The effect of catheter based renal denervation on nocturnal blood pressure and nocturnal pulse pressure in patients with true resistant hypertension: National heart institute Malaysia experience

Abstract

Introduction: Nocturnal hypertension and increased pulse pressure (PP) are relevant predictors of poor cardiovascular outcomes. According to the American Heart Association Council on High Blood pressure research, nocturnal blood pressure (NBP) 125/75 is deemed abnormal. At present, there is limited data on the effect of renal denervation therapy (RDN) on the NBP and nocturnal pulse pressure (NPP) in patients with True Resistant Hypertension (TRH). Purpose: To assess the change in the NBP and NPP from baseline to 1,3,6 and 12 months follow up in TRH patients who have undergone RDN at a tertiary cardiac centre between Sept 2011 and August 2012. Methods: 15 patients underwent RDN using the Symplicity™ renal denervation system. Ambulatory blood pressure monitoring (ABPM) was performed using the Bpro® device and NBP is recorded between 12 midnight to 6am. Inclusion and exclusion criteria are similar to the SYMPLICITY HTN1 and 2 trials. Results: There was a reduction of mean nocturnal systolic blood pressure (NSBP) from a baseline of 149.9±16.2mmHg to 137.2±13mmHg at 1 month (p value=0.0485), 134.3±18.2mmHg at 3 months (p value=0.0302), 131.2±10.6mmHg at 6 months (p value=0.0055) and 121.2±11.8mmHg at 12 months (p value=0.0019). There was a reduction of mean nocturnal diastolic blood pressure (NDBP) from a baseline of 80.6±13.6mmHg to 65.4±11.5 (p value=0.0382) at 12 months. There was a reduction of mean NPP from a baseline of 69.3±11.8mmHg to 54.1±13.1mmHg at 6 months (p value=0.0077) and 55.8±6.9mmHg at 12 months (p value=0.0276) ![Figure][1] Figure 1. Time course of nocturnal BP change. Conclusions: Renal denervation therapy causes early significant reduction of nocturnal blood pressure and nocturnal pulse pressure. This reduction is persistent and progressive over 1 year. [1]: pending:yes