Effects of Renal Sympathetic Denervation on Arterial Stiffness and Central Hemodynamics in Patients With Resistant Hypertension

Oct 11, 2012
Font Size
A
A
A
Authors:
Brandt MC, Reda S, Mahfoud F, Lenski M, Böhm M, Hoppe UC.
Citation:
J Am Coll Cardiol 2012;Oct 10:[Epub ahead of print].
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

What is the impact of catheter-based renal sympathetic denervation (RD) on central hemodynamics in patients with resistant hypertension?

Methods:

The authors assessed the effect of RD in 110 patients with resistant hypertension. 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 who did not undergo RD served as controls.

Results:

RD was associated with a significant reduction in mean central aortic blood pressure 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). 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). A significant reduction was seen at 6 months in aortic augmentation (-11 mm Hg, p < 0.001) and augmentation index (-5.3%, p < 0.001). Carotid to femoral pulse wave velocity was significantly reduced from 11.6 m/s to 9.6 m/s at 6 months (p < 0.001). There were significant reductions in ejection duration and aortic systolic pressure load by RD. No significant changes were obtained in control patients.

Conclusions:

The authors concluded that RD is associated with an improvement in arterial stiffness and central hemodynamic in patients with resistant hypertension.

Perspective:

Central aortic blood pressure is a strong predictor of adverse cardiovascular outcomes (CAFÉ study, Circulation, 2006), and this study confirms the salutary impact of RD on both central and peripheral blood pressure. This suggests that the reduction in blood pressure seen with this therapy is likely to result in significant reduction in cardiovascular morbidity (and potentially reduced mortality).

Keywords: Radial Artery, Arterial Pressure, Pulse Wave Analysis, Blood Pressure, Blood Pressure Determination, Hypertension, Pregnancy, Hemodynamics, Vascular Stiffness


< Back to Listings