2.5 THE EFFECT OF RENAL DENERVATION ON CENTRAL BLOOD PRESSURE AND ARTERIAL STIFFNESS IN TREATMENT RESISTANT ESSENTIAL HYPERTENSION: A SUBSTUDY OF A RANDOMIZED SHAM-CONTROLLED DOUBLE-BLINDED TRIAL (THE RESET TRIAL)

• Main Authors: Christian D. Peters, Ole N. Mathiasen, Henrik Vase, Jesper Bech, Kent L. Christensen, Anne P. Schroeder, Ole Lederballe, Hans Rickers, Ulla Kampmann, Per L. Poulsen, Sten Langfeldt, Gratien Andersen, Klavs W. Hansen, Hans E. Bøtker, Morten Engholm, Jannik B. Bertelsen, Jens F. Lassen, Erling B. Pedersen, Anne Kaltoft, Niels H. Buus
• Format: Article
• Language: English
• Published: Atlantis Press 2016-11-01
• Series: Artery Research
• Online Access: https://www.atlantis-press.com/article/125930385/view

Background: A recent sham-controlled trial (ReSET) showed no sustained effect of renal denervation (RDN) on 24-hour ambulatory blood pressure (24hA-BP) measurements in patients with treatment resistant hypertension.1 The aim of this substudy was to investigate, whether RDN affects central blood pressure (C-BP) and arterial stiffness independently of brachial artery BP-levels. Methods: ReSET was a randomized, sham-controlled, double-blinded single-center trial. Main inclusion criteria were: daytime systolic 24hA-BP ≥145mmHg following 1 month of stable medication and 2 weeks of compliance registration. RDN was performed by a single experienced operator using the unipolar Medtronic Flex catheter1. C-BP and carotid-femoral pulse wave velocity (PWV) were obtained at baseline and after 6 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 24hA-BP 153±14/151±13 mmHg; systolic C-BP 146±20/143±17 mmHg; diastolic C-BP 92±14/94±10 mmHg; augmentation index (AIx) 26±9/28±13 %; PWV 10.7±2.1/10.1±2.2 m/s. Changes in systolic C-BP (−2±17 (SHAM) vs. −8±16 (RDN) mmHg), diastolic C-BP (−2±9 (SHAM) vs. −5±9 (RDN) mmHg), AIx (0.7±7.0 (SHAM) vs. 1.0±7.4 (RDN) %), and PWV (0.1±1.9 (SHAM) vs. −0.6±1.3 (RDN) m/s) were not significantly different after six months (P>0.13 in all tests). Changes in brachial BP and 24hA-BP were also not significantly different. Conclusions: In a sham-controlled setting, there were no significant effects of RDN on C-BP or arterial stiffness. Thus, the idea of BP-independent effects of RDN on large arteries is not supported.