P4.14 RENAL DENERVATION IMPROVES CENTRAL HEMODYNAMICS AND PULSE PRESSURE AMPLIFICATION IN PATIENTS WITH TREATMENT RESISTANT HYPERTENSION

Abstract

Background: Renal denervation (RDN) was shown to be effective in reducing peripheral BP in treatment resistant hypertension. Accumulating data suggest that central pressures may be a better predictor of cardiovascular events and outcomes than the corresponding peripheral pressure. PP amplification is among others inversely related to stiffer arteries and peripheral arterial resistance. Methods: 57 patients with treatment resistant hypertension (office BP ≥140/90 mmHg, while on at least 3 antihypertensive agents, and diagnosis confirmed by 24-h ABPM ≥130/80 mmHg) underwent catheter-based RDN using the Symplicity FlexTM catheter (Medtronic Inc., Palo Alto, CA). In addition, in our lab pulse wave analysis was assessed with the SphygmoCorTM device (AtCor Medical, Australia) before and after 6 months of RDN. PP amplification is determined as ratio of peripheral PP to central PP. Results: Patients (59±12 years) were treated with 6.0±1.3 antihypertensive drugs on average. Peripheral as well as central systolic and diastolic BP were reduced (all p<0.01) 6 months after RDN. In accordance, peripheral PP (77.5±22 versus 71.5±23 mmHg, p=0.008) and central PP (63.2±21 versus 56.7±22 mmHg, p=0.001) were reduced 6 months after RDN. Consistently, there was a significant improvement in PP amplification (1.25±0.2 versus 1.30±0.2, p=0.012). Also central augmentation pressure (20±12 versus 16±13 mmHg, p<0.001) and cAIx@75 (24±10 versus 21±11 %, p=0.005) decreased 6 months after RDN. There was no change on heart rate (63±11 versus 64±10 bpm, p=0.499). Conclusion: Our data suggest that RDN might exert beneficial effects indicated by an improvement of central PP beyond peripheral PP, and hence PP amplification.