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Multicenter Study
. 2016 Jun;105(6):544-52.
doi: 10.1007/s00392-015-0959-4. Epub 2016 Jan 22.

Renal artery sympathetic denervation: observations from the UK experience

Andrew S P Sharp  1 , Justin E Davies  2 , Melvin D Lobo  3   4 , Clare L Bent  5 , Patrick B Mark  6 , Amy E Burchell  7 , Simon D Thackray  8 , Una Martin  9 , William S McKane  10 , Robert T Gerber  11 , James R Wilkinson  12 , Tarek F Antonios  13 , Timothy W Doulton  14 , Tiffany Patterson  15 , Piers C Clifford  16 , Alistair Lindsay  17 , Graeme J Houston  18 , Jonathan Freedman  19 , Neelan Das  14 , Anna M Belli  13 , Mohamad Faris  11 , Trevor J Cleveland  20 , Angus K Nightingale  6 , Awais Hameed  21 , Kalaivani Mahadevan  12 , Judith A Finegold  2 , Adam N Mather  22 , Terry Levy  5 , Richard D'Souza  23 , Peter Riley  24 , Jonathan G Moss  25 , Carlo Di Mario  17 , Simon R Redwood  15 , Andreas Baumbach  6 , Mark J Caulfield  3   4 , Indranil Dasgupta  26
Affiliations
Multicenter Study

Renal artery sympathetic denervation: observations from the UK experience

Andrew S P Sharp et al. Clin Res Cardiol. 2016 Jun.

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 Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn.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: Aldosterone; Catheter ablation; Hypertension; Sympathetic nervous system.

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Figures

Fig. 1
Fig. 1
Change in daytime ambulatory systolic blood pressure (ASBP), daytime ambulatory diastolic blood pressure (ADBP), office systolic BP (SBP) and office diastolic BP (DBP) to RDN by quartile analysis of starting daytime ambulatory SBP
See this image and copyright information in PMC

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