Abstract
We searched for an association between changes in blood pressure (BP) at 12 and 24 months after renal denervation (RDN) and the different patterns of ablation spots placement along the renal artery vasculature. We performed a post-hoc analysis of a 24-month follow-up evaluation of 30 patients who underwent RDN between 2011 and 2012 using our previous database. Patients who had (i) resistant hypertension, as meticulously described previously, and (ii) Chronic kidney disease (CKD) stages 2, 3 and 4. Correlations were assessed using the Pearson or Spearman correlation tests as appropriate. The mean change in systolic ambulatory BP monitoring (ABPM) compared to baseline was −19.4 ± 12.7 mmHg at the 12th (p < 0.0001) and −21.3 ± 14.1 mmHg at the 24th month (p < 0.0001). There was no correlation between the ABPM Systolic Blood Pressure (SBP)-lowering effect and the total number of ablated spots in renal arteries (17.7 ± 6.0) either at 12 (r = −0.3, p = 0.1542) or at 24 months (r = −0.2, p = 0.4009). However, correlations between systolic BP-lowering effect and the number of ablation spots performed in the distal segment and branches were significant at the 12 (r = −0.7, p < 0.0001) and 24 months (r = −0.8, p < 0.0001) follow-up. Our findings indicate a substantial correlation between the numbers of ablated sites in the distal segment and branches of renal arteries and the systolic BP-lowering effect in the long-term.
Highlights
Catheter-based renal denervation (RDN), targeting the renal afferent and efferent sympathetic nerves is an established alternative treatment option for patients with hypertension [1,2,3,4]
We report that the number of treated sites in branches is extremely important for the Systolic blood pressure (SBP)-lowering effect in human Chronic kidney disease (CKD) patients
The mean office systolic/diastolic BP at baseline was 184.9 ± 18.4/106.9 ± 13.3 mmHg, the mean systolic/diastolic ambulatory BP monitoring (ABPM) was 152.1 ± 16.6/93.0 ± 11.0 mmHg, the mean estimated glomerular filtration rate (eGFR) was 61.9 ± 23.9 mL/min/1.73 m2, and patients were on an average of 4.6 ± 1.4 different classes of antihypertensive drugs
Summary
Catheter-based renal denervation (RDN), targeting the renal afferent and efferent sympathetic nerves is an established alternative treatment option for patients with hypertension [1,2,3,4]. This is almost 4× the number of ablations (average 11.2 ± 2.8) performed in the SYMPLICITY HTN-3 [6] trial, which purposely spared the branches Both SPYRAL HTN-OFF MED [11] and SPYRAL HTN-ON MED [12] trials used the same RDN technique and presented similar results in three and six months follow-up, respectively. This data set suggests a broader and focused distal RDN approach is effective in achieving a clinically significant BP-lowering effect in line with pre-clinical results [10]. We report that the number of treated sites in branches is extremely important for the Systolic blood pressure (SBP)-lowering effect in human CKD patients
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