Abstract
BackgroundCatheter-based sympathetic renal denervation (RDN) is a recent therapeutic option for patients with resistant hypertension. However, the impact of RDN in left ventricular (LV) mass and function is not completely established. Our aim was to evaluate the effects of RDN on LV structure and function (systolic and diastolic) in patients with resistant hypertension (HTN).Methods and ResultsFrom a single centre prospective registry including 65 consecutive patients with resistant HTN submitted to RDN between July-2011 and April-2015, 31 patients with baseline and 1-year follow-up echocardiogram were included in this analysis. Mean age was 65±7 years, 48% were males, 71% had type 2 diabetes. Most had hypertension lasting for more than 10 years (90%), and were being treated with a median number of 6 anti-hypertensive drugs, including 74% on spironolactone. At 1-year, there was a significant decrease both on office SBP (176±24 to 149±13mmHg, p<0.001) and DBP (90±14 to 79±11mmHg, p<0.001), and also in 24h ABPM SBP (150±20 to 132±14mmhg, p<0.001) and DBP (83±10 to 74±9mmHg, p<0.001). There was also a significant decrease in LV mass from 152±32 to 136±34g/m2 (p<0.001), an increase in LV end diastolic volume (93±18 to 111±27 mL, p = 0.004), an increase in LV ejection fraction (65±9 to 68±9%, p = 0.001) and mitral valve E deceleration time (225±49 to 247±51ms, p = 0.015) at 1-year follow up. There were no significant changes in left atrium volume index or in the distribution of patients among the different left ventricle geometric patterns and diastolic function subgroups.ConclusionsIn this single centre registry of patients with resistant hypertension, renal denervation was associated with significant reduction in both office and ABPM blood pressure and a significant decrease in left ventricle mass evaluated by transthoracic echocardiogram at 1 year follow-up.
Highlights
Long-standing hypertension (HTN) results in cardiac remodelling including myocardial hypertrophy, diastolic dysfunction and left atrial (LA) enlargement leading to atrial and ventricular arrhythmias, heart failure and to myocardial infarction and stroke, which are the leading causes of death and morbidity in developed countries [1].The link between chronic sympathetic hyperactivity and drug-resistant HTN is well known for several years, and is the rationale behind the development of catheter-based sympathetic renal denervation (RDN)
From a single centre prospective registry including 65 consecutive patients with resistant HTN submitted to RDN between July-2011 and April-2015, 31 patients with baseline and 1year follow-up echocardiogram were included in this analysis
Impact of Renal Denervation on Left Ventricle Structure and Function. In this single centre registry of patients with resistant hypertension, renal denervation was associated with significant reduction in both office and ambulatory blood pressure measurements (ABPM) blood pressure and a significant decrease in left ventricle mass evaluated by transthoracic echocardiogram at 1 year follow-up
Summary
The link between chronic sympathetic hyperactivity and drug-resistant HTN is well known for several years, and is the rationale behind the development of catheter-based sympathetic renal denervation (RDN). This treatment approach for drug resistant HTN had very promising results in early non-blinded studies [2,3]. The aim of the present study was to evaluate the effects of RDN on LV structure and function (systolic and diastolic) in patients with resistant HTN. Our aim was to evaluate the effects of RDN on LV structure and function (systolic and diastolic) in patients with resistant hypertension (HTN)
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