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Blood Pressure Response to Main Renal Artery and Combined Main Renal Artery Plus Branch Renal Denervation in Patients With Resistant Hypertension
BACKGROUND: Single‐electrode ablation of the main renal artery for renal sympathetic denervation showed mixed blood pressure (BP)‐lowering effects. Further improvement of the technique seems crucial to optimize effectiveness of the procedure. Because sympathetic nerve fibers are closer to the lumen...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586457/ https://www.ncbi.nlm.nih.gov/pubmed/28862930 http://dx.doi.org/10.1161/JAHA.117.006196 |
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author | Fengler, Karl Ewen, Sebastian Höllriegel, Robert Rommel, Karl‐Philipp Kulenthiran, Saaraaken Lauder, Lucas Cremers, Bodo Schuler, Gerhard Linke, Axel Böhm, Michael Mahfoud, Felix Lurz, Philipp |
author_facet | Fengler, Karl Ewen, Sebastian Höllriegel, Robert Rommel, Karl‐Philipp Kulenthiran, Saaraaken Lauder, Lucas Cremers, Bodo Schuler, Gerhard Linke, Axel Böhm, Michael Mahfoud, Felix Lurz, Philipp |
author_sort | Fengler, Karl |
collection | PubMed |
description | BACKGROUND: Single‐electrode ablation of the main renal artery for renal sympathetic denervation showed mixed blood pressure (BP)‐lowering effects. Further improvement of the technique seems crucial to optimize effectiveness of the procedure. Because sympathetic nerve fibers are closer to the lumen in the distal part of the renal artery, treatment of the distal main artery and its branches has been shown to reduce variability in treatment effects in preclinical studies and a recent randomized trial. Whether this optimized technique improves clinical outcomes remains uncertain. We report a 2‐center experience of main renal artery and combined main renal artery plus branches renal denervation in patients with resistant hypertension using a multielectrode catheter. METHODS AND RESULTS: Twenty‐five patients with therapy‐resistant hypertension underwent renal sympathetic denervation with combined main renal artery and renal branch ablation and were compared to matched controls undergoing an ablation of the main renal artery only. BP change was assessed by ambulatory measurement at baseline and after 3 months. At baseline, BP was balanced between the groups. After 3 months, BP changed significantly in the combined ablation group (systolic/diastolic 24‐hour mean and daytime mean BP −8.5±9.8/−7.0±10.7 and −9.4±9.8/−7.1±13.5 mm Hg, P<0.001/0.003 and <0.001/0.016, respectively), but not in patients with main artery treatment (−3.5±11.1/−2.0±7.6 and −2.8±10.9/−1.8±7.7 mm Hg, P=0.19/0.20 and 0.19/0.24, respectively). Systolic daytime BP was significantly more reduced in patients with combined ablation than in patients with main artery ablation (P=0.033). CONCLUSIONS: Combined ablation of the main renal artery and branches appears to improve BP‐lowering efficacy and should be further investigated. |
format | Online Article Text |
id | pubmed-5586457 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-55864572017-09-11 Blood Pressure Response to Main Renal Artery and Combined Main Renal Artery Plus Branch Renal Denervation in Patients With Resistant Hypertension Fengler, Karl Ewen, Sebastian Höllriegel, Robert Rommel, Karl‐Philipp Kulenthiran, Saaraaken Lauder, Lucas Cremers, Bodo Schuler, Gerhard Linke, Axel Böhm, Michael Mahfoud, Felix Lurz, Philipp J Am Heart Assoc Original Research BACKGROUND: Single‐electrode ablation of the main renal artery for renal sympathetic denervation showed mixed blood pressure (BP)‐lowering effects. Further improvement of the technique seems crucial to optimize effectiveness of the procedure. Because sympathetic nerve fibers are closer to the lumen in the distal part of the renal artery, treatment of the distal main artery and its branches has been shown to reduce variability in treatment effects in preclinical studies and a recent randomized trial. Whether this optimized technique improves clinical outcomes remains uncertain. We report a 2‐center experience of main renal artery and combined main renal artery plus branches renal denervation in patients with resistant hypertension using a multielectrode catheter. METHODS AND RESULTS: Twenty‐five patients with therapy‐resistant hypertension underwent renal sympathetic denervation with combined main renal artery and renal branch ablation and were compared to matched controls undergoing an ablation of the main renal artery only. BP change was assessed by ambulatory measurement at baseline and after 3 months. At baseline, BP was balanced between the groups. After 3 months, BP changed significantly in the combined ablation group (systolic/diastolic 24‐hour mean and daytime mean BP −8.5±9.8/−7.0±10.7 and −9.4±9.8/−7.1±13.5 mm Hg, P<0.001/0.003 and <0.001/0.016, respectively), but not in patients with main artery treatment (−3.5±11.1/−2.0±7.6 and −2.8±10.9/−1.8±7.7 mm Hg, P=0.19/0.20 and 0.19/0.24, respectively). Systolic daytime BP was significantly more reduced in patients with combined ablation than in patients with main artery ablation (P=0.033). CONCLUSIONS: Combined ablation of the main renal artery and branches appears to improve BP‐lowering efficacy and should be further investigated. John Wiley and Sons Inc. 2017-08-10 /pmc/articles/PMC5586457/ /pubmed/28862930 http://dx.doi.org/10.1161/JAHA.117.006196 Text en © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Research Fengler, Karl Ewen, Sebastian Höllriegel, Robert Rommel, Karl‐Philipp Kulenthiran, Saaraaken Lauder, Lucas Cremers, Bodo Schuler, Gerhard Linke, Axel Böhm, Michael Mahfoud, Felix Lurz, Philipp Blood Pressure Response to Main Renal Artery and Combined Main Renal Artery Plus Branch Renal Denervation in Patients With Resistant Hypertension |
title | Blood Pressure Response to Main Renal Artery and Combined Main Renal Artery Plus Branch Renal Denervation in Patients With Resistant Hypertension |
title_full | Blood Pressure Response to Main Renal Artery and Combined Main Renal Artery Plus Branch Renal Denervation in Patients With Resistant Hypertension |
title_fullStr | Blood Pressure Response to Main Renal Artery and Combined Main Renal Artery Plus Branch Renal Denervation in Patients With Resistant Hypertension |
title_full_unstemmed | Blood Pressure Response to Main Renal Artery and Combined Main Renal Artery Plus Branch Renal Denervation in Patients With Resistant Hypertension |
title_short | Blood Pressure Response to Main Renal Artery and Combined Main Renal Artery Plus Branch Renal Denervation in Patients With Resistant Hypertension |
title_sort | blood pressure response to main renal artery and combined main renal artery plus branch renal denervation in patients with resistant hypertension |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586457/ https://www.ncbi.nlm.nih.gov/pubmed/28862930 http://dx.doi.org/10.1161/JAHA.117.006196 |
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