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J Am Heart Assoc. 2017 Oct 10;6(10). pii: e007062. doi: 10.1161/JAHA.117.007062.

Abdominal Aortic Calcifications Influences the Systemic and Renal Hemodynamic Response to Renal Denervation in the DENERHTN (Renal Denervation for Hypertension) Trial.

Author information

1
Hôpital Croix-Rousse, Cardiology Department, European Society of Hypertension Excellence Centre, Hospices Civils de Lyon, France.
2
CREATIS UMR5220 INSERM U1044 INSA-Lyon Université de Lyon Université Claude Bernard Lyon 1, Lyon, France.
3
Clinical Research Unit, Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France.
4
INSERM CIC1418 Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France.
5
Vascular and Oncological Interventional Radiology Department, Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France.
6
Cardiology/Hypertension Department, Centre Hospitalier Universitaire de Bordeaux Hôpital Saint André, Bordeaux, France.
7
Institut Mutualiste Montsouris, Paris, France.
8
Hypertension Unit, Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France.
9
Hôpital Cardiologique, Médecine Vasculaire et HTA, Centre Hospitalier Régional Universitaire de Lille, France.
10
Hôpital Arthur Gardiner, Centre d'excellence en HTA Rennes-Dinard, Dinard, France.
11
Service de Cardiologie et Maladies Vasculaires, Centre Hospitalier Universitaire de Rennes, France.
12
Hôpital Bretonneau, Tours, France.
13
Hôpital de la Pitié Salpétrière, Paris, France.
14
Inserm Centre d'Investigations Cliniques-1433 Inserm U1116 CHRU Nancy F-CRIN INI-CRCT Université de Lorraine, Nancy, France.
15
CHU de Grenoble, France.
16
CHU de la Timone, Marseille, France.
17
Cardiology Department, CHU de Poitiers, Poitiers, France.
18
Hôpital Lapeyronie, Montpellier, France.
19
Hôpital Arnaud de Villeneuve, Montpellier, France.
20
CHU Rangueil, Toulouse, France.
21
Hôpital Avicenne, Bobigny, France.
22
Hôpital Pasteur, Nice, France.
23
Paris-Descartes University, Paris, France.
24
INSERM CIC1418 Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France michel.azizi@aphp.fr.

Abstract

BACKGROUND:

The DENERHTN (Renal Denervation for Hypertension) trial confirmed the efficacy of renal denervation (RDN) in lowering daytime ambulatory systolic blood pressure when added to standardized stepped-care antihypertensive treatment (SSAHT) for resistant hypertension at 6 months.

METHODS AND RESULTS:

This post hoc exploratory analysis assessed the impact of abdominal aortic calcifications (AAC) on the hemodynamic and renal response to RDN at 6 months. In total, 106 patients with resistant hypertension were randomly assigned to RDN plus SSAHT or to the same SSAHT alone (control group). Total AAC volume was measured, with semiautomatic software and blind to randomization, from the aortic hiatus to the iliac bifurcation using the prerandomization noncontrast abdominal computed tomography scans of 90 patients. Measurements were expressed as tertiles. The baseline-adjusted difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the RDN and control groups was -10.1 mm Hg (P=0.0462) in the lowest tertile and -2.5 mm Hg (P=0.4987) in the 2 highest tertiles of AAC volume. Estimated glomerular filtration rate remained stable at 6 months for the patients in the lowest tertile of AAC volume who underwent RDN (+2.5 mL/min per 1.73 m2) but decreased in the control group (-8.0 mL/min per 1.73 m2, P=0.0148). In the 2 highest tertiles of AAC volume, estimated glomerular filtration rate decreased similarly in the RDN and control groups (P=0.2640).

CONCLUSIONS:

RDN plus SSAHT resulted in a larger decrease in daytime ambulatory systolic blood pressure than SSAHT alone in patients with a lower AAC burden than in those with a higher AAC burden. This larger decrease in daytime ambulatory systolic blood pressure was not associated with a decrease in estimated glomerular filtration rate.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01570777.

KEYWORDS:

antihypertensive therapy/sympathetic nervous system; aortic calcification; aortic disease; atherosclerosis; renal denervation; resistant hypertension

PMID:
29018027
PMCID:
PMC5721886
DOI:
10.1161/JAHA.117.007062
[Indexed for MEDLINE]
Free PMC Article

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