Abstract 17558: Age-Dependent Effects of Renal Denervation Therapy on Diastolic Blood Pressure and Pulse Pressure in Office and Home Blood Pressure Monitoring
Background: Percutaneous renal sympathetic denervation (RDN) significantly decreases blood pressure in patients with resistant hypertension. High pulse pressure (PP) has been shown to be related to increased cardiovascular events. In assessing the efficancy of antihypertensive treatment, it may therefore be important to determine changes in PP systolic BP and diastolic BP. However, the long-term effect of RDN on SBP, DBP and PP in young vs. elderly patients has never been studied.
Methods: 24 Patients were selected according to the SIMPLICITY criteria (SBP ≥ 160 mmHg and ≥ 150 mmHg in diabetics, treated with three or more antihypertensive drugs). 11 were ≤ 65 years and 13 were above this age. 33% were women, and 29% were diabetic. BP testing was performed via office BP measurements (OMRON™device) and confirmed via home BP monitoring. Patients were advised to measure 3x daily BP at home (hBP) according to ESH guidelines. Out of these measurements the mean hBP was calculated for each week before baseline and during follow-up.
Results: At baseline the two groups were similar with respect to SBP, however the older group displayed significantly lower DBP and significantly higher PP. The effect of RDN on SBP was comparable in the two groups. However, only the younger patients decreased their DBP, whereas the elderly patients had a significant decrease in PP (Table: Office BP). The hBP monitoring confirmed the office BP results showing a significant reduction of PP in older patients (PP: 70 mmHg at baseline vs. 56 mmHg at 6 month; p<0.05).
Conclusion: RDN results in a substantial reduction in SBP after 6 month in patients with resistant hypertension. RDN modifies DBP in younger patients and PP in elderly patients. Since an elevated DBP in young patients and elevated PP in old patients is a strong predictor of cerebro- and cardiovascular events, RDN might be effective independently of age. These findings are supported by the long-term BP measurements at home, excluding the white-coat effect.
- © 2012 by American Heart Association, Inc.