The effect of two different renal denervation strategies on blood pressure in resistant hypertension: Comparison of full-length versus proximal renal artery ablation.

BackgroundRenal denervation (RDN) is used to manage blood pressure (BP) in patients with resistant hypertension (rHT), but effectiveness is still a concern, and key arterial portion for successful RDN is not clear. ObjectiveThe aim of this study was to investigate the efficacy and safety of proximal versus full-length renal artery ablation in patients with resistant hypertension (rHT). MethodsForty-seven patients with rHT were randomly assigned to receive full-length ablation (n=23) or proximal ablation (n=24) of the renal arteries. All lesions were treated with radiofrequency energy via a saline-irrigated catheter. Office BP was measured during 12 months of follow-up and ambulatory BP at baseline and 6 months (n=15 in each group). ResultsCompared with full-length ablation, proximal ablation reduced the number of ablation points in both the right (6.10.7 vs. 3.3 +/- 0.6, P<0.001) and the left renal arteries (6.2 +/- 0.7 vs. 3.3 +/- 0.8, P<0.001), with significantly shorter RF delivery time (P<0.001), but higher RF power (P=0.011). Baseline office BPs was 179.4 +/- 13.7/102.8 +/- 9.4 mm Hg in the full-length group and 181.9 +/- 12.8/103.5 +/- 8.9 mm Hg in the proximal group (P>0.5). Similar office BPs was reduced by -39.4 +/- 11.5/-20.9 +/- 7.1 mm Hg at 6 months and -38.2 +/- 10.3/-21.5 +/- 5.8 mm Hg at 12 months in the full-length group (P<0.001), -42.0 +/- 11.6/-21.4 +/- 7.9 mm Hg at 6 months and -40.9 +/- 10.3/-22.1 +/- 5.6 mm Hg at 12 months in the proximal group (P<0.001), and progressive BP reductions were observed over the 6 months (P<0.001) in both groups. The drop in ambulatory 24-hr SBP and DBP were significantly less than the drop in office BP (P<0.001). No renovascular or other adverse complications were observed. ConclusionsThe results indicate that proximal RDN has a similar efficacy and safety profile compared with full-length RDN, and propose the proximal artery as the key portion for RDN. (c) 2016 Wiley Periodicals, Inc.