Abstract 14741: Ambulatory Arterial Stiffness Index Predicts Responder of Renal Denervation
Introduction: Renal denervation (RDN) can reduce blood pressure in patients with resistant hypertension, particularly those with the highest office blood pressure, but less so in patients with isolated systolic hypertension). A possible explanation is that patients with stiffer arteries may have lesser neural contribution to their hypertension.
Hypothesis and Methods: We hypothesized that arterial stiffness predicts the response to RDN. From ambulatory BP monitoring (ABPM), ambulatory arterial stiffness index (AASI) was calculated as 1 minus the regression slope of ambulatory diastolic BP plotted against ambulatory systolic BP (SBP).
Results: In 111 patients with resistant hypertension, RDN reduced office and ambulatory 24h SBP after 3, 6, and 12 months (by 12/11/16 and 4/5/7 mmHg, P<0.01, respectively). The patients with high baseline AASI (>0.50, median) showed no change in 24h SBP 6 month after denervation (0.6±11.4 mmHg, P>0.05). Those with AASI less than 0.50 showed a marked reduction in 24h SBP (-9.4±10.6 mmHg, P<0.01). Non-responder rate (<5% reduction of 24h SBP at 6 months) was 58% in the entire cohort. Across the baseline AASI quartile, the rate of non-responder rose with increasing AASI (42/50/55/84 %, P<0.05). After adjustment for age, gender, body mass index, office and 24h SBP, AASI correlated with the response to RDN (odds ratio 3.54, P=0.04). Although the baseline MSNA was similar (47±13 vs 47±15 bursts/min, P=0.96), the reduction in MSNA after RDN was less pronounced in those with stiffer arteries (-1±3 vs -8±4 bursts/min, P<0.05).
Conclusions: We conclude that AASI is a strong and independent predictor of the anti-hypertensive response to RDN, which suggests that resistant hypertension with compliant vasculature may have a greater neural rather than structural contribution to their hypertension.
Author Disclosures: Y. Sata: None. G.A. Head: None. M.D. Esler: None. M.P. Schlaich: None.
- © 2016 by American Heart Association, Inc.