Effects of Renal Sympathetic Denervation on 24-hour Blood Pressure Variability

Effects of Renal Sympathetic Denervation on 24-hour Blood Pressure Variability

Background: In patients with arterial hypertension, increased blood pressure (BP) variability contributes to end organ damage independently from mean levels of arterial BP. Increased BP variability has been linked to alterations in autonomic function including sympathetic overdrive. We hypothesized...

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Main Authors: Zuern, Christine S., Rizas, Konstantinos D., Eick, Christian, Stoleriu, Cosmina, Bunk, Lena, Barthel, Petra, Balletshofer, Bernd, Gawaz, Meinrad, Bauer, Axel
Format: Online
Language:English
Published: Frontiers Research Foundation 2012
Online Access:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349245/
id pubmed-3349245
recordtype oai_dc
spelling pubmed-33492452012-05-15 Effects of Renal Sympathetic Denervation on 24-hour Blood Pressure Variability Zuern, Christine S. Rizas, Konstantinos D. Eick, Christian Stoleriu, Cosmina Bunk, Lena Barthel, Petra Balletshofer, Bernd Gawaz, Meinrad Bauer, Axel Physiology Background: In patients with arterial hypertension, increased blood pressure (BP) variability contributes to end organ damage independently from mean levels of arterial BP. Increased BP variability has been linked to alterations in autonomic function including sympathetic overdrive. We hypothesized that catheter-based renal sympathetic denervation (RDN) confers beneficial effects on BP variability. Methods and Results: Eleven consecutive patients with therapy-refractory arterial hypertension (age 68.9 ± 7.0 years; baseline systolic BP 189 ± 23 mmHg despite medication with 5.6 ± 2.1 antihypertensive drugs) underwent bilateral RDN. Twenty-four hour ambulatory BP monitoring (ABPM) was performed before RDN and 6 months thereafter. BP variability was primarily assessed by means of standard deviation of 24-h systolic arterial BP (SDsys). Secondary measures of BP variability were maximum systolic BP (MAXsys) and maximum difference between two consecutive readings of systolic BP (Δmaxsys) over 24 h. Six months after RDN, SDsys, MAXsys, and Δmaxsys were significantly reduced from 16.9 ± 4.6 to 13.5 ± 2.5 mmHg (p = 0.003), from 190 ± 22 to 172 ± 20 mmHg (p < 0.001), and from 40 ± 15 to 28 ± 7 mmHg (p = 0.006), respectively, without changes in concomitant antihypertensive therapy. Reductions of SDsys, MAXsys, and Δmaxsys were observed in 10/11 (90.9%), 11/11 (100%), and 9/11 (81.8%) patients, respectively. Although we noted a significant reduction of systolic office BP by 30.4 ± 27.7 mmHg (p = 0.007), there was only a trend in reduction of average systolic BP assessed from ABPM (149 ± 19 to 142 ± 18 mmHg; p = 0.086). Conclusion: In patients with therapy-refractory arterial hypertension, RDN leads to significant reductions of BP variability. Effects of RDN on BP variability over 24 h were more pronounced than on average levels of BP. Frontiers Research Foundation 2012-05-10 /pmc/articles/PMC3349245/ /pubmed/22590460 http://dx.doi.org/10.3389/fphys.2012.00134 Text en Copyright © 2012 Zuern, Rizas, Eick, Stoleriu, Bunk, Barthel, Balletshofer, Gawaz and Bauer. http://www.frontiersin.org/licenseagreement This is an open-access article distributed under the terms of the Creative Commons Attribution Non Commercial License, which permits non-commercial use, distribution, and reproduction in other forums, provided the original authors and source are credited.
repository_type Open Access Journal
institution_category Foreign Institution
institution US National Center for Biotechnology Information
building NCBI PubMed
collection Online Access
language English
format Online
author Zuern, Christine S.
Rizas, Konstantinos D.
Eick, Christian
Stoleriu, Cosmina
Bunk, Lena
Barthel, Petra
Balletshofer, Bernd
Gawaz, Meinrad
Bauer, Axel
spellingShingle Zuern, Christine S.
Rizas, Konstantinos D.
Eick, Christian
Stoleriu, Cosmina
Bunk, Lena
Barthel, Petra
Balletshofer, Bernd
Gawaz, Meinrad
Bauer, Axel
Effects of Renal Sympathetic Denervation on 24-hour Blood Pressure Variability
author_facet Zuern, Christine S.
Rizas, Konstantinos D.
Eick, Christian
Stoleriu, Cosmina
Bunk, Lena
Barthel, Petra
Balletshofer, Bernd
Gawaz, Meinrad
Bauer, Axel
author_sort Zuern, Christine S.
title Effects of Renal Sympathetic Denervation on 24-hour Blood Pressure Variability
title_short Effects of Renal Sympathetic Denervation on 24-hour Blood Pressure Variability
title_full Effects of Renal Sympathetic Denervation on 24-hour Blood Pressure Variability
title_fullStr Effects of Renal Sympathetic Denervation on 24-hour Blood Pressure Variability
title_full_unstemmed Effects of Renal Sympathetic Denervation on 24-hour Blood Pressure Variability
title_sort effects of renal sympathetic denervation on 24-hour blood pressure variability
description Background: In patients with arterial hypertension, increased blood pressure (BP) variability contributes to end organ damage independently from mean levels of arterial BP. Increased BP variability has been linked to alterations in autonomic function including sympathetic overdrive. We hypothesized that catheter-based renal sympathetic denervation (RDN) confers beneficial effects on BP variability. Methods and Results: Eleven consecutive patients with therapy-refractory arterial hypertension (age 68.9 ± 7.0 years; baseline systolic BP 189 ± 23 mmHg despite medication with 5.6 ± 2.1 antihypertensive drugs) underwent bilateral RDN. Twenty-four hour ambulatory BP monitoring (ABPM) was performed before RDN and 6 months thereafter. BP variability was primarily assessed by means of standard deviation of 24-h systolic arterial BP (SDsys). Secondary measures of BP variability were maximum systolic BP (MAXsys) and maximum difference between two consecutive readings of systolic BP (Δmaxsys) over 24 h. Six months after RDN, SDsys, MAXsys, and Δmaxsys were significantly reduced from 16.9 ± 4.6 to 13.5 ± 2.5 mmHg (p = 0.003), from 190 ± 22 to 172 ± 20 mmHg (p < 0.001), and from 40 ± 15 to 28 ± 7 mmHg (p = 0.006), respectively, without changes in concomitant antihypertensive therapy. Reductions of SDsys, MAXsys, and Δmaxsys were observed in 10/11 (90.9%), 11/11 (100%), and 9/11 (81.8%) patients, respectively. Although we noted a significant reduction of systolic office BP by 30.4 ± 27.7 mmHg (p = 0.007), there was only a trend in reduction of average systolic BP assessed from ABPM (149 ± 19 to 142 ± 18 mmHg; p = 0.086). Conclusion: In patients with therapy-refractory arterial hypertension, RDN leads to significant reductions of BP variability. Effects of RDN on BP variability over 24 h were more pronounced than on average levels of BP.
publisher Frontiers Research Foundation
publishDate 2012
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349245/
_version_ 1611528645972590592

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