Ambulatory arterial stiffness index as a predictor of blood pressure response to renal denervation*. Issue 6 (June 2018)

• Record Type: Journal Article
• Authors: Sata, Yusuke; Hering, Dagmara; Head, Geoffrey A.; Walton, Antony S.; Peter, Karlheinz; Marusic, Petra; Duval, Jaqueline; Lee, Rebecca; Hammond, Louise J.; Lambert, Elisabeth A.; Lambert, Gavin W.; Esler, Murray D.; Schlaich, Markus P.
• Is Part Of: Journal of hypertension. Volume 36:Issue 6(2018:Jun.)
• Publication Date: 2018-06
• Subjects: ambulatory arterial stiffness index -- hypertension -- renal denervation -- resistant -- sympathetic; Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/HJH.0000000000001682
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Background: Renal denervation (RDN) can reduce blood pressure (BP) in patients with resistant hypertension, but less so in patients with isolated systolic hypertension. A possible explanation is that patients with stiffer arteries may have lesser neural contribution to their hypertension. Method: We hypothesized that arterial stiffness predicts the response to RDN. From ambulatory BP monitoring (ABPM), ambulatory arterial stiffness index (AASI) was calculated as 1 − the regression slope of DBP versus SBP. Results: In 111 patients with resistant hypertension, RDN reduced office and 24-h SBP after 3, 6, and 12 months (by −11 ± 22, −11 ± 25, −14 ± 21 mmHg for office, and −4 ± 11, −5 ± 12, −5 ± 15 mmHg for 24-h SBP, respectively, P < 0.01). Patients with baseline AASI above the median (>0.51) showed no change in 24-h SBP at 6 months after RDN (−0.4 ± 12.3 mmHg, P > 0.05), whereas an AASI below 0.51was associated with a marked reduction (−9.3 ± 11.0 mmHg, P < 0.01). Across AASI quartiles, patients in the highest quartile (AASI ≥ 0.60) had lower muscle sympathetic nerve activity than the other three quartiles (39 ± 13 versus 49 ± 13 bursts/min, P = 0.035). The responder rate, defined as a 24-h SBP reduction of at least 5% was 58% in the lowest AASI quartile (<0.45) and 16% in the highest quartile (≥0.60). After adjustment for age, sex, BMI, office and 24-h SBP, an AASI less than 0.51predicted those who respond to RDN (odds ratio 3.46, P = 0.04). Conclusion: We conclude that in patients with resistant hypertension, a lower AASI is an independent predictor of the BP response to RDN, possibly explained by a more pronounced neurogenic rather than biomechanical contribution to their BP elevation. Abstract : Supplemental Digital Content is available in the text