Blood pressure changes after catheter-based renal denervation are related to reductions in total peripheral resistance

Abstract

RDN reduced office BP, beat-to-beat BP, and 24-h ambulatory BP in patients with resistant hypertension after 6 months. The BP changes were associated with reductions in peripheral resistance, whereas cardiac output, plasma renin, and aldosterone levels remained unchanged. The observed effects were not explained by an increased intake of antihypertensive medications.

Renal denervation improves 24‐hour central and peripheral blood pressures, arterial stiffness, and peripheral resistance

“…Therefore, our data of a significant reduction of TVR being stable over the follow‐up, which may have been changed, amongst others, by peripheral vasodilation and improvement of endothelial dysfunction, are confirmatory. Consistently, as seen in latter study the reduction of TVR was independently of changes of cardiac output, which remained stable over the 12 months follow‐up after RDN.…”

“…Indeed, it was shown that (at least in part) BP reduction due to RDN is associated with reduction in sympathetic nerve activity (assessed by multiple SNA) . Previously, in a single‐center study (N = 30) from Ewen et al, it was shown that RDN significantly reduces (office) measured TVR, however, independently of changes in cardiac output . Therefore, our data of a significant reduction of TVR being stable over the follow‐up, which may have been changed, amongst others, by peripheral vasodilation and improvement of endothelial dysfunction, are confirmatory.…”

Blood pressure response to renal denervation is correlated with baseline blood pressure variability

“…From a pathophysiologic perspective, these results are meaningful. Indeed, the steady component of BP reflected by mean or diastolic BP is a measure of peripheral vascular resistance [31], which in its turn is dependent on sympathetic tone [32] and decreases after renal sympathetic nerve ablation [33]. Several lines of evidence suggest that increased vascular resistance, a hallmark of diastolic hypertension in young patients with sympathetic overactivity [34] is due to narrowing of pre-capillary arterioles, and that these changes precede BP elevation [35].…”

Renal denervation in the era of HTN-3. Comprehensive review and glimpse into the future

“…62 RDN also appears to lower total peripheral resistance, a change not associated with significant changes in cardiac output. 63 An elevated central pulse pressure (CPP), as an indicative of this arterial stiffening and enhanced vascular aging, may be helpful in predicting BP reduction after RDN. Ott C et al 64 stratified RDN patients according to the median CPP and found that BP reduction after RDN is greater in patients with lower CPP, which is indicative of a lower degree of arterial damage.…”