Blood Pressure and Renal Responses to Orthostatic Stress Before and After Radiofrequency Renal Denervation in Patients with Resistant Hypertension

Yann Vuignier, Eric Grouzmann, Olivier Muller, Nima Vakilzadeh, Mohamed Faouzi, Marc P Maillard, Salah D Qanadli, Michel Burnier, Grégoire Wuerzner, Yann Vuignier, Eric Grouzmann, Olivier Muller, Nima Vakilzadeh, Mohamed Faouzi, Marc P Maillard, Salah D Qanadli, Michel Burnier, Grégoire Wuerzner

Abstract

Background/aims: In patients with resistant hypertension, renal denervation (RDN) studies have mainly focused their outcomes on blood pressure (BP). The aim of this study was to evaluate the long-term effect of RDN on neurohormonal profiles, renal hemodynamics and sodium excretion in a resting state and during stress induced by lower body negative pressure (LBNP).

Materials and methods: This was a single center prospective observational study. Norepinephrine, plasma renin activity (PRA), glomerular filtration rate (GFR), renal plasma flow (RPF) and sodium excretion were measured in unstimulated conditions (rest) and after one hour of LBNP at three different time points: before (M0), one (M1) and twelve months (M12) after RDN.

Results: Thirteen patients with resistant hypertension were included. In the resting state, no differences were observed in norepinephrine, PRA, sodium excretion and mean BP levels after RDN. GFR (78 ± 32 ml/min at M0 vs 66 ± 26 ml/min at M12 (p = 0.012) and filtration fraction (22.6 ±5.4% at M0 vs 15.1 ±5.3% at M12 (p = 0.002)) both decreased after RDN. During LBNP, the magnitude of the mean BP increase was reduced from +6.8 ± 6.6 mm Hg at M0 to +2.3 ± 1.3 mm Hg at M12 (p = 0.005). The LBNP-induced increase in norepinephrine and decrease in GFR and sodium excretion observed before RDN were blunted after the procedure.

Conclusion: A decrease in GFR and filtration fraction was observed one year after RDN. In addition, our results suggest that RDN blunts not only the norepinephrine but also the mean BP, the GFR and the sodium excretion responses to an orthostatic stress one year after the intervention.

Registry number: NCT01734096.

Keywords: glomerular filtration rate; hypertension; lower body negative pressure; renal denervation; renal plasma flow; sodium excretion; sympathetic nervous system.

Figures

Figure 1
Figure 1
Study day schedule, which was repeated before renal denervation (M0), one month after renal denervation (M1) and 12 months after renal denervation (M12). LBNP, lower body negative pressure; PAH, para-amino hippurate. Infusion of inulin and PAH were used to measure glomerular filtration rate and renal plasma flow. LBNP was fixed at −30 mbar for one hour.
Figure 2
Figure 2
Norepinephrine (NE), Plasma renin activity (PRA) and twenty-four hour sodium excretion (UNa 24H) in healthy normotensive volunteers (HV, N = 20), obese normotensive and hypertensive patients (OB, N = 20), and in hypertensive resistant patients (RH, N = 13). NE, PRA and UNa 24H were measured in the same experimental setting. Data are expressed as median and interquartile range, minimum and maximum (A) and mean ± SD (B).
Figure 3
Figure 3
Resting filtration fraction (FF) before renal denervation (M0), 1 month (M0) and 12 months (M12) after renal denervation. Data are median, interquartile range, minimum and maximum. The small header shows individual changes.
Figure 4
Figure 4
Changes in mean blood pressure (MBP) induced by lower body negative pressure before RDN (M0), 1 month (M1) and 12 months (M12) after renal denervation. Data are median and interquartile range, minimum and maximum. The small header shows individual changes.

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