Renal artery sympathetic denervation: observations from the UK experience

Andrew S P Sharp (Lead / Corresponding author), Justin E Davies, Melvin D Lobo, Clare L Bent, Patrick B Mark, Amy E Burchell, Simon D Thackray, Una Martin, William S McKane, Robert T Gerber, James R Wilkinson, Tarek F Antonios, Timothy W Doulton, Tiffany Patterson, Piers C Clifford, Alistair Lindsay, Graeme J Houston, Jonathan Freedman, Neelan Das, Anna M BelliMohamad Faris, Trevor J Cleveland, Angus K Nightingale, Awais Hameed, Kalaivani Mahadevan, Judith A Finegold, Adam N Mather, Terry Levy, Richard D'Souza, Peter Riley, Jonathan G Moss, Carlo Di Mario, Simon R Redwood, Andreas Baumbach, Mark J Caulfield, Indranil Dasgupta

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    Abstract

    BACKGROUND: Renal denervation (RDN) may lower blood pressure (BP); however, it is unclear whether medication changes may be confounding results. Furthermore, limited data exist on pattern of ambulatory blood pressure (ABP) response-particularly in those prescribed aldosterone antagonists at the time of RDN.

    METHODS: We examined all patients treated with RDN for treatment-resistant hypertension in 18 UK centres.

    RESULTS: Results from 253 patients treated with five technologies are shown. Pre-procedural mean office BP (OBP) was 185/102 mmHg (SD 26/19; n = 253) and mean daytime ABP was 170/98 mmHg (SD 22/16; n = 186). Median number of antihypertensive drugs was 5.0: 96 % ACEi/ARB; 86 % thiazide/loop diuretic and 55 % aldosterone antagonist. OBP, available in 90 % at 11 months follow-up, was 163/93 mmHg (reduction of 22/9 mmHg). ABP, available in 70 % at 8.5 months follow-up, was 158/91 mmHg (fall of 12/7 mmHg). Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn. Dose changes appeared neutral. Quartile analysis by starting ABP showed mean reductions in systolic ABP after RDN of: 0.4; 6.5; 14.5 and 22.1 mmHg, respectively (p < 0.001 for trend). Use of aldosterone antagonist did not predict response (p > 0.2).

    CONCLUSION: In 253 patients treated with RDN, office BP fell by 22/9 mmHg. Ambulatory BP fell by 12/7 mmHg, though little response was seen in the lowermost quartile of starting blood pressure. Fall in BP was not explained by medication changes and aldosterone antagonist use did not affect response.

    Original languageEnglish
    Pages (from-to)544-552
    Number of pages9
    JournalClinical Research in Cardiology
    Volume105
    Issue number6
    Early online date22 Jan 2016
    DOIs
    Publication statusPublished - Jun 2016

    Keywords

    • Aged
    • Antihypertensive Agents
    • Blood Pressure
    • Blood Pressure Monitoring, Ambulatory
    • Drug Resistance
    • Drug Therapy, Combination
    • Female
    • Humans
    • Hypertension
    • Kidney
    • Male
    • Middle Aged
    • Mineralocorticoid Receptor Antagonists
    • Office Visits
    • Registries
    • Renal Artery
    • Retrospective Studies
    • Sympathectomy
    • Sympathetic Nervous System
    • Time Factors
    • Treatment Outcome
    • United Kingdom
    • Journal Article
    • Multicenter Study

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