Renal sympathetic denervation restores aortic distensibility in patients with resistant hypertension: data from a multi-center trial

Abstract

Renal sympathetic denervation (RDN) is under investigation as a treatment option in patients with resistant hypertension (RH). Determinants of arterial compliance may, however, help to predict the BP response to therapy. Aortic distensibility (AD) is a well-established parameter of aortic stiffness and can reliably be obtained by CMR. This analysis sought to investigate the effects of RDN on AD and to assess the predictive value of pre-treatment AD for BP changes. We analyzed data of 65 patients with RH included in a multicenter trial. RDN was performed in all participants. A standardized CMR protocol was utilized at baseline and at 6-month follow-up. AD was determined as the change in cross-sectional aortic area per unit change in BP. Office BP decreased significantly from 173/92 ± 24/16 mmHg at baseline to 151/85 ± 24/17 mmHg (p < 0.001) 6 months after RDN. Maximum aortic areas increased from 604.7 ± 157.7 to 621.1 ± 157.3 mm2 (p = 0.011). AD improved significantly by 33% from 1.52 ± 0.82 to 2.02 ± 0.93 × 10−3 mmHg−1 (p < 0.001). Increase of AD at follow-up was significantly more pronounced in younger patients (p = 0.005) and responders to RDN (p = 0.002). Patients with high-baseline AD were significantly younger (61.4 ± 10.1 vs. 67.1 ± 8.4 years, p = 0.022). However, there was no significant correlation of baseline AD to response to RDN. AD is improved after RDN across all age groups. Importantly, these improvements appear to be unrelated to observed BP changes, suggesting that RDN may have direct effects on the central vasculature.Electronic supplementary materialThe online version of this article (10.1007/s00392-018-1229-z) contains supplementary material, which is available to authorized users.

Acute renal denervation normalizes aortic function and decreases blood pressure in spontaneously hypertensive rats

“…SHR rats have reduced aorta responses to different vasoconstrictors such as norepinephrine 77 , phenylephrine, angiotensin II, endothelin-1 and urotensin-II 70 . In the present study, we demonstrated contractile activity induced by phenylephrine, and we found a lower response in hypertensive sham animals compared to Wistar rats.…”

“…have shown that renal denervation prevented reduction of aortic distensibility in atherosclerosis prone ApoE‑deficient rats 8 weeks after intervention 76 . In humans, data from a multi-center trial showed that aortic distensibility is improved 6 months after RDN regardless of the BP response to the intervention 77 . It should be emphasized that our animal vessels were evaluated 7 days after RDN.…”

New data, new studies, new hopes for renal denervation in patients with uncontrolled hypertension

“…Since then, several other studies with similar design have been completed and published. Most of these studies enrolled patients with uncontrolled and/or resistant hypertension taking 3 or more antihypertensive medications and monitored office BP and ambulatory BPM changes for at least 6 months or later [ [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] ]. Results are shown in Fig.…”

Validation of simple measures of aortic distensibility based on standard 4-chamber cine CMR: a new approach for clinical studies

“…Aortic distensibility (AD) provides an estimation of these elastic properties and normalizes arterial compliance with the size of the vessel, allowing for a better comparison between individuals [4].…”

“…Previously, several authors have made significant contributions to assess aortic compliance with various imaging methods [5][6][7][8]. Measurements of AD can give information even on subclinical vascular changes and are being investigated as predictors of cardiovascular morbidity [4,[9][10][11]. Newer preclinical and clinical studies are focusing on mechanisms of influencing AD.…”