Renal artery sympathetic denervation: observations from the UK experience

Andrew S P Sharp; 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 Belli; Mohamad 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

doi:10.1007/s00392-015-0959-4

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 Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn.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 language	English
Pages (from-to)	544-552
Number of pages	9
Journal	Clinical Research in Cardiology
Volume	105
Issue number	6
Early online date	22 Jan 2016
DOIs	https://doi.org/10.1007/s00392-015-0959-4
Publication status	Published - 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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© The Author(s) 2016. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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Sharp, A. S. P., Davies, J. E., Lobo, M. D., Bent, C. L., Mark, P. B., Burchell, A. E., Thackray, S. D., Martin, U., McKane, W. S., Gerber, R. T., Wilkinson, J. R., Antonios, T. F., Doulton, T. W., Patterson, T., Clifford, P. C., Lindsay, A., Houston, G. J., Freedman, J., Das, N., ... Dasgupta, I. (2016). Renal artery sympathetic denervation: observations from the UK experience. Clinical Research in Cardiology , 105(6), 544-552. https://doi.org/10.1007/s00392-015-0959-4

@article{40c4d68ccd5744d1968ebe35e76ff751,

title = "Renal artery sympathetic denervation: observations from the UK experience",

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.",

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",

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

note = "No funding was sought or received for this study.",

year = "2016",

month = jun,

doi = "10.1007/s00392-015-0959-4",

language = "English",

volume = "105",

pages = "544--552",

journal = "Clinical Research in Cardiology ",

issn = "1861-0684",

publisher = "Taylor & Francis",

number = "6",

}

Sharp, ASP, Davies, JE, Lobo, MD, Bent, CL, Mark, PB, Burchell, AE, Thackray, SD, Martin, U, McKane, WS, Gerber, RT, Wilkinson, JR, Antonios, TF, Doulton, TW, Patterson, T, Clifford, PC, Lindsay, A, Houston, GJ, Freedman, J, Das, N, Belli, AM, Faris, M, Cleveland, TJ, Nightingale, AK, Hameed, A, Mahadevan, K, Finegold, JA, Mather, AN, Levy, T, D'Souza, R, Riley, P, Moss, JG, Di Mario, C, Redwood, SR, Baumbach, A, Caulfield, MJ & Dasgupta, I 2016, 'Renal artery sympathetic denervation: observations from the UK experience', Clinical Research in Cardiology , vol. 105, no. 6, pp. 544-552. https://doi.org/10.1007/s00392-015-0959-4

TY - JOUR

T1 - Renal artery sympathetic denervation

T2 - observations from the UK experience

AU - Sharp, Andrew S P

AU - Davies, Justin E

AU - Lobo, Melvin D

AU - Bent, Clare L

AU - Mark, Patrick B

AU - Burchell, Amy E

AU - Thackray, Simon D

AU - Martin, Una

AU - McKane, William S

AU - Gerber, Robert T

AU - Wilkinson, James R

AU - Antonios, Tarek F

AU - Doulton, Timothy W

AU - Patterson, Tiffany

AU - Clifford, Piers C

AU - Lindsay, Alistair

AU - Houston, Graeme J

AU - Freedman, Jonathan

AU - Das, Neelan

AU - Belli, Anna M

AU - Faris, Mohamad

AU - Cleveland, Trevor J

AU - Nightingale, Angus K

AU - Hameed, Awais

AU - Mahadevan, Kalaivani

AU - Finegold, Judith A

AU - Mather, Adam N

AU - Levy, Terry

AU - D'Souza, Richard

AU - Riley, Peter

AU - Moss, Jonathan G

AU - Di Mario, Carlo

AU - Redwood, Simon R

AU - Baumbach, Andreas

AU - Caulfield, Mark J

AU - Dasgupta, Indranil

N1 - No funding was sought or received for this study.

PY - 2016/6

Y1 - 2016/6

N2 - 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.

AB - 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.

KW - Aged

KW - Antihypertensive Agents

KW - Blood Pressure

KW - Blood Pressure Monitoring, Ambulatory

KW - Drug Resistance

KW - Drug Therapy, Combination

KW - Female

KW - Humans

KW - Hypertension

KW - Kidney

KW - Male

KW - Middle Aged

KW - Mineralocorticoid Receptor Antagonists

KW - Office Visits

KW - Registries

KW - Renal Artery

KW - Retrospective Studies

KW - Sympathectomy

KW - Sympathetic Nervous System

KW - Time Factors

KW - Treatment Outcome

KW - United Kingdom

KW - Journal Article

KW - Multicenter Study

U2 - 10.1007/s00392-015-0959-4

DO - 10.1007/s00392-015-0959-4

M3 - Article

C2 - 26802018

SN - 1861-0684

VL - 105

SP - 544

EP - 552

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

IS - 6

ER -

Renal artery sympathetic denervation: observations from the UK experience

Abstract

Keywords

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