The effect of renal denervation on arterial stiffness, central blood pressure and heart rate variability in treatment resistant essential hypertension: a substudy of a randomized sham-controlled double-blinded trial (the ReSET trial)

• Published in: Blood pressure 2017-11, Vol.26 (6), p.366-380
• Main Authors: Peters, Christian Daugaard, Mathiassen, Ole Norling, Vase, Henrik, Bech Nørgaard, Jesper, Christensen, Kent Lodberg, Schroeder, Anne Pauline, Rickers, Hans Joachim von Hofe, Opstrup, Ulla Kampmann, Poulsen, Per Løgstrup, Langfeldt, Sten, Andersen, Gratien, Hansen, Klavs Würgler, Bøtker, Hans Erik, Engholm, Morten, Bertelsen, Jannik Buus, Pedersen, Erling Bjerregaard, Kaltoft, Anne, Buus, Niels Henrik
• Format: Article
• Language: English
• Subjects: arterial stiffness; Blood Pressure; central blood pressure; Denervation - methods; Double-Blind Method; Essential Hypertension - physiopathology; Essential Hypertension - surgery; Essential Hypertension - therapy; Female; Heart Rate; heart rate variability; Humans; Kidney - innervation; Kidney - surgery; Male; Middle Aged; Pulse Wave Analysis; pulse wave velocity; randomized controlled trial; Renal denervation; Vascular Stiffness
• ISSN: 0803-7051; 1651-1999
• DOI: 10.1080/08037051.2017.1368368

Objectives: To investigate, whether renal denervation (RDN) improves arterial stiffness, central blood pressure (C-BP) and heart rate variability (HRV) in patients with treatment resistant hypertension. Methods: ReSET was a randomized, sham-controlled, double-blinded trial (NCT01459900). RDN was performed by a single experienced operator using the Medtronic unipolar Symplicity Flex TM catheter. C-BP, carotid-femoral pulse wave velocity (PWV), and HRV were obtained at baseline and after six months with the SphygmoCor ® -device. Results: Fifty-three patients (77% of the ReSET-cohort) were included in this substudy. The groups were similar at baseline (SHAM/RDN): n = 27/n = 26; 78/65% males; age 59 ± 9/54 ± 8 years (mean ± SD); systolic brachial BP 158 ± 18/154 ± 17 mmHg; systolic 24-hour ambulatory BP 153 ± 14/151 ± 13 mmHg. Changes in PWV (0.1 ± 1.9 (SHAM) vs. −0.6 ± 1.3 (RDN) m/s), systolic C-BP (−2 ± 17 (SHAM) vs. −8 ± 16 (RDN) mmHg), diastolic C-BP (−2 ± 9 (SHAM) vs. −5 ± 9 (RDN) mmHg), and augmentation index (0.7 ± 7.0 (SHAM) vs. 1.0 ± 7.4 (RDN) %) were not significantly different after six months. Changes in HRV-parameters were also not significantly different. Baseline HRV or PWV did not predict BP-response after RDN. Conclusions: In a sham-controlled setting, there were no significant effects of RDN on arterial stiffness, C-BP and HRV. Thus, the idea of BP-independent effects of RDN on large arteries and cardiac autonomic activity is not supported.