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Renal artery sympathetic denervation: observations from the UK experience. | LitMetric

AI Article Synopsis

  • Renal denervation (RDN) was examined in 253 patients with treatment-resistant hypertension, revealing a significant reduction in both office blood pressure (BP) and ambulatory blood pressure (ABP) post-treatment.
  • Patients experienced an average drop in office BP of 22/9 mmHg and ambulatory BP of 12/7 mmHg, despite changes in medication showing minimal impact on these results.
  • The response to RDN did not correlate with the use of aldosterone antagonists, and patients in the lowest initial BP quartile showed the least improvement.

Article Abstract

Background: Renal denervation (RDN) may lower blood pressure (BP); however, it is unclear whether medication changes may be confounding results. Furthermore, limited data exist on pattern of ambulatory blood pressure (ABP) response-particularly in those prescribed aldosterone antagonists at the time of RDN.

Methods: We examined all patients treated with RDN for treatment-resistant hypertension in 18 UK centres.

Results: Results from 253 patients treated with five technologies are shown. Pre-procedural mean office BP (OBP) was 185/102 mmHg (SD 26/19; n = 253) and mean daytime ABP was 170/98 mmHg (SD 22/16; n = 186). Median number of antihypertensive drugs was 5.0: 96 % ACEi/ARB; 86 % thiazide/loop diuretic and 55 % aldosterone antagonist. OBP, available in 90 % at 11 months follow-up, was 163/93 mmHg (reduction of 22/9 mmHg). ABP, available in 70 % at 8.5 months follow-up, was 158/91 mmHg (fall of 12/7 mmHg). Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn. Dose changes appeared neutral. Quartile analysis by starting ABP showed mean reductions in systolic ABP after RDN of: 0.4; 6.5; 14.5 and 22.1 mmHg, respectively (p < 0.001 for trend). Use of aldosterone antagonist did not predict response (p > 0.2).

Conclusion: In 253 patients treated with RDN, office BP fell by 22/9 mmHg. Ambulatory BP fell by 12/7 mmHg, though little response was seen in the lowermost quartile of starting blood pressure. Fall in BP was not explained by medication changes and aldosterone antagonist use did not affect response.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882343PMC
http://dx.doi.org/10.1007/s00392-015-0959-4DOI Listing

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