Renal Denervation: Results of a Single-Center Cohort Study

 

 Permissions and Reprints

Abstract

Purpose: To investigate the effect of renal denervation on office-based and 24-h ambulatory blood pressure measurements (ABPM) in a highly selective patient population with drug-resistant hypertension.

Materials and Methods: Patients with drug resistant hypertension eligible for renal denervation were included in the study population. Office blood pressure and ABPM were assessed prior to and after renal denervation. To detect procedure related renal or renal artery damage, magnetic resonance imaging (MRI) and angiography (MRA) were performed pre-interventional, one day post-interventional, and one month after renal denervation.

Results: Mean follow-up time between renal denervation and blood pressure re-assessment was 9.5 ± 3.9 months. Between August 2011 and March 2013, 17 patients prospectively underwent renal denervation. Pre-interventional mean office blood pressure and ABPM were 177.3 ± 20.3/103.8 ± 20.4 mmHg and 155.2 ± 20.5/93.7 ± 14.5 mmHg, respectively. Post-interventional, office blood pressure was significantly reduced to 144.7 ± 14.9/89.5 ± 12.1 (p < 0.05). ABPM values remained unchanged (147.9 ± 20.3/90.3 ± 15.6, p > 0.05). The number of prescribed antihypertensive drugs was unchanged after renal denervation (4.7 ± 2.0 vs. 4.2 ± 1.2, p = 0.18). No renovascular complications were detected in follow-up MRI.

Conclusion: After renal denervation, no significant decrease in ABPM was observed. These results may indicate a limited impact of renal denervation for drug resistant hypertension.

Key Points:

• Renal denervation showed no significant effects on 24-h ambulatory blood pressure measurements.

• A significant decrease in office blood pressure measurements may be explained by a potential detection bias.

• Renal artery alterations were not observed on follow-up MRI scans.

Citation Format:

• Luetkens J. A., Wilhelm K., Düsing R. et al. Renal Denervation: Results of a Single-Center Cohort Study. Fortschr Röntgenstr 2015; 187: 36 – 41

Zusammenfassung

Ziel: Erfassung der Blutdruckveränderung nach renaler Denervation in einem hochselektiven Patientenkollektiv mit therapierefraktärer Hypertonie mittels Praxis- und 24-Stunden-Blutdruckmessung.

Material und Methoden: Zwischen August 2011 und März 2013 wurde bei 17 Patienten mit therapierefraktärer Hypertonie eine renale Denervation durchgeführt. Prä- und postinterventionell wurde der Blutdruck mittels Praxisblutdruckmessung und 24-Stundenmessung bestimmt. Zur Detektion von interventionsassoziierten Veränderungen wurden MRT-Untersuchungen der Nieren und Nierenarterien präinterventionell, am Tag nach renaler Denervation und nach einem Monat durchgeführt.

Ergebnisse: Die postinterventionellen Blutdruckmessungen (Praxisblutdruck und 24-Stundenblutdruck) wurden durchschnittlich 9,5 ± 3,9 Monaten nach renaler Denervation durchgeführt. Der mittlere Praxisblutdruck sank signifikant von 177,3 ± 20,3/103,8 ± 20,4 mmHg (systolisch/diastolisch) vor renaler Denervation auf 144,7 ± 14,9/89,5 ± 12,1 (p < 0,05) nach renaler Denervation. Der mittlere Blutdruck in der 24-Stundenmessung nahm nicht signifikant von 155,2 ± 20,5/93,7 ± 14,5 mmHg auf 147,9 ± 20,3/90,3 ± 15,6 (p > 0,05) ab. Die durchschnittliche Anzahl eingenommener Antihypertensiva nahm nicht signifikant ab (4,7 ± 2,0 vs. 4,2 ± 1,2, p = 0,18). Komplikationen oder Spätfolgen wurden nicht beobachtet.

Schlussfolgerung: Durch die renale Denervation kommt es nicht zu einer signifikanten Reduktion der prognostisch wichtigen 24 Stundenblutdruckwerte. Diese Ergebnisse deuten auf einen eingeschränkten Nutzen der renalen Denervation bei therapierefraktärer Hypertonie hin.

• References

• 1 Ezzati M, Lopez AD, Rodgers A et al. Selected major risk factors and global and regional burden of disease. Lancet 2002; 360: 1347-1360
  CrossrefPubMedGoogle Scholar
• 2 Kearney PM, Whelton M, Reynolds K et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365: 217-223
  CrossrefPubMedGoogle Scholar
• 3 Nahle CP, Schild H, Wilhelm K. Renal denervation: ready for prime time?. Dtsch Med Wochenschr 2013; 138: 2212-2218
  Article in Thieme ConnectPubMedGoogle Scholar
• 4 Bobrie G, Chatellier G, Genes N et al. Cardiovascular prognosis of “masked hypertension” detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA 2004; 291: 1342-1349
  CrossrefPubMedGoogle Scholar
• 5 Calhoun DA, Jones D, Textor S et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 2008; 51: 1403-1419
  CrossrefPubMedGoogle Scholar
• 6 Mancia G, Fagard R, Narkiewicz K et al. 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 2013; 34: 2159-2219
  Google Scholar
• 7 Esler M, Ferrier C, Lambert G et al. Biochemical evidence of sympathetic hyperactivity in human hypertension. Hypertension 1991; 17: III29-III35
  PubMedGoogle Scholar
• 8 Smithwick RH, Thompson JE. Splanchnicectomy for essential hypertension; results in 1266 cases. J Am Med Assoc 1953; 152: 1501-1504
  CrossrefPubMedGoogle Scholar
• 9 Grimson KS, Orgain ES, Anderson B et al. Total thoracic and partial to total lumbar sympathectomy, splanchnicectomy and celiac ganglionectomy for hypertension. Ann Surg 1953; 138: 532-547
  CrossrefPubMedGoogle Scholar
• 10 Krum H, Schlaich M, Whitbourn R et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 2009; 373: 1275-1281
  CrossrefPubMedGoogle Scholar
• 11 Krum H, Schlaich MP, Sobotka PA et al. Percutaneous renal denervation in patients with treatment-resistant hypertension: final 3-year report of the Symplicity HTN-1 study. Lancet 2014; 383: 622-629
  CrossrefPubMedGoogle Scholar
• 12 Worthley SG, Tsioufis CP, Worthley MI et al. Safety and efficacy of a multi-electrode renal sympathetic denervation system in resistant hypertension: the EnligHTN I trial. Eur Heart J 2013; 34: 2132-2140
  CrossrefPubMedGoogle Scholar
• 13 Clement DL, De Buyzere ML, De Bacquer DA et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med 2003; 348: 2407-2415
  CrossrefPubMedGoogle Scholar
• 14 Schrader J, Schoel G, Buhr-Schinner H et al. Comparison of the antihypertensive efficiency of nitrendipine, metoprolol, mepindolol and enalapril using ambulatory 24-hour blood pressure monitoring. Am J Cardiol 1990; 66: 967-972
  CrossrefPubMedGoogle Scholar
• 15 Pickering TG, James GD, Boddie C et al. How common is white coat hypertension?. JAMA 1988; 259: 225-228
  CrossrefPubMedGoogle Scholar
• 16 Salles GF, Cardoso CR, Muxfeldt ES. Prognostic influence of office and ambulatory blood pressures in resistant hypertension. Arch Intern Med 2008; 168: 2340-2346
  CrossrefPubMedGoogle Scholar
• 17 Esler MD, Krum H, Sobotka PA et al. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet 2010; 376: 1903-1909
  CrossrefPubMedGoogle Scholar
• 18 Howard JP, Nowbar AN, Francis DP. Size of blood pressure reduction from renal denervation: insights from meta-analysis of antihypertensive drug trials of 4121 patients with focus on trial design: the CONVERGE report. Heart 2013; 99: 1579-1587
  CrossrefPubMedGoogle Scholar
• 19 Bhatt DL, Kandzari DE, O'Neill WW et al. A Controlled Trial of Renal Denervation for Resistant Hypertension. N Engl J Med 2014; 370: 1393-1401
  CrossrefPubMedGoogle Scholar
• 20 Fadl EFE, Hoffmann P, Larstorp AC et al. Adjusted drug treatment is superior to renal sympathetic denervation in patients with true treatment-resistant hypertension. Hypertension 2014; 63: 991-999
  CrossrefPubMedGoogle Scholar
• 21 Kaltenbach B, Id D, Franke JC et al. Renal artery stenosis after renal sympathetic denervation. J Am Coll Cardiol 2012; 60: 2694-2695
  CrossrefPubMedGoogle Scholar
• 22 Vonend O, Antoch G, Rump LC et al. Secondary rise in blood pressure after renal denervation. Lancet 2012; 380: 778
  CrossrefPubMedGoogle Scholar

• Supplementary Material