Abstract
AimsTo examine the effect of renal denervation (RDN) on 24‑h ambulatory blood pressure (ABP) with a standard radiofrequency ablation catheter (RF catheter).MethodsSeventy-five patients with resistant hypertension received bilateral RDN with an RF catheter (6 RF applications, 1 minute each, 8–12 watts). Seventy patients fulfilled inclusion criteria with mean systolic ABP ≥140 mmHg (mean 165/89) despite treatment with ≥3 antihypertensive drugs (mean 5.9) including a diuretic, and were further analysed for ABP changes. Follow-up at 1/3/6/12 months comprised biochemical evaluations and ABP measurement. At 6/12 months, duplex sonography of the renal arteries was additionally performed.ResultsAt 1/3/6/12 months we observed a significant reduction in systolic ABP of −15/−17/−18/−15 mmHg (n = 55/53/57/50; non-parametric Friedman test, p < 0.001) and diastolic ABP of −6/−9/−10/−7 mmHg (p < 0.001). Of the patients, 70 %/64 % showed a systolic ABP reduction of ≥10 mmHg, and 77 %/70 % of ≥5 mmHg at 6/12-month follow-up. Two patients (2.7 %) developed renal artery stenosis (>70 %) with subsequent stenting without complications. Logistic regression analysis with systolic ABP reduction ≥10 mmHg at 12 months follow-up as criterion revealed that only the mean baseline systolic ABP was significant, OR = 2.174.ConclusionsRDN with a standard RF catheter can be used safely to reduce mean ABP in resistant hypertension as shown in long-term follow-up.
Highlights
Arterial hypertension is a major global health problem that affects 30–45 % of the general population [1]
Five patients admitted to our hospital for renal denervation (RDN) with a documented homeand office-based systolic blood pressure (BP) of >160 mmHg did not show a mean systolic 24-h ambulatory blood pressure (ABP) ≥140 mmHg and were excluded from our 24-h ABP analysis
All patients had at least one follow-up with duplex sonography. This is the study with the largest number of patients in whom RDN was performed with standard RF ablation catheter with to date the longest follow-up
Summary
Arterial hypertension is a major global health problem that affects 30–45 % of the general population [1]. An increasing number of especially elderly patients do not respond to antihypertensive therapy in an adequate manner [4]. As a new invasive treatment for resistant hypertension, the successful use of catheter-based renal denervation (RDN) was first described in the two landmark studies HTN-1 and HTN-2 [5, 6]. In both studies significant reduction of office-based BP following bilateral RDN was demonstrated with an on-going treatment effect up to three years of follow-up [7, 8].
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