Ambulatory arterial stiffness index as a predictor of blood pressure response to renal denervation

Yusuke Sata, Dagmara Hering, Geoffrey A. Head, Antony S. Walton, Karlheinz Peter, Petra Marusic, Jaqueline Duval, Rebecca Lee, Louise J. Hammond, Elisabeth A. Lambert, Gavin W. Lambert, Murray D. Esler, Markus P. Schlaich

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Renal denervation (RDN) can reduce blood pressure (BP) in patients with resistant hypertension, but less so in patients with isolated systolic hypertension. A possible explanation is that patients with stiffer arteries may have lesser neural contribution to their hypertension. Method: We hypothesized that arterial stiffness predicts the response to RDN. From ambulatory BP monitoring (ABPM), ambulatory arterial stiffness index (AASI) was calculated as 1 - the regression slope of DBP versus SBP. Results: In 111 patients with resistant hypertension, RDN reduced office and 24-h SBP after 3, 6, and 12 months (by -11 ± 22, -11 ± 25, -14 ± 21 mmHg for office, and -4 ± 11, -5 ± 12, -5 ± 15 mmHg for 24-h SBP, respectively, P < 0.01). Patients with baseline AASI above the median (>0.51) showed no change in 24-h SBP at 6 months after RDN (-0.4 ± 12.3 mmHg, P > 0.05), whereas an AASI below 0.51was associated with a marked reduction (-9.3 ± 11.0 mmHg, P < 0.01). Across AASI quartiles, patients in the highest quartile (AASI ≥ 0.60) had lower muscle sympathetic nerve activity than the other three quartiles (39 ± 13 versus 49 ± 13 bursts/min, P = 0.035). The responder rate, defined as a 24-h SBP reduction of at least 5% was 58% in the lowest AASI quartile (<0.45) and 16% in the highest quartile (≥0.60). After adjustment for age, sex, BMI, office and 24-h SBP, an AASI less than 0.51predicted those who respond to RDN (odds ratio 3.46, P = 0.04). Conclusion: We conclude that in patients with resistant hypertension, a lower AASI is an independent predictor of the BP response to RDN, possibly explained by a more pronounced neurogenic rather than biomechanical contribution to their BP elevation.

Original languageEnglish
Pages (from-to)1414-1422
Number of pages9
JournalJournal of Hypertension
Volume36
Issue number6
DOIs
Publication statusPublished - 1 Jun 2018

Keywords

  • ambulatory arterial stiffness index
  • hypertension
  • renal denervation
  • resistant
  • sympathetic

Cite this

Sata, Yusuke ; Hering, Dagmara ; Head, Geoffrey A. ; Walton, Antony S. ; Peter, Karlheinz ; Marusic, Petra ; Duval, Jaqueline ; Lee, Rebecca ; Hammond, Louise J. ; Lambert, Elisabeth A. ; Lambert, Gavin W. ; Esler, Murray D. ; Schlaich, Markus P. / Ambulatory arterial stiffness index as a predictor of blood pressure response to renal denervation. In: Journal of Hypertension. 2018 ; Vol. 36, No. 6. pp. 1414-1422.
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abstract = "Background: Renal denervation (RDN) can reduce blood pressure (BP) in patients with resistant hypertension, but less so in patients with isolated systolic hypertension. A possible explanation is that patients with stiffer arteries may have lesser neural contribution to their hypertension. Method: We hypothesized that arterial stiffness predicts the response to RDN. From ambulatory BP monitoring (ABPM), ambulatory arterial stiffness index (AASI) was calculated as 1 - the regression slope of DBP versus SBP. Results: In 111 patients with resistant hypertension, RDN reduced office and 24-h SBP after 3, 6, and 12 months (by -11 ± 22, -11 ± 25, -14 ± 21 mmHg for office, and -4 ± 11, -5 ± 12, -5 ± 15 mmHg for 24-h SBP, respectively, P < 0.01). Patients with baseline AASI above the median (>0.51) showed no change in 24-h SBP at 6 months after RDN (-0.4 ± 12.3 mmHg, P > 0.05), whereas an AASI below 0.51was associated with a marked reduction (-9.3 ± 11.0 mmHg, P < 0.01). Across AASI quartiles, patients in the highest quartile (AASI ≥ 0.60) had lower muscle sympathetic nerve activity than the other three quartiles (39 ± 13 versus 49 ± 13 bursts/min, P = 0.035). The responder rate, defined as a 24-h SBP reduction of at least 5{\%} was 58{\%} in the lowest AASI quartile (<0.45) and 16{\%} in the highest quartile (≥0.60). After adjustment for age, sex, BMI, office and 24-h SBP, an AASI less than 0.51predicted those who respond to RDN (odds ratio 3.46, P = 0.04). Conclusion: We conclude that in patients with resistant hypertension, a lower AASI is an independent predictor of the BP response to RDN, possibly explained by a more pronounced neurogenic rather than biomechanical contribution to their BP elevation.",
keywords = "ambulatory arterial stiffness index, hypertension, renal denervation, resistant, sympathetic",
author = "Yusuke Sata and Dagmara Hering and Head, {Geoffrey A.} and Walton, {Antony S.} and Karlheinz Peter and Petra Marusic and Jaqueline Duval and Rebecca Lee and Hammond, {Louise J.} and Lambert, {Elisabeth A.} and Lambert, {Gavin W.} and Esler, {Murray D.} and Schlaich, {Markus P.}",
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Ambulatory arterial stiffness index as a predictor of blood pressure response to renal denervation. / Sata, Yusuke; Hering, Dagmara; Head, Geoffrey A.; Walton, Antony S.; Peter, Karlheinz; Marusic, Petra; Duval, Jaqueline; Lee, Rebecca; Hammond, Louise J.; Lambert, Elisabeth A.; Lambert, Gavin W.; Esler, Murray D.; Schlaich, Markus P.

In: Journal of Hypertension, Vol. 36, No. 6, 01.06.2018, p. 1414-1422.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Ambulatory arterial stiffness index as a predictor of blood pressure response to renal denervation

AU - Sata, Yusuke

AU - Hering, Dagmara

AU - Head, Geoffrey A.

AU - Walton, Antony S.

AU - Peter, Karlheinz

AU - Marusic, Petra

AU - Duval, Jaqueline

AU - Lee, Rebecca

AU - Hammond, Louise J.

AU - Lambert, Elisabeth A.

AU - Lambert, Gavin W.

AU - Esler, Murray D.

AU - Schlaich, Markus P.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: Renal denervation (RDN) can reduce blood pressure (BP) in patients with resistant hypertension, but less so in patients with isolated systolic hypertension. A possible explanation is that patients with stiffer arteries may have lesser neural contribution to their hypertension. Method: We hypothesized that arterial stiffness predicts the response to RDN. From ambulatory BP monitoring (ABPM), ambulatory arterial stiffness index (AASI) was calculated as 1 - the regression slope of DBP versus SBP. Results: In 111 patients with resistant hypertension, RDN reduced office and 24-h SBP after 3, 6, and 12 months (by -11 ± 22, -11 ± 25, -14 ± 21 mmHg for office, and -4 ± 11, -5 ± 12, -5 ± 15 mmHg for 24-h SBP, respectively, P < 0.01). Patients with baseline AASI above the median (>0.51) showed no change in 24-h SBP at 6 months after RDN (-0.4 ± 12.3 mmHg, P > 0.05), whereas an AASI below 0.51was associated with a marked reduction (-9.3 ± 11.0 mmHg, P < 0.01). Across AASI quartiles, patients in the highest quartile (AASI ≥ 0.60) had lower muscle sympathetic nerve activity than the other three quartiles (39 ± 13 versus 49 ± 13 bursts/min, P = 0.035). The responder rate, defined as a 24-h SBP reduction of at least 5% was 58% in the lowest AASI quartile (<0.45) and 16% in the highest quartile (≥0.60). After adjustment for age, sex, BMI, office and 24-h SBP, an AASI less than 0.51predicted those who respond to RDN (odds ratio 3.46, P = 0.04). Conclusion: We conclude that in patients with resistant hypertension, a lower AASI is an independent predictor of the BP response to RDN, possibly explained by a more pronounced neurogenic rather than biomechanical contribution to their BP elevation.

AB - Background: Renal denervation (RDN) can reduce blood pressure (BP) in patients with resistant hypertension, but less so in patients with isolated systolic hypertension. A possible explanation is that patients with stiffer arteries may have lesser neural contribution to their hypertension. Method: We hypothesized that arterial stiffness predicts the response to RDN. From ambulatory BP monitoring (ABPM), ambulatory arterial stiffness index (AASI) was calculated as 1 - the regression slope of DBP versus SBP. Results: In 111 patients with resistant hypertension, RDN reduced office and 24-h SBP after 3, 6, and 12 months (by -11 ± 22, -11 ± 25, -14 ± 21 mmHg for office, and -4 ± 11, -5 ± 12, -5 ± 15 mmHg for 24-h SBP, respectively, P < 0.01). Patients with baseline AASI above the median (>0.51) showed no change in 24-h SBP at 6 months after RDN (-0.4 ± 12.3 mmHg, P > 0.05), whereas an AASI below 0.51was associated with a marked reduction (-9.3 ± 11.0 mmHg, P < 0.01). Across AASI quartiles, patients in the highest quartile (AASI ≥ 0.60) had lower muscle sympathetic nerve activity than the other three quartiles (39 ± 13 versus 49 ± 13 bursts/min, P = 0.035). The responder rate, defined as a 24-h SBP reduction of at least 5% was 58% in the lowest AASI quartile (<0.45) and 16% in the highest quartile (≥0.60). After adjustment for age, sex, BMI, office and 24-h SBP, an AASI less than 0.51predicted those who respond to RDN (odds ratio 3.46, P = 0.04). Conclusion: We conclude that in patients with resistant hypertension, a lower AASI is an independent predictor of the BP response to RDN, possibly explained by a more pronounced neurogenic rather than biomechanical contribution to their BP elevation.

KW - ambulatory arterial stiffness index

KW - hypertension

KW - renal denervation

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KW - sympathetic

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