Renal artery sympathetic denervation: observations from the UK experience.

Sharp, Andrew S P; Davies, Justin E; Lobo, Melvin D; Bent, Clare L; Mark, Patrick B; Burchell, Amy E; Thackray, Simon D; Martin, Una; McKane, William S; Gerber, Robert T; Wilkinson, James R; Antonios, Tarek F; Doulton, Timothy W; Patterson, Tiffany; Clifford, Piers C; Lindsay, Alistair; Houston, Graeme J; Freedman, Jonathan; Das, Neelan; Belli, Anna M; Faris, Mohamad; Cleveland, Trevor J; Nightingale, Angus K; Hameed, Awais; Mahadevan, Kalaivani; Finegold, Judith A; Mather, Adam N; Levy, Terry; D'Souza, Richard; Riley, Peter; Moss, Jonathan G; Di Mario, Carlo; Redwood, Simon R; Baumbach, Andreas; Caulfield, Mark J; Dasgupta, Indranil

BACKGROUND Renal denervation (RDN) may lower blood pressure (BP); however, it is unclear whether medication changes may be confounding results. Furthermore, limited data exist on pattern of ambulatory blood pressure (ABP) response-particularly in those prescribed aldosterone antagonists at the time of RDN. METHODS We examined all patients treated with RDN for treatment-resistant hypertension in 18 UK centres. RESULTS Results from 253 patients treated with five technologies are shown. Pre-procedural mean office BP (OBP) was 185/102 mmHg (SD 26/19; n = 253) and mean daytime ABP was 170/98 mmHg (SD 22/16; n = 186). Median number of antihypertensive drugs was 5.0: 96 % ACEi/ARB; 86 % thiazide/loop diuretic and 55 % aldosterone antagonist. OBP, available in 90 % at 11 months follow-up, was 163/93 mmHg (reduction of 22/9 mmHg). ABP, available in 70 % at 8.5 months follow-up, was 158/91 mmHg (fall of 12/7 mmHg). Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn. Dose changes appeared neutral. Quartile analysis by starting ABP showed mean reductions in systolic ABP after RDN of: 0.4; 6.5; 14.5 and 22.1 mmHg, respectively (p < 0.001 for trend). Use of aldosterone antagonist did not predict response (p > 0.2). CONCLUSION In 253 patients treated with RDN, office BP fell by 22/9 mmHg. Ambulatory BP fell by 12/7 mmHg, though little response was seen in the lowermost quartile of starting blood pressure. Fall in BP was not explained by medication changes and aldosterone antagonist use did not affect response.