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Blood pressure variability after catheter-based renal sympathetic denervation in patients with resistant hypertension

Ewen, Sebastiana; Dörr, Oliverb; Ukena, Christiana; Linz, Dominika; Cremers, Bodoa; Laufs, Ulricha; Hamm, Christianb; Nef, Holgerb; Bauer, Axelc; Mancia, Giusepped; Böhm, Michaela; Mahfoud, Felixa

doi: 10.1097/HJH.0000000000000751
ORIGINAL PAPERS: Resistant hypertension
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Background: Renal denervation (RDN) reduces sympathetic activity and blood pressure (BP) in patients with resistant hypertension. Increased 24-h BP variability is associated with adverse cardiovascular outcomes and related to sympathetic activation.

Methods and results: This multicenter study investigated the effect of RDN on BP variability in 84 patients with uncontrolled hypertension (office systolic BP ≥140 mmHg) despite treatment with greater than three antihypertensive agents. BP variability was assessed by means of standard deviation, coefficient of variation (standard deviation/mean), and average real variability of 24-h ambulatory SBP at 3-month and 6-month follow-up. RDN significantly reduced office BP by 17/6 mmHg at 3-month and 19/7 mmHg at 6-month follow-up (P < 0.001 for all) and 24-h ambulatory BP by 9/5 mmHg (P < 0.001/P = 0.001) after 3 months and 12/7 mmHg (P < 0.001/P < 0.001) after 6 months. Standard deviation significantly decreased from 17.1 to 14.9 mmHg (P = 0.008) and 15.3 mmHg (P = 0.037), consistent with a reduction of coefficient of variation from 0.116 to 0.103 (P = 0.035) and 0.104 (P = 0.071) and average real variability from 12.3 to 10.9 (P = 0.029) and 11.0 (P = 0.054) after 3-month and 6-month, respectively. Interestingly, also BP nonresponders (change in office systolic BP < 10 mmHg after 6 months) showed a significant reduction of standard deviation after 3 months (P = 0.041, n = 26) and a borderline significant reduction at 6-month (P = 0.057, n = 28).

Conclusions: RDN reduces office and ambulatory BP and BP variability in patients with resistant hypertension. Improvement in BP variability was also documented in patients characterized as office BP nonresponders after 6 months.

aKlinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin Universitätsklinikum des Saarlandes, Homburg/Saar

bUniversity of Giessen, Department of Cardiology, Giessen

cMedizinische Klinik und Poliklinik I, Ludwig Maximilian Universität, and Deutsches Zentrum für Herzkreislaufforschung (DZHK), München, Germany

dIRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, Milan, Italy

Correspondence to Sebastian Ewen, MD, Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40 66421 Homburg/Saar, Germany. Tel: +49 6841 16 21346; fax: +49 6841 16 13211; e-mail: Sebastian.Ewen@uks.eu

Abbreviations: Δmaxsys, maximum difference of SBP observed between two consecutive readings; ABPM, ambulatory blood pressure monitoring; ARV, average real variability; BP, blood pressure; FU, follow-up; HR, heart rate; MAXsys, maximum SBP; RDN, renal sympathetic denervation; SDsys, standard deviation of SBP values

Received 23 April, 2015

Revised 14 August, 2015

Accepted 14 August, 2015

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