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Open Access 01-06-2016 | Original Paper

Renal artery sympathetic denervation: observations from the UK experience

Authors: Andrew S. P. Sharp, Justin E. Davies, Melvin D. Lobo, Clare L. Bent, Patrick B. Mark, Amy E. Burchell, Simon D. Thackray, Una Martin, William S. McKane, Robert T. Gerber, James R. Wilkinson, Tarek F. Antonios, Timothy W. Doulton, Tiffany Patterson, Piers C. Clifford, Alistair Lindsay, Graeme J. Houston, Jonathan Freedman, Neelan Das, Anna M. Belli, Mohamad Faris, Trevor J. Cleveland, Angus K. Nightingale, Awais Hameed, Kalaivani Mahadevan, Judith A. Finegold, Adam N. Mather, Terry Levy, Richard D’Souza, Peter Riley, Jonathan G. Moss, Carlo Di Mario, Simon R. Redwood, Andreas Baumbach, Mark J. Caulfield, Indranil Dasgupta

Published in: Clinical Research in Cardiology | Issue 6/2016

Abstract

Background

Renal denervation (RDN) may lower blood pressure (BP); however, it is unclear whether medication changes may be confounding results. Furthermore, limited data exist on pattern of ambulatory blood pressure (ABP) response—particularly in those prescribed aldosterone antagonists at the time of RDN.

Methods

We examined all patients treated with RDN for treatment-resistant hypertension in 18 UK centres.

Results

Results from 253 patients treated with five technologies are shown. Pre-procedural mean office BP (OBP) was 185/102 mmHg (SD 26/19; n = 253) and mean daytime ABP was 170/98 mmHg (SD 22/16; n = 186). Median number of antihypertensive drugs was 5.0: 96 % ACEi/ARB; 86 % thiazide/loop diuretic and 55 % aldosterone antagonist. OBP, available in 90 % at 11 months follow-up, was 163/93 mmHg (reduction of 22/9 mmHg). ABP, available in 70 % at 8.5 months follow-up, was 158/91 mmHg (fall of 12/7 mmHg). Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn. Dose changes appeared neutral. Quartile analysis by starting ABP showed mean reductions in systolic ABP after RDN of: 0.4; 6.5; 14.5 and 22.1 mmHg, respectively (p < 0.001 for trend). Use of aldosterone antagonist did not predict response (p > 0.2).

Conclusion

In 253 patients treated with RDN, office BP fell by 22/9 mmHg. Ambulatory BP fell by 12/7 mmHg, though little response was seen in the lowermost quartile of starting blood pressure. Fall in BP was not explained by medication changes and aldosterone antagonist use did not affect response.

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Title: Renal artery sympathetic denervation: observations from the UK experience
Authors: Andrew S. P. Sharp
Justin E. Davies
Melvin D. Lobo
Clare L. Bent
Patrick B. Mark
Amy E. Burchell
Simon D. Thackray
Una Martin
William S. McKane
Robert T. Gerber
James R. Wilkinson
Tarek F. Antonios
Timothy W. Doulton
Tiffany Patterson
Piers C. Clifford
Alistair Lindsay
Graeme J. Houston
Jonathan Freedman
Neelan Das
Anna M. Belli
Mohamad Faris
Trevor J. Cleveland
Angus K. Nightingale
Awais Hameed
Kalaivani Mahadevan
Judith A. Finegold
Adam N. Mather
Terry Levy
Richard D’Souza
Peter Riley
Jonathan G. Moss
Carlo Di Mario
Simon R. Redwood
Andreas Baumbach
Mark J. Caulfield
Indranil Dasgupta
Publication date: 01-06-2016
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 6/2016
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-015-0959-4

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