Renal sympathetic denervation restores aortic distensibility in patients with resistant hypertension: data from a multi-center trial

Lukas Stoiber, Felix Mahfoud, Seyedeh Mahsa Zamani, Tomas Lapinskas, Michael Böhm, Sebastian Ewen, Saarraaken Kulenthiran, Markus P. Schlaich, Murray D. Esler, Tommy Hammer, Knut Haakon Stensæth, Burkert Pieske, Stephan Dreysse, Eckart Fleck, Titus Kühne, Marcus Kelm, Philipp Stawowy, Sebastian Kelle

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Renal sympathetic denervation (RDN) is under investigation as a treatment option in patients with resistant hypertension (RH). Determinants of arterial compliance may, however, help to predict the BP response to therapy. Aortic distensibility (AD) is a well-established parameter of aortic stiffness and can reliably be obtained by CMR. This analysis sought to investigate the effects of RDN on AD and to assess the predictive value of pre-treatment AD for BP changes. We analyzed data of 65 patients with RH included in a multicenter trial. RDN was performed in all participants. A standardized CMR protocol was utilized at baseline and at 6-month follow-up. AD was determined as the change in cross-sectional aortic area per unit change in BP. Office BP decreased significantly from 173/92 ± 24/16 mmHg at baseline to 151/85 ± 24/17 mmHg (p < 0.001) 6 months after RDN. Maximum aortic areas increased from 604.7 ± 157.7 to 621.1 ± 157.3 mm2 (p = 0.011). AD improved significantly by 33% from 1.52 ± 0.82 to 2.02 ± 0.93 × 10−3 mmHg−1 (p < 0.001). Increase of AD at follow-up was significantly more pronounced in younger patients (p = 0.005) and responders to RDN (p = 0.002). Patients with high-baseline AD were significantly younger (61.4 ± 10.1 vs. 67.1 ± 8.4 years, p = 0.022). However, there was no significant correlation of baseline AD to response to RDN. AD is improved after RDN across all age groups. Importantly, these improvements appear to be unrelated to observed BP changes, suggesting that RDN may have direct effects on the central vasculature.

Original languageEnglish
Pages (from-to)642-652
Number of pages11
JournalClinical Research in Cardiology
Volume107
Issue number8
DOIs
Publication statusPublished - 1 Aug 2018

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