Different responses of arterial blood pressure to electrical stimulation of the renal artery in patients with resistant hypertension

Abstract

SIMPLICITY-HTN 3 revealed several limitations of renal denervation (RDN) for the treatment of resistant hypertension [ [1] Bhatt D.L. Kandzari D.E. O'Neill W.W. D'Agostino R. Flack J.M. Katzen B.T. Leon M.B. Liu M. Mauri L. Negoita M. Cohen S.A. Oparil S. Rocha-Singh K. Townsend R.R. Bakris G.L. SYMPLICITY HTN-3 Investigators: a controlled trial of renal denervation for resistant hypertension. N. Engl. J. Med. 2014; 370: 1393-1401 Crossref PubMed Scopus (1566) Google Scholar ]. One of the main limitations is that the current RDN technique lacks a measurable endpoint. Recently, electrical stimulation of the renal nerves through the ablation catheter introduced in the renal artery before and after RDN was proposed as a promising method in this journal [ 2 Hilbert S. Kosiuk J. Hindricks G. Bollmann A. Blood pressure and autonomic responses to electrical stimulation of the renal arterial nerves before and after ablation of the renal artery. Int. J. Cardiol. 2014; 177: 669-671 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar , 3 Hao Y. Lu Z. Renal denervation: should we still hang in there?. Int. J. Cardiol. 2014; 176: 1255-1256 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ]. These reports showed that the effect of intra-renal artery electrical stimulation on renal nerves, especially the afferent sensory nerve, before and after ablation, was useful as RDN endpoint. However, the afferent sensory nerve on the lateral side of renal artery might include not only afferent excitatory sympathetic nerve fibers but also inhibitory sympathetic nerve fibers [ [4] Stella A. Weaver L. Golin R. Genovesi S. Zanchetti A. Cardiovascular effects of afferent renal nerve stimulation. Clin. Exp. Hypertens. A. 1987; 9: 97-111 Crossref PubMed Scopus (12) Google Scholar ]. In this report, we present two patients with resistant hypertension who showed opposite arterial blood pressure responses to electrical stimulation before and after RDN.