Abstract 17201: Influence of Renal Sympathetic Denervation on Orthostatic Function in Patients with Resistant Hypertension
Background Renal sympathetic denervation (RDN) is a novel treatment option for patients with resistant hypertension, proved to reduce renal and whole-body sympathetic activity and blood pressure (BP). The effect of RDN on orthostatic regulation has not been studied.
Method In 27 patients (age 64±7 years, 77% male) with resistant hypertension (office blood pressure 167/91±22/12 mmHg) treated with 4.8±0.3 antihypertensive drugs, tilt table test (TTT) was performed before and 3 months after RDN. After 5 min in supine position, all subjects were tilted at 60° for 20 min. Subsequently drug provocation with 400 mg nitro-glycerine sublingual was performed while tilt position was maintained for additional 10 min. Antihypertensive drugs were maintained throughout the study. Patients with atrial fibrillation, pacemaker/ICD or history of syncope were excluded.
Results After RDN systolic (SBP) and diastolic blood pressure (DBP) in supine position were reduced by 7.7/4.4 mmHg (p0.05) whereas mean HR during 20 min tilting period was significantly reduced by 4.9 beats/min (p0.05). During 10 min drug provocation period minimal BP (min. SBP: 98±7 vs. 99±7 mmHg, min. DBP: 61±4 vs. 61±4 mmHg; p>0.05) and minimal HR (74±5 vs. 70±3 /min; p>0.05) were not significantly changed. The total number of pre-syncopes and syncopes were not different after RDN: Before and after RDN 6 pre-syncopes (p<0.05) as well as 3 vs. 4 syncopes (p<0.05) occurred during the TTT (p<0.05).
Conclusion In patients with resistant hypertension catheter-based renal sympathetic denervation significantly reduced blood pressure and heart during tilting testing after 3 months without causing orthostatic dysfunction or (pre-)syncopes.
- © 2012 by American Heart Association, Inc.