Renal Nerve Stimulation–Induced Blood Pressure Changes Predict Ambulatory Blood Pressure Response After Renal Denervation

Abstract

R enal denervation (RDN) has been reported as a successful treatment of resistant hypertension in multiple trials studying the efficacy of RDN. [1][2][3][4][5][6] The sham-controlled Symplicity Hypertension-3 (HTN-3) trial, however, failed to show significant RDN-induced changes in blood pressure (BP) versus control, 7 raising serious doubts about the efficacy of RDN. 8-11Variable effects of RDN on BP have been reported, with a wide spectrum ranging between nonresponse to marked reduction in BP. 12 The absence of an ablation procedural end point for RDN is a potential explanation for variable responses, and the successful implementation of a reliably predictable end point could improve procedural success and clinical response.Recently, we reported on the feasibility of high-frequency electric renal nerve stimulation (RNS) in patients with resistant hypertension and demonstrated that RNS-induced BP increase was significantly blunted after RDN. 13 We hypothesized that the difference between RNS-induced BP rise before and after RDN could be used as a procedural end point for RDN and may prove a reliable functional test to predict BP response to RDN. The main goal of the current analysis was to investigate the 24-hour ambulatory BP changes after RDN and the relation to RNS before and after RDN. Methods PatientsAll patients with treatment-resistant hypertension referred for RDN between May 2014 and February 2015 were screened for inclusion in the RNS study. Patients were eligible if they were on a stable Abstract-Blood pressure (BP) response to renal denervation (RDN) is highly variable and its effectiveness debated. A procedural end point for RDN may improve consistency of response. The objective of the current analysis was to look for the association between renal nerve stimulation (RNS)-induced BP increase before and after RDN and changes in ambulatory BP monitoring (ABPM) after RDN. Fourteen patients with drug-resistant hypertension referred for RDN were included. RNS was performed under general anesthesia at 4 sites in the right and left renal arteries, both before and immediately after RDN. RNS-induced BP changes were monitored and correlated to changes in ambulatory BP at a follow-up of 3 to 6 months after RDN. RNS resulted in a systolic BP increase of 50±27

Effects of renal sympathetic denervation on the stellate ganglion and brain stem in dogs

“…A recent study suggested that renal nerve stimulation can be used as an acute end point for RD. 31 However, we did not perform renal nerve stimulation during the procedure. We observed only an insignificant decrease in serum norepinephrine level, consistent with that reported by Linz et al 32 These findings suggest that the serum norepinephrine levels may have limited sensitivity in detecting the changes of norepinephrine release in various organs.…”

Efficiency and Safety of Bipolar Renal Denervation and the Role of Renal Nerves Stimulation in the Prognosis of Intervention Outcomes

“…Стимуляция осуществлялась в двух зонах почечной артерии (в области верхней стенки проксимально и дистально). Зоны для стимуляции были выбраны на основании литературных данных [9]. Длительность одного цикла стимуляции составляла 60 с или менее в случае повы шения АД более 180 мм рт.…”

“…В ряде экспериментальных исследований для оценки полноты вмешательства был применен ме тод оценки реакции АД на стимуляцию почечных нервов до и после аблации [8,9]. В клиническом исследовании deJong MR на 19 пациентах было по казано, что ответ на стимуляцию почечных нервов коррелирует с отдаленными результатами аблации, однако неясно, обусловлено ли это полнотой абла ции или вкладом данного механизма в развитие АГ в каждом конкретном случае.…”

Attenuation of Splanchnic Autotransfusion Following Noninvasive Ultrasound Renal Denervation: A Novel Marker of Procedural Success

“…Renal nerve stimulation‐induced BP increase pre‐ and post‐RDN has been shown to be a good marker to predict BP response and assess efficacy of RDN but requires further validation 15. Thus, there remains a pressing need to identify valid biomarkers to confirm procedural success that are noninvasive and easy to use in everyday clinical practice.…”