[PP.25.40] HAEMODYNAMIC CHANGES IN PATIENTS WITH TREATMENT-RESISTANT HYPERTENSION AFTER RENAL SYMPATHETIC DENERVATION COMPARED TO INDIVIDUALIZED DRUG THERAPY. (September 2017)

• Record Type: Journal Article
• Authors: Bergo, K.; Larstorp, A.C.K.; Høieggen, A.; Hjørnholm, U.P.; Rostrup, M.; Fadl Elmula, F.E.M.
• Is Part Of: Journal of hypertension. Volume 35(2017)Supplement 2
• Publication Date: 2017-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000523896.53160.62
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Renal denervation (RDN) was introduced in the last years as a new treatment in patients with treatment-resistant hypertension (TRH). However, the blood pressure (BP) lowering effect of RDN is not yet well accepted. In the present study we describe haemodynamic changes after RDN as compared to individually adjusted drug therapy in patients with TRH. Design and method: We analyzed the haemodynamic data from the Oslo RDN study, a randomized clinical trial investigating the BP lowering effect of RDN (n = 9) vs individualized drug therapy guided by noninvasive haemodynamic measurements (n = 10) in patients with TRH. TRH was confirmed with ambulatory BP measurement after witnessed intake of antihypertensive drugs. Haemodynamic data were obtained using a validated noninvasive impedance cardiography device. We aimed in this study to characterize the haemodynamic changes after RDN and individualized drug therapy, evaluated with Friedman test at baseline, and at 3 and 6 months follow up. Only significant results were further investigated with Wilcoxon signed rank test. Results: Median systemic vascular resistance index (SVRI) in the RDN group significantly decreased with 599 dyn*s*cm^-5*m 2 between 3 and 6 months (p = 0.015). There were no significant changes in cardiac index (CI) or left stroke work index (LSWI), but heart rate increased with 5 bpm in the same period (p = 0.038). Simultaneously supine mean arterial and diastolic BPs decreased significantly; 13 mmHg (p = 0.015) and 10 mmHg (p = 0.008) respectively. In the individualized drug therapy group, CI slightly decreased by 0.1 L/min/m 2 from baseline to 6 months follow up (p = 0.047) and LSWI decreased 14.1 g.m/m 2 in the same time period (p = 0.013). There was a significant overall change in SVRI (p = 0.014). Supine mean arterial, systolic and diastolic BP levels were all significantly decreased from baseline to 6 months; 15 mmHg (p = 0.005), 17 mmHg (p = 0.007) and 14 mmHg (p = 0.005), respectively. Conclusions: RDN induced a late (after 3 months) reduction in systemic vascular resistance corresponding to reduced supine BPs, while individualized drug therapy caused a decrease in CI and LSWI, possibly indicating reduced circulating volume corresponding to reduced supine BPs.