 g/m(2.7) (94.9 ± 29.8 g/m(2)) (p < 0.001) at 1 month and 6 months, respectively. The mitral valve lateral E/E' decreased after RD from 9.9 ± 4.0 to 7.9 ± 2.2 at 1 month and 7.4 ± 2.7 at 6 months (p < 0.001), indicating reduction of LV filling pressures. Isovolumic relaxation time shortened (baseline 109.1 ± 21.7 ms vs. 85.6 ± 24.4 ms at 6 months, p = 0.006), whereas ejection fraction significantly increased after RD (baseline: 63.1 ± 8.1% vs. 70.1 ± 11.5% at 6 months, p < 0.001). No significant changes were obtained in control patients. Besides the known effect on blood pressure, our study showed for the first time that RD significantly reduces LV mass and improves diastolic function, which might have important prognostic implications in patients with resistant hypertension at high cardiovascular risk.

Brandt MC ，Mahfoud F ，Reda S ，Schirmer SH ，Erdmann E ，Böhm M ，Hoppe UC ... -  《-》

Pulse Wave Velocity Predicts Response to Renal Denervation in Isolated Systolic Hypertension.

Renal sympathetic denervation seems to be less effective as a treatment for hypertension in patients with isolated systolic hypertension, a condition associated with elevated central arterial stiffness. Because isolated systolic hypertension can also be caused by wave reflection or increased cardiac output, a more differentiated approach might improve patient preselection for renal sympathetic denervation. We sought to evaluate the additional predictive value of invasive pulse wave velocity for response to renal sympathetic denervation in patients with combined versus isolated systolic hypertension. Patients scheduled for renal sympathetic denervation underwent additional invasive measurement of pulse wave velocity and pulse pressure before denervation. Blood pressure was assessed via ambulatory measurement at baseline and after 3 months. In total 109 patients (40 patients with isolated systolic hypertension) were included in our analysis. After 3 months, blood pressure reduction was more pronounced among patients with combined hypertension compared with patients with isolated systolic hypertension (systolic 24-hour average 9.3±10.5 versus 5.0±11.5 mm Hg, P=0.046). However, when stratifying patients with isolated systolic hypertension by invasive pulse wave velocity, patients in the lowest tertile of pulse wave velocity had comparable blood pressure reduction (12.1±12.6 mm Hg, P=0.006) despite lower baseline blood pressure than patients with combined hypertension (systolic 24-hour average 154.8±12.5 mm Hg in combined hypertension versus 141.2±8.1, 148.4±10.9, and 150.5±12.7 mm Hg, respectively, by tertiles of pulse wave velocity, P=0.002). Extended assessment of arterial stiffness can help improve patient preselection for renal sympathetic denervation and identify a subgroup of isolated systolic hypertension patients who benefit from sympathetic modulation.

Fengler K ，Rommel KP ，Hoellriegel R ，Blazek S ，Besler C ，Desch S ，Schuler G ，Linke A ，Lurz P ... -  《Journal of the American Heart Association》

Renal hemodynamics and renal function after catheter-based renal sympathetic denervation in patients with resistant hypertension.

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 ，Böhm M ... -  《-》