Changes in sympathetic nervous system activity after renal denervation: results from the randomised Oslo RDN study

Abstract

Purpose: Sympathetic nervous system (SNS) over-activity is associated with essential hypertension.Renal sympathetic denervation (RDN) possibly lowers office-and ambulatory blood pressure (BP) in patients with treatment-resistant hypertension (TRH). We aimed to assess the effect of RDN compared to drug adjustment on SNS activity among patients with TRH by measuring plasma catecholamines and heart rate variability (HRV) during stress tests. Materials and methods:Patients with TRH were randomized to RDN (n=9) or Drug Adjustment (DA) (n=10). We measured continuous HRV and beat-to-beat-BP using FinaPres® and obtained plasma catecholamines during standardized orthostatic-and cold-pressor stress tests (CPT) before-and six months after randomization.Results: CPT revealed no differences between groups at baseline in peak adrenaline concentration (69.3pg/mL in the DA group vs. 70.0pg/mL in the RDN group, p=0.38) or adrenaline reactivity (∆23.1pg/mL in the DA group vs. ∆29.3pg/mL in the RDN group, p=0.40). After six months, adrenaline concentrations were statistically different between groups after one minute (66.9pg/mL in the DA group vs. 55.3pg/mL in the RDN group, p=0.03), and six minutes (62.4pg/mL in the DA group vs. 50.1pg/mL in the RDN group, p=0.03). There was a tendency of reduction in adrenaline reactivity after six months in the RDN group (∆26.3pg/mL at baseline vs. ∆12.8pg/ml after six months, p=0.08), while it increased in the DA group (∆13.6pg/mL at baseline vs. ∆19.9pg/mL after six months, p=0.53).We also found a difference in the Low Frequency band at baseline following the CPT (667µs 2 in the DA group vs. 1628µs 2 in the RDN group, p=0.03) with a clear tendency of reduction in the RDN group to 743µs 2 after six months (p=0.07), compared to no change in the DA group (1052µs 2, p=0.39). Conclusion:Our data suggest that RDN reduces SNS activity after six months. This finding warrants investigation in a larger study.

Effects of renal denervation on cardiac function after percutaneous coronary intervention in patients with acute myocardial infarction

“…In our study, RDN intervention significantly improved these indicators. This finding is similar to previous studies showing similar effects of RDN on non-AMI patients [ 47 , 48 ]. Our study thus hints that RDN can restore the sympathetic-vagal balance in AMI-PCI patients, which may contribute to improving cardic function post RDN in AMI-PCI patients.…”

Effects of catheter‐based renal denervation on renin‐aldosterone system, catecholamines, and electrolytes: A systematic review and meta‐analysis

“…Follow‐up duration ranged from 0.5 to 72 months. Ten studies reported data on plasma renin, 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 nine studies on plasma aldosterone, 14 , 15 , 16 , 18 , 19 , 21 , 22 , 23 , 24 two studies on plasma norepinephrine, 20 , 25 seven studies on serum sodium, 23 , 24 , 26 , 27 , 28 , 29 , 30 nine studies on serum potassium, 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 five studies on urinary sodium, 18 , 20 , 24 , 26 , 33 and two studies on urinary potassium. 24 , 26 The characteristics of included studies are summarized in Table 1 .…”

Patient Selection for Renal Denervation in Hypertensive Patients: What Makes a Good Candidate?

“…Nevertheless, the baseline level of sympathetic activity may not be as important as initially assumed in determining the response to RDN. In a recent study comparing the effect of RDN and drug adjustment in hypertensive patients, 61 no significant difference was noted in baseline plasma catecholamines, which was used an indirect or surrogate marker for sympathetic activity, between the two groups. Nevertheless, a significantly lower level of plasma catecholamines during stress tests after RDN was noted in two RDN responders.…”