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Catheter–based renal sympathetic denervation (RD) causes significant blood pressure (BP) reductions in patients with resistant hypertension (rHTN). However, patients with accessory renal arteries (ARAs) have been excluded in previous trials. Therefore, the efficacy of RD in patients with ARAs is unknown. The purpose of this study was to assess the efficacy of RD in patients with ARAs and to compare the blood pressure lowering effect to that observed in patients with bilateral single renal arteries (BSRAs) after RD.
We reviewed all consecutive patients with rHTN who were treated with RD and completed 6 months follow–up. Seventy–four patients were included in this prospective study. Patients were assigned to two main groups: a BSRAs group I (n=54) and an ARAs group II (n=20). Group II consisted of 9 patients all of whose ARAs were denervated (Group IIa) and 11 patients whose ARAs were not, or only incompletely denervated (Group IIb). Clinical findings were reviewed at baseline and 6 months follow–up to assess differences in office BP, 24–h ambulatory BP and BP medications between groups. Primary endpoint was the change in office systolic BP after 6 months.
The procedure was successful in all patients. Group I: Mean BP at baseline was 166.2/89.4 ± 20.5/14.6 mmHg and decreased by −16.6/–6.7 mmHg (p<0.001 for systolic values; p= 0.016 for diastolic values) at 6 months follow–up. Group II: Mean BP at baseline was 164.2/89.1 ± 19.9/15.4 mmHg and decreased by −6.2/–0.2 mmHg (p=0.19 for systolic values) at 6 months follow–up. Patients in group IIa had an office BP reduction of −8.8/1.1 mmHg (p=0.20 for systolic values) and patients in group IIb of −4.1/–1.3 mmHg (p=0.55 for systolic values). Similarly, significant improvements in 24–hour mean systolic BP were seen in group I (−8/–5 mmHg, p<0.01) whereas none in group II (3.7/–0.3 mmHg, p=0.4). The number of antihypertensive medications was unchanged from baseline in all groups.
Our results indicate for the first time that the BP reduction achieved after RD in patients with ARA is less pronounced than in patients with BSRA. This has major implications for patient selection and future device designs.
West, Room 3005
Saturday, March 09, 2013, 9:15 a.m.–9:30 a.m.
Session Title: Vascular Medicine: New Insights in Arterial Disease
Abstract Category: 34. Vascular Medicine: Endovascular Therapy
Presentation Number: 911–8
- 2013 American College of Cardiology Foundation