Can we predict the blood pressure response to renal denervation?

Abstract

Renal denervation (RDN) is a new therapy used to treat drug-resistant hypertension in the clinical setting. Published human trials show substantial inter-individual variability in the blood pressure (BP) response to RDN, even when technical aspects of the treatment are standardized as much as possible between patients. Widespread acceptance of RDN for treating hypertension will require accurate identification of patients likely to respond to RDN with a fall in BP that is clinically significant in magnitude, well-maintained over time and does not cause adverse consequences. In this paper we review and evaluate clinical studies that address possible predictors of the BP response to RDN. We conclude that only one generally reliable predictor has been identified to date, namely pre-RDN BP level, although there is some evidence for a few other factors. Experimental interventions in laboratory animals provide the opportunity to explore potential predictors that are difficult to investigate in human patients. Therefore we also describe results (from our lab and others) with RDN in spontaneously hypertensive rats. Since virtually all patients receiving RDN are taking three or more antihypertensive drugs, a particular focus of our work was on how ongoing antihypertensive drug treatment might alter the BP response to RDN. We conclude that patient age (or duration of hypertension) and concomitant treatment with certain drugs can affect the blood pressure response to RDN and that this information could help predict a favorable clinical response.

Predictors for success in renal denervation–a single centre retrospective analysis

“…Percutaneous renal denervation (RDN) has been shown to effectively reduce blood pressure (BP) in different previous trials 1 – 3 . However, reported responses vary from large falls in BP to unchanged or small increase in BP even within a given study population 4 . This suggests, that specific patient characteristics may predict the response to RDN.…”

Renal sympathetic denervation for resistant hypertension: where do we stand after more than a decade

“…Pre-clinical studies with several animal models of hypertension showed reduction in blood pressure following renal sympathetic denervation 44,45,46,47 . For instance, in experimental studies with elderly mice with high systolic blood pressure, there was a drop in blood pressure after the procedure and this effect persisted for many weeks 44 . On the other hand, in younger mice, the fall in blood pressure after denervation was not sustained 44 .…”

“…For instance, in experimental studies with elderly mice with high systolic blood pressure, there was a drop in blood pressure after the procedure and this effect persisted for many weeks 44 . On the other hand, in younger mice, the fall in blood pressure after denervation was not sustained 44 . In different experimental models of hypertension, renal denervation reduced baseline blood pressure 48,45,46,47 , with concomitant decrease in plasma levels of epinephrine, norepinephrine, renin activity, angiotensin II, and aldosterone 49 .…”

(Prediction of long-term renal denervation efficacy)

“…21 Výsledky studií na zvířecím modelu naznačují, že centrálně působící antihypertenziva (a možná i beta-blokátory) mohou za jistých okolností modifi kovat odpověd na RDN; zatímco nejčastěji užívané třídy (diuretika, sartany a blokátory kalciových kanálů) nemají tento účinek. 22 Odpověď na RDN může predikovat invazivní rychlost šíření pulsní vlny (pulse wave velocity, PWV). 23 Ve smyslu predikce odpovědi na RDN byla ověřována i anatomie renálních tepen -srovnání jednoduchých renálních tepen oboustranně, zdvojených renálních tepen na jedné nebo obou stranách nebo jiných anatomických konstelací naznačuje, že jednoduché renální tepny se strukturálními abnormalitami nebo bez strukturálních abnormalit jsou asociovány s výraznějším poklesem TK než zdvojené renální tepny.…”

“…Za variabilitu predikce ve výše zmíněných studiích [14][15][16][17][18][19] může být zodpovědných několik faktorů, například technické otázky související se samotnou procedurou nebo s měřením TK, vstupní charakteristika pacientů nebo konkomitantní antihypertenzní léčba. 22 Alternace během dvouletého sledování potvrzuje variabilitu prediktorů odpovědi a může podporovat význam preference dlouhodobé odpovědi na RDN založené na trvajícím podklesu TK. Možnost popsané reinervace již po šesti měsících na zvířecím modelu 35 ještě podporuje význam této analýzy.…”