Renal artery anatomy affects the blood pressure response to renal denervation in patients with resistant hypertension

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• 作者：Dagmara Hering^a ; ^b ; Petra Marusic^a ; ^b ; Antony S. Walton^c ; Jacqueline Duval^a ; Rebecca Lee^a ; Yusuke Sata^a ; Henry Krum^c ; ^d ; Elisabeth Lambert^a ; Karlheinz Peter^c ; ^e ; Geoff Head^f ; Gavin Lambert^a ; Murray D. Esler^a ; ^c ; Markus P. Schlaich^a ; ^b ; ^d ; ^g ; ^{markus.schlaich@uwa.edu.au" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Resistant hypertension ; Renal denervation ; Renal artery anatomy
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 January 2016
• 年：2016
• 卷：202
• 期：Complete
• 页码：388-393
• 全文大小：356 K

文摘

Renal denervation (RDN) has been shown to reduce blood pressure (BP), muscle sympathetic nerve activity (MSNA) and target organ damage in patients with resistant hypertension (RH) and bilateral single renal arteries. The safety and efficacy of RDN in patients with multiple renal arteries remains unclear.

Methods

We measured office and 24-hour BP at baseline, 3 and 6 months following RDN in 91 patients with RH, including 65 patients with single renal arteries bilaterally (group 1), 16 patients with dual renal arteries on either one or both sides (group 2) and 10 patients with other anatomical constellations or structural abnormalities (group 3). Thirty nine out of 91 patients completed MSNA at baseline and follow-up.

Results

RDN significantly reduced office and daytime SBP in group 1 at both 3 and 6 months follow-up (P < 0.001) but not in groups 2 and 3. Similarly, a significant reduction in resting baseline MSNA was only observed in group 1 (P < 0.05). There was no deterioration in kidney function in any group.

Conclusion

While RDN can be performed safely irrespective of the underlying renal anatomy, the presence of single renal arteries with or without structural abnormalities is associated with a more pronounced BP and MSNA lowering effect than the presence of dual renal arteries in patients with RH. However, when patients with dual renal arteries received renal nerve ablation in all arteries there was trend towards a greater BP reduction. Insufficient renal sympathetic nerve ablation may account for these differences.