Background: The sympathetic nervous system is an important factor in hypertension. In patients suffering from resistant hypertension, transfemoral renal sympathetic denervation (RDN) reduces office blood pressure (BP) values.
Hypothesis: Ambulatory BP measurement (ABPM) is a better predictor than office BP of cardiovascular morbidity and mortality. We thus believe that ABPM should be added to the systematic evaluation and follow-up protocol when treating patients with resistant hypertension with RDN. Therefore, we evaluated the effect of RDN on mean 24-hour BP by the use of ABPM.
Methods: Patients with resistant hypertension (office systolic BP >160 mm Hg, or >150 mm Hg in patients with diabetes) have been treated with RDN. Ambulatory BP measurement was performed at baseline and at 3 and 6 months after RDN. Patients with a 24-hour systolic BP reduction of ≥5 mm Hg were classified as responders.
Results: Of 86 patients initially enrolled in the study, 5 had to be excluded from the analysis because of <70% valid ABPM recordings. Out of the 81 studied patients, we found 49 responders (60.5%). In all patients, office BP decreased from 169.9/87.8 mm Hg to 153.5/86.3 mm Hg (P < 0.001/P = not significant [NS]) and 24-hour BP decreased from 144.3/86.0 mm Hg to 139.9/84.0 mm Hg (P = 0.025/P = NS) 6 months after RDN. In responders, office BP decreased from 169.6/90.3 mm Hg to 143.7/79.7 mm Hg (P < 0.001/P < 0.001). The ABPM levels started at 144.3/84.7 mm Hg and decreased to 138.3/81.5 mm Hg (P = 0.025/P = 0.045). In nonresponders, office BP was 150.2/84.0 mm Hg and 24-hour BP was 144.5/84.7 mm Hg at baseline; at 6 months, office BP was 168.7/96.4 mm Hg (P < 0.001/P = NS) and 24-hour BP was 142.2/81.5 mm Hg (P = NS/P = NS).
Conclusions: Office BP and AMBP levels can be significantly lowered by RDN in patients with resistant hypertension.
© 2014 Wiley Periodicals, Inc.