Ambulatory Blood Pressure Changes after Renal Sympathetic Denervation in Patients with Resistant Hypertension
Background—Catheter-based renal sympathetic denervation (RDN) reduces office blood pressure (BP) in patients with resistant hypertension according to office BP. Less is known about the effect of RDN on 24-hour BP measured by ambulatory blood pressure monitoring (ABPM) and correlates of response in individuals with true or pseudo-resistant hypertension.
Methods and Results—A total of 346 uncontrolled hypertensive patients, separated according to daytime ABPM into 303 with true resistant (office SBP 172.2 ± 22 mmHg; 24-hour SBP 154 ± 16.2 mmHg) and 43 with pseudo-resistant hypertension (office SBP 161.2 ± 20.3 mmHg; 24-hour SBP 121.1 ± 19.6 mmHg), from 10 centers were studied. At 3, 6 and 12 months follow-up office SBP was reduced by 21.5/23.7/27.3 mmHg, office DBP by 8.9/9.5/11.7 mmHg, and pulse pressure by 13.4/14.2/14.9 mmHg (n=245/236/90; p for all <0.001), respectively. In patients with true treatment resistance there was a significant reduction with RDN in 24-hour SBP (-10.1/-10.2/-11.7 mmHg, p<0.001), DBP (-4.8/-4.9/-7.4 mmHg, p<0.001), maximum SBP (-11.7/-10.0/-6.1 mmHg, p<0.001) and minimum SBP (-6.0/-9.4/-13.1 mmHg, p<0.001) at 3, 6 and 12 months, respectively. There was no effect on ABPM in pseudo-resistant patients, while office BP was reduced to a similar extent. RDN was equally effective in reducing BP in different subgroups of patients. OSBP at baseline was the only independent correlate of BP response.
Conclusions—RDN reduced office BP and improved relevant aspects of ABPM, commonly linked to high cardiovascular risk, in patients with true-treatment resistant hypertension while it only affected office BP in pseudo-resistant hypertension.
- Received December 25, 2012.
- Revision received May 14, 2013.
- Accepted May 17, 2013.