Renal artery sympathetic denervation: observations from the UK experience

Andrew S P Sharp; Justin E Davies; Melvin D Lobo; Clare L Bent; Patrick B Mark; Amy E Burchell; Simon D Thackray; Una Martin; William S McKane; Robert T Gerber; James R Wilkinson; Tarek F Antonios; Timothy W Doulton; Tiffany Patterson; Piers C Clifford; Alistair Lindsay; Graeme J Houston; Jonathan Freedman; Neelan Das; Anna M Belli; Mohamad Faris; Trevor J Cleveland; Angus K Nightingale; Awais Hameed; Kalaivani Mahadevan; Judith A Finegold; Adam N Mather; Terry Levy; Richard D'Souza; Peter Riley; Jonathan G Moss; Carlo Di Mario; Simon R Redwood; Andreas Baumbach; Mark J Caulfield; Indranil Dasgupta

doi:10.1007/s00392-015-0959-4

Renal artery sympathetic denervation: observations from the UK experience

Andrew S P Sharp, Justin E Davies, Melvin D Lobo, Clare L Bent, Patrick B Mark, Amy E Burchell, Simon D Thackray, Una Martin, William S McKane, Robert T Gerber, James R Wilkinson, Tarek F Antonios, Timothy W Doulton, Tiffany Patterson, Piers C Clifford, Alistair Lindsay, Graeme J Houston, Jonathan Freedman, Neelan Das, Anna M BelliMohamad Faris, Trevor J Cleveland, Angus K Nightingale, Awais Hameed, Kalaivani Mahadevan, Judith A Finegold, Adam N Mather, Terry Levy, Richard D'Souza, Peter Riley, Jonathan G Moss, Carlo Di Mario, Simon R Redwood, Andreas Baumbach, Mark J Caulfield, Indranil Dasgupta

Research output: Contribution to journal › Article › peer-review

23 Citations (Scopus)

Abstract

BACKGROUND: Renal denervation (RDN) may lower blood pressure (BP); however, it is unclear whether medication changes may be confounding results. Furthermore, limited data exist on pattern of ambulatory blood pressure (ABP) response-particularly in those prescribed aldosterone antagonists at the time of RDN.

METHODS: We examined all patients treated with RDN for treatment-resistant hypertension in 18 UK centres.

RESULTS: Results from 253 patients treated with five technologies are shown. Pre-procedural mean office BP (OBP) was 185/102 mmHg (SD 26/19; n = 253) and mean daytime ABP was 170/98 mmHg (SD 22/16; n = 186). Median number of antihypertensive drugs was 5.0: 96 % ACEi/ARB; 86 % thiazide/loop diuretic and 55 % aldosterone antagonist. OBP, available in 90 % at 11 months follow-up, was 163/93 mmHg (reduction of 22/9 mmHg). ABP, available in 70 % at 8.5 months follow-up, was 158/91 mmHg (fall of 12/7 mmHg). Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn. Dose changes appeared neutral. Quartile analysis by starting ABP showed mean reductions in systolic ABP after RDN of: 0.4; 6.5; 14.5 and 22.1 mmHg, respectively (p < 0.001 for trend). Use of aldosterone antagonist did not predict response (p > 0.2).

CONCLUSION: In 253 patients treated with RDN, office BP fell by 22/9 mmHg. Ambulatory BP fell by 12/7 mmHg, though little response was seen in the lowermost quartile of starting blood pressure. Fall in BP was not explained by medication changes and aldosterone antagonist use did not affect response.

Original language	English
Journal	Clinical Research in Cardiology
Early online date	22 Jan 2016
DOIs	https://doi.org/10.1007/s00392-015-0959-4
Publication status	E-pub ahead of print - 22 Jan 2016

Keywords

Hypertension
Sympathetic nervous system
Catheter ablation
Aldosterone

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10.1007/s00392-015-0959-4Licence: Creative Commons: Attribution (CC BY)

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Sharp, A. S. P., Davies, J. E., Lobo, M. D., Bent, C. L., Mark, P. B., Burchell, A. E., Thackray, S. D., Martin, U., McKane, W. S., Gerber, R. T., Wilkinson, J. R., Antonios, T. F., Doulton, T. W., Patterson, T., Clifford, P. C., Lindsay, A., Houston, G. J., Freedman, J., Das, N., ... Dasgupta, I. (2016). Renal artery sympathetic denervation: observations from the UK experience. Clinical Research in Cardiology. Advance online publication. https://doi.org/10.1007/s00392-015-0959-4

@article{ee8ac44c5f7245c099c5645ce6bb331b,

title = "Renal artery sympathetic denervation: observations from the UK experience",

abstract = "BACKGROUND: Renal denervation (RDN) may lower blood pressure (BP); however, it is unclear whether medication changes may be confounding results. Furthermore, limited data exist on pattern of ambulatory blood pressure (ABP) response-particularly in those prescribed aldosterone antagonists at the time of RDN.METHODS: We examined all patients treated with RDN for treatment-resistant hypertension in 18 UK centres.RESULTS: Results from 253 patients treated with five technologies are shown. Pre-procedural mean office BP (OBP) was 185/102 mmHg (SD 26/19; n = 253) and mean daytime ABP was 170/98 mmHg (SD 22/16; n = 186). Median number of antihypertensive drugs was 5.0: 96 % ACEi/ARB; 86 % thiazide/loop diuretic and 55 % aldosterone antagonist. OBP, available in 90 % at 11 months follow-up, was 163/93 mmHg (reduction of 22/9 mmHg). ABP, available in 70 % at 8.5 months follow-up, was 158/91 mmHg (fall of 12/7 mmHg). Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn. Dose changes appeared neutral. Quartile analysis by starting ABP showed mean reductions in systolic ABP after RDN of: 0.4; 6.5; 14.5 and 22.1 mmHg, respectively (p < 0.001 for trend). Use of aldosterone antagonist did not predict response (p > 0.2).CONCLUSION: In 253 patients treated with RDN, office BP fell by 22/9 mmHg. Ambulatory BP fell by 12/7 mmHg, though little response was seen in the lowermost quartile of starting blood pressure. Fall in BP was not explained by medication changes and aldosterone antagonist use did not affect response.",

keywords = "Hypertension, Sympathetic nervous system, Catheter ablation, Aldosterone",

author = "Sharp, {Andrew S P} and Davies, {Justin E} and Lobo, {Melvin D} and Bent, {Clare L} and Mark, {Patrick B} and Burchell, {Amy E} and Thackray, {Simon D} and Una Martin and McKane, {William S} and Gerber, {Robert T} and Wilkinson, {James R} and Antonios, {Tarek F} and Doulton, {Timothy W} and Tiffany Patterson and Clifford, {Piers C} and Alistair Lindsay and Houston, {Graeme J} and Jonathan Freedman and Neelan Das and Belli, {Anna M} and Mohamad Faris and Cleveland, {Trevor J} and Nightingale, {Angus K} and Awais Hameed and Kalaivani Mahadevan and Finegold, {Judith A} and Mather, {Adam N} and Terry Levy and Richard D'Souza and Peter Riley and Moss, {Jonathan G} and {Di Mario}, Carlo and Redwood, {Simon R} and Andreas Baumbach and Caulfield, {Mark J} and Indranil Dasgupta",

year = "2016",

month = jan,

day = "22",

doi = "10.1007/s00392-015-0959-4",

language = "English",

journal = "Clinical Research in Cardiology",

issn = "1861-0684",

publisher = "Springer",

}

Sharp, ASP, Davies, JE, Lobo, MD, Bent, CL, Mark, PB, Burchell, AE, Thackray, SD, Martin, U, McKane, WS, Gerber, RT, Wilkinson, JR, Antonios, TF, Doulton, TW, Patterson, T, Clifford, PC, Lindsay, A, Houston, GJ, Freedman, J, Das, N, Belli, AM, Faris, M, Cleveland, TJ, Nightingale, AK, Hameed, A, Mahadevan, K, Finegold, JA, Mather, AN, Levy, T, D'Souza, R, Riley, P, Moss, JG, Di Mario, C, Redwood, SR, Baumbach, A, Caulfield, MJ & Dasgupta, I 2016, 'Renal artery sympathetic denervation: observations from the UK experience', Clinical Research in Cardiology. https://doi.org/10.1007/s00392-015-0959-4

TY - JOUR

T1 - Renal artery sympathetic denervation

T2 - observations from the UK experience

AU - Sharp, Andrew S P

AU - Davies, Justin E

AU - Lobo, Melvin D

AU - Bent, Clare L

AU - Mark, Patrick B

AU - Burchell, Amy E

AU - Thackray, Simon D

AU - Martin, Una

AU - McKane, William S

AU - Gerber, Robert T

AU - Wilkinson, James R

AU - Antonios, Tarek F

AU - Doulton, Timothy W

AU - Patterson, Tiffany

AU - Clifford, Piers C

AU - Lindsay, Alistair

AU - Houston, Graeme J

AU - Freedman, Jonathan

AU - Das, Neelan

AU - Belli, Anna M

AU - Faris, Mohamad

AU - Cleveland, Trevor J

AU - Nightingale, Angus K

AU - Hameed, Awais

AU - Mahadevan, Kalaivani

AU - Finegold, Judith A

AU - Mather, Adam N

AU - Levy, Terry

AU - D'Souza, Richard

AU - Riley, Peter

AU - Moss, Jonathan G

AU - Di Mario, Carlo

AU - Redwood, Simon R

AU - Baumbach, Andreas

AU - Caulfield, Mark J

AU - Dasgupta, Indranil

PY - 2016/1/22

Y1 - 2016/1/22

N2 - BACKGROUND: Renal denervation (RDN) may lower blood pressure (BP); however, it is unclear whether medication changes may be confounding results. Furthermore, limited data exist on pattern of ambulatory blood pressure (ABP) response-particularly in those prescribed aldosterone antagonists at the time of RDN.METHODS: We examined all patients treated with RDN for treatment-resistant hypertension in 18 UK centres.RESULTS: Results from 253 patients treated with five technologies are shown. Pre-procedural mean office BP (OBP) was 185/102 mmHg (SD 26/19; n = 253) and mean daytime ABP was 170/98 mmHg (SD 22/16; n = 186). Median number of antihypertensive drugs was 5.0: 96 % ACEi/ARB; 86 % thiazide/loop diuretic and 55 % aldosterone antagonist. OBP, available in 90 % at 11 months follow-up, was 163/93 mmHg (reduction of 22/9 mmHg). ABP, available in 70 % at 8.5 months follow-up, was 158/91 mmHg (fall of 12/7 mmHg). Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn. Dose changes appeared neutral. Quartile analysis by starting ABP showed mean reductions in systolic ABP after RDN of: 0.4; 6.5; 14.5 and 22.1 mmHg, respectively (p < 0.001 for trend). Use of aldosterone antagonist did not predict response (p > 0.2).CONCLUSION: In 253 patients treated with RDN, office BP fell by 22/9 mmHg. Ambulatory BP fell by 12/7 mmHg, though little response was seen in the lowermost quartile of starting blood pressure. Fall in BP was not explained by medication changes and aldosterone antagonist use did not affect response.

AB - BACKGROUND: Renal denervation (RDN) may lower blood pressure (BP); however, it is unclear whether medication changes may be confounding results. Furthermore, limited data exist on pattern of ambulatory blood pressure (ABP) response-particularly in those prescribed aldosterone antagonists at the time of RDN.METHODS: We examined all patients treated with RDN for treatment-resistant hypertension in 18 UK centres.RESULTS: Results from 253 patients treated with five technologies are shown. Pre-procedural mean office BP (OBP) was 185/102 mmHg (SD 26/19; n = 253) and mean daytime ABP was 170/98 mmHg (SD 22/16; n = 186). Median number of antihypertensive drugs was 5.0: 96 % ACEi/ARB; 86 % thiazide/loop diuretic and 55 % aldosterone antagonist. OBP, available in 90 % at 11 months follow-up, was 163/93 mmHg (reduction of 22/9 mmHg). ABP, available in 70 % at 8.5 months follow-up, was 158/91 mmHg (fall of 12/7 mmHg). Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn. Dose changes appeared neutral. Quartile analysis by starting ABP showed mean reductions in systolic ABP after RDN of: 0.4; 6.5; 14.5 and 22.1 mmHg, respectively (p < 0.001 for trend). Use of aldosterone antagonist did not predict response (p > 0.2).CONCLUSION: In 253 patients treated with RDN, office BP fell by 22/9 mmHg. Ambulatory BP fell by 12/7 mmHg, though little response was seen in the lowermost quartile of starting blood pressure. Fall in BP was not explained by medication changes and aldosterone antagonist use did not affect response.

KW - Hypertension

KW - Sympathetic nervous system

KW - Catheter ablation

KW - Aldosterone

U2 - 10.1007/s00392-015-0959-4

DO - 10.1007/s00392-015-0959-4

M3 - Article

C2 - 26802018

SN - 1861-0684

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

ER -

Renal artery sympathetic denervation: observations from the UK experience

Abstract

Keywords

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