Sympathetic nerve traffic and blood pressure changes after bilateral renal denervation in resistant hypertension: A time-integrated analysis

Gino Seravalle, Graziella D'Arrigo, Giovanni Tripepi, Francesca Mallamaci, Gianmaria Brambilla, Giuseppe Mancia, Guido Grassi, Carmine Zoccali

Research output: Contribution to journalArticle

Abstract

Renal denervation reduces blood pressure (BP) and sympathetic drive in experimental animal models, but the effect of this intervention on sympathetic activity in patients with treatment-resistant hypertension is still unclear. Methods In an incident series of 29 patients with treatment-resistant hypertension, we performed serial measurements (n = 123) of muscle sympathetic nerve activity (MSNA, microneurography) and standardized BP measurements. Data were analysed by mixed linear modelling (MLM) and by regression analysis of time-integrated changes of both MSNA and synchronous, standardized (in-lab) BP measurements. Results Bilateral renal denervation was accompanied by a marked reduction in MSNA (P = 0.01 by MLM), which was parallelled by a reduction in systolic (from 175 ± 14 to 156 ± 16 mmHg) and, to a lesser extent, in diastolic (from 96 ± 12 to 87 ± 6 mmHg) BP over time. Neither systolic nor diastolic BP associated to a significant extent with corrected MSNA (MSNAC) in the MLM analysis (systolic BP versus MSNAC: β = â '0.08, P = 0.08; diastolic BP versus MSNAC: β = â '0.007, P = 0.75). However, the study of time-integrated changes in MSNA and BP showed a robust association between proportional changes in MSNA over time and simultaneous changes in systolic and diastolic BP (β = 0.61, P < 0.001 and β = 0.37 P < 0.05). Conclusions Time-integrated changes in MSNAC and BP after bilateral renal denervation document a close link between the sympathetic activity and BP responses to this procedure. These findings further strengthen the relevance of the sympathetic nervous system both in the pathophysiology of resistant hypertension and in the BP-lowering effect of the procedure.

Original languageEnglish
Pages (from-to)1351-1356
Number of pages6
JournalNephrology Dialysis Transplantation
Volume32
Issue number8
DOIs
Publication statusPublished - Aug 1 2017

Keywords

  • blood pressure
  • renal denervation
  • resistant hypertension
  • sympathetic activity

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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