Percutaneous renal denervation (RDN) improves central hemodynamics and arterial stiffness - results of 24h ambulatory measurements

Background: Percutaneous renal denervation (RDN) is established as a novel treatment strategy for patients with resistant arterial hypertension. Central aortic blood pressures and aortic stiffness are better predictors for cardiovascular risk than standard peripheral blood pressures. The present study aimed therefore to evaluate the effects of RDN on central pressures and arterial stiffness derived from 24h ambulatory monitoring. Methods: 26 resistant arterial hypertension patients (31–85 years, mean age 66±9 years) with a mean 24h ambulatory systolic blood pressure (ABP) of more than 135 mmHg and an office systolic peripheral blood pressure of more than 150 mmHg were included. Patients were treated with an Ardian/Medtronic™ PRD radiofrequency ablation catheter system. ABP, central pressure and arterial stiffness were measured with an I.E.M. device (MobiloGraph™). Results: In all patients [5.7±1.9 antihypertensive drugs] RDN was technically successful. Peripheral systolic blood pressure (pSBP) declined significantly in the therapy group from 153±13 mmHg to 145±14 mmHg [p=0.002] after three month and to 144±16 mmHg after six months [p<0.05]. Likewise, central systolic blood pressure (cSBP) improved from 139±14 mmHg to 133±15 mmHg after three month [p=0.007] and to 132±15 mmHg after six months [p<0.05]. Pulse wave velocity (PWV) improved from 10.3±1.2 m/s to 10.0±1.2 m/s after one month [p<0.05] and to 10.2±1.3 m/s after three months [p<0.05]. Multivariate analysis of variance (f-test) showed that improvement of PWV was independent from mean arterial pressure (MAP) as well as heart rate (HR). Changes of pSBP, cSBP and PWV were more prominent during daytime. Conclusion: RDN significantly improved central aortic pressures and arterial stiffness, especially during daytime. Thus, RDN has beneficial effects on central hemodynamics and arterial stiffness and may improve cardiovascular outcome beyond peripheral blood pressure effects in patients suffering from resistant arterial hypertension.