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de Jong MR, Hoogerwaard AF, Gal P, Adiyaman A, Smit JJJ, Delnoy PPH, Ramdat Misier AR, van Hasselt BA, Heeg JE, le Polain de Waroux JB, Lau EO, Staessen JA, Persu A, Elvan A. Persistent Increase in Blood Pressure After Renal Nerve Stimulation in Accessory Renal Arteries After Sympathetic Renal Denervation. Hypertension 2016; 67:1211-7. [DOI: 10.1161/hypertensionaha.115.06604] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 03/22/2016] [Indexed: 12/17/2022]
Abstract
Blood pressure response to renal denervation is highly variable, and the proportion of responders is disappointing. This may be partly because of accessory renal arteries too small for denervation, causing incomplete ablation. Renal nerve stimulation before and after renal denervation is a promising approach to assess completeness of renal denervation and may predict blood pressure response to renal denervation. The objective of the current study was to assess renal nerve stimulation–induced blood pressure increase before and after renal sympathetic denervation in main and accessory renal arteries of anaesthetized patients with drug-resistant hypertension. The study included 21 patients. Nine patients had at least 1 accessory renal artery in which renal denervation was not feasible. Renal nerve stimulation was performed in the main arteries of all patients and in accessory renal arteries of 6 of 9 patients with accessory arteries, both before and after renal sympathetic denervation. Renal nerve stimulation before renal denervation elicited a substantial increase in systolic blood pressure, both in main (25.6±2.9 mm Hg;
P
<0.001) and accessory (24.3±7.4 mm Hg;
P
=0.047) renal arteries. After renal denervation, renal nerve stimulation–induced systolic blood pressure increase was blunted in the main renal arteries (Δ systolic blood pressure, 8.6±3.7 mm Hg;
P
=0.020), but not in the nondenervated renal accessory renal arteries (Δ systolic blood pressure, 27.1±7.6 mm Hg;
P
=0.917). This residual source of renal sympathetic tone may result in persistent hypertension after ablation and partly account for the large response variability.
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Affiliation(s)
- Mark R. de Jong
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Annemiek F. Hoogerwaard
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Pim Gal
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Ahmet Adiyaman
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Jaap Jan J. Smit
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Peter Paul H.M. Delnoy
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Anand R. Ramdat Misier
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Boudewijn A.A.M. van Hasselt
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Jan-Evert Heeg
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Jean-Benoit le Polain de Waroux
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Elizabeth O.Y. Lau
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Jan A. Staessen
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Alexandre Persu
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
| | - Arif Elvan
- From the Departments of Cardiology, Internal Medicine and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.F.H., P.G., A.A., J.J.J.S., P.P.H.M.D., A.R.R.M., B.A.A.M.v.H., J.-E.H., A.E.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (J.-B.l.P.d.W., A.P.); Center for
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