Impact of renal sympathetic denervation on home blood pressure monitoring in well defined patients with resistant hypertension

Background

Catheter-based percutaneous renal denervation therapy (RDN) is a controversially discussed treatment-strategy for patients with resistant arterial hypertension. Home blood pressure monitoring (HBPM) is superior to office blood pressure (OBP) measurements documenting effects of drug or interventional therapy and for predicting cardiovascular morbidity and mortality. We therefore aimed at comparing effects of RDN on OBP and HBPM.

Methods

28 patients with resistant hypertension were studied; 21 patients (29–85 years, median 67 years, 5.4 ± 1.3 antihypertensive drugs) were included into the treatment arm and 7 patients (37–70 years, median 68 years, 5.1 ± 2.2 antihypertensive drugs) served as controls. RDN was performed with a Medtronic™ radiofrequency catheter-ablation-system. For OBP and HBPM measurements patients were followed up to 6 months. For controls, a mean of approximately 378 measurements in 167 ± 13.5 days was included into analysis. In RDN patients follow-up was 157.7 ± 61.8 days with a mean of approximately 323 ambulatory measurements. A mean for each week was calculated.

Results

In controls, no significant change of OBP was observed (baseline: systolic 162.2 ± 11.6 mm Hg vs. 6 months: systolic 162.8 ± 22.9 mm Hg; p > 0.05). Accordingly, HBPM values didn't change (baseline: systolic 161.2 ± 15.1 mm Hg vs. 6 months: systolic 155.8 ± 24.6 mm Hg, p > 0.05). In RDN patients a significant reduction of OBP (baseline: systolic 169 ± 12.5 mm Hg vs. 6 months: systolic 150.6 ± 19.2 mm Hg, p < 0.01) and HBPM (baseline: systolic 156.2 ± 12.9 mm Hg vs. 6 months: systolic 139.7 ± 10.2 mm Hg, p < 0.001) was observed.

Conclusion

In patients with resistant hypertension RDN significantly reduced HBPM and OBP already one week after treatment.