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Influence of pseudo‐resistance on the effect of renal denervation on 24‐hour ambulatory blood pressure levels
Author(s) -
Lambert Thomas,
Nahler Alexander,
Reiter Christian,
Gammer Verena,
Blessberger Hermann,
Kammler Jürgen,
Grund Michael,
Saleh Karim,
Schwarz Stefan,
Steinwender Clemens
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26030
Subject(s) - medicine , resistant hypertension , blood pressure , ambulatory blood pressure , denervation , ambulatory , cardiology , cohort , surgery
Background Renal denervation (RDN) is a promising treatment option in addition to medical antihypertensive treatment in patients suffering from resistant hypertension. Despite the growing interest in RDN, the negative result of the Symplicity HTN‐3 trial led to a debate on the efficacy of RDN. Methods We systematically investigated the effects of RDN, evaluated by 24‐hr ambulatory blood pressure measurements (ABPM), in a consecutive series of patients with resistant hypertension, which was defined by a mean office systolic blood pressure (SBP) >160 mm Hg (>150 mm Hg in patients with diabetes). Patients with a mean 24‐hr SBP of less than 130 mm Hg at baseline were classified as pseudo‐resistant, while all other patients were classified as true‐resistant. After six months, we analyzed the response rates in true‐resistant and in pseudo‐resistant patients, respectively, by the means of 24‐hr ABPM. Thereby, patients with a reduction of more than 5 mm Hg in 24‐hr SBP were classified as responders. Results RDN was performed in 106 patients. By 24‐hr ABPM, 20 patients (18.9%) were classified as pseudo‐resistant patients. In this cohort, we only found two responders (response rate 10%) six months after RDN. By contrast, in true‐resistant patients, the response rate was almost 60% and the mean BP reduction was −18.6/−9 mm Hg in 24‐hr ABPM. Conclusions We found a significant BP reduction in almost 60% of patients with true‐resistant hypertension, but only in 10% in patients with pseudo‐resistant hypertension. According to our results, patient selection seems to be crucial for acceptable response rates after RDN. © 2015 Wiley Periodicals, Inc.