Artery Research (Nov 2016)

2.5 THE EFFECT OF RENAL DENERVATION ON CENTRAL BLOOD PRESSURE AND ARTERIAL STIFFNESS IN TREATMENT RESISTANT ESSENTIAL HYPERTENSION: A SUBSTUDY OF A RANDOMIZED SHAM-CONTROLLED DOUBLE-BLINDED TRIAL (THE RESET TRIAL)

  • Christian D. Peters,
  • Ole N. Mathiasen,
  • Henrik Vase,
  • Jesper Bech,
  • Kent L. Christensen,
  • Anne P. Schroeder,
  • Ole Lederballe,
  • Hans Rickers,
  • Ulla Kampmann,
  • Per L. Poulsen,
  • Sten Langfeldt,
  • Gratien Andersen,
  • Klavs W. Hansen,
  • Hans E. Bøtker,
  • Morten Engholm,
  • Jannik B. Bertelsen,
  • Jens F. Lassen,
  • Erling B. Pedersen,
  • Anne Kaltoft,
  • Niels H. Buus

DOI
https://doi.org/10.1016/j.artres.2016.10.009
Journal volume & issue
Vol. 16

Abstract

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Background: A recent sham-controlled trial (ReSET) showed no sustained effect of renal denervation (RDN) on 24-hour ambulatory blood pressure (24hA-BP) measurements in patients with treatment resistant hypertension.1 The aim of this substudy was to investigate, whether RDN affects central blood pressure (C-BP) and arterial stiffness independently of brachial artery BP-levels. Methods: ReSET was a randomized, sham-controlled, double-blinded single-center trial. Main inclusion criteria were: daytime systolic 24hA-BP ≥145mmHg following 1 month of stable medication and 2 weeks of compliance registration. RDN was performed by a single experienced operator using the unipolar Medtronic Flex catheter1. C-BP and carotid-femoral pulse wave velocity (PWV) were obtained at baseline and after 6 months with the SphygmoCor®-device. Results: Fifty-three patients (77% of the ReSET cohort) were included in this substudy. The groups were similar at baseline (SHAM/RDN): n=27/n=26; 78/65% males; age 59±9/54±8 years (mean±SD); systolic brachial BP 158±18/154±17 mmHg; systolic 24hA-BP 153±14/151±13 mmHg; systolic C-BP 146±20/143±17 mmHg; diastolic C-BP 92±14/94±10 mmHg; augmentation index (AIx) 26±9/28±13 %; PWV 10.7±2.1/10.1±2.2 m/s. Changes in systolic C-BP (−2±17 (SHAM) vs. −8±16 (RDN) mmHg), diastolic C-BP (−2±9 (SHAM) vs. −5±9 (RDN) mmHg), AIx (0.7±7.0 (SHAM) vs. 1.0±7.4 (RDN) %), and PWV (0.1±1.9 (SHAM) vs. −0.6±1.3 (RDN) m/s) were not significantly different after six months (P>0.13 in all tests). Changes in brachial BP and 24hA-BP were also not significantly different. Conclusions: In a sham-controlled setting, there were no significant effects of RDN on C-BP or arterial stiffness. Thus, the idea of BP-independent effects of RDN on large arteries is not supported.