Abstract
Objective: The study investigated the impact of renal sympathetic denervation on office blood pressure and ambulatory blood pressure monitoring in patients with resistant hypertension. We evaluated whether a decrease in blood pressure may improve local carotid stiffness and parameters of wave intensity. Methods: Renal sympathetic denervation was performed in 17 patients (age 55 ± 9 years) with true resistant hypertension. Measurements of carotid stiffness and wave intensity were performed using ultrasound combined with echo-tracking. Results: We found significantly improved office systolic blood pressure changes 1 month (p=0.023) and together with pulse pressure changes at the 6 month follow up (p=0.041; p=0.016). Changes in systolic blood pressure during the daytime were significantly decreased at 1 month and diastolic blood pressure changes during the daytime were significantly reduced at 1 and 3 months. Stiffness parameters beta stiffness and pressure-strain elastic modulus were significantly reduced (p=0.04; p=0.03) and arterial compliance was increased (p=0.03), especially 1 and 3 months. The changes in negative area were significantly reduced after 1 month (p=0.041) and the ejection period was significantly increased at the 6 month follow-up (p=0.011). According to linear regression analysis systolic blood pressure correlated positively with the beta stiffness, pressure-strain elastic modulus, pulse wave velocity, and negatively with arterial compliance. Conclusions: We found significantly lower office blood pressure as well as blood pressure from ambulatory blood pressure monitoring in patients with resistant hypertension 6 months after renal sympathetic denervation. The decrease in blood pressure was followed by improvement of carotid stiffness and wave intensity. That may be reflected in enhancement of ventricular-arterial coupling.
Highlights
In recent years many authors have pointed out that arterial stiffness is considered to be an independent predictor of total and cardiovascular (CV) morbidity and mortality [1]
Changes in systolic blood pressure during the daytime were significantly decreased at 1 month and diastolic blood pressure changes during the daytime were significantly reduced at 1 and 3 months
The decrease in blood pressure was followed by improvement of carotid stiffness and wave intensity
Summary
At the 6 months SBP and DBP correlated positive with indexes Ep, PWV and negative with AC (Table 5). The changes in PP correlated positive with changes in indexes Ep and PWV 6 months after RDN (Table 6, Figure 3). Modulus; AC: Arterial Compliance; PWV: One-Point Pulse Wave Velocity; AIx: Augmentation Index; RDN: Renal Sympathetic Denervation; rs=Spearman Rank Correlation Coefficient; p=p-value; Changes in SBP Changes in DBP Changes in PP. SBP: Systolic Blood Pressure; DBP: Diastolic Blood Pressure; PP: Pulse Pressure; beta: Stiffness Index; Ep: Pressure-Strain Elasticity Modulus; AC: Arterial Compliance; PWV: one-Point Pulse Wave Velocity; Aix: Augmentation Index; RDN: Renal Sympathetic Denervation; rs=Spearman Rank Correlation Coefficient; p=p-value; Figure 3: Correlation between changes in pulse pressure (PP) and changes in one point pulse wave velocity (PWV) in patients with resistant hypertension 6 months after renal sympathetic denervation.
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