Renal sympathetic denervation in therapy resistant hypertension - pathophysiological aspects and predictors for treatment success

Table 1 Effects of renal sympathetic denervation

Ref.	Year	n (RDN/control)	Effector	Effect	Control
Ott et al[15]	2013	19/-	Renal blood flow	None	None
Pöss et al[19]	2015	137/-	Renal sodium excretion	Increased sodium excretion, less pronounced in responders	None
Mahfoud et al[24] Doltra et al[25] McLellan et al[26] Lu et al[27]	2014 2014 2015 2016	55/17 5/23 14/- 139/-	Left ventricular mass	Reduced left ventricular mass after RDN	Medical therapy Medical therapy None Meta-analysis
McLellan et al[26]	2015	14/-	Atrial conduction	Improved atrial conduction after RDN	None
Qiu et al[31]	2016	21/-	Persistent atrial fibrillation	Reduced heart rate after RDN	None
Armaganijan et al[36]	2015	10/-	Ventricular arrhythmia	Reduced frequency of ventricular arrhythmia episodes	None
Ott et al[15] Brandt et al[38] Mortensen et al[39] Hering et al[40] Okon et al[41]	2013 2012 2012 2013 2016	19/- 110/10 21/- 40/10 23/-	Central hemo-dynamics	Reduced central BP and augmentation index after RDN Reduced aortic pulse pressure, pulse wave velocity and augmentation index Reduced augmentation index Unchanged invasive pulse wave velocity after RDN	None Medical None Medical None
Donazzan et al[51] van Brussel et al[52] Tsioufis et al[53] Vink et al[55] Brinkmann et al[56] Hering et al[57] Dörr et al[58,59]	2015 2016 2014 2014 2012 2013 2015 2015	11/- 21/- 14/- 13/- 12/- 10/25 150/- 100/-	Sympathetic activity	Reduced cardiac sympathetic activity after RDN Unchanged cardiac sympathetic activity after RDN Reduced heart rate and arrhythmia burden and improved heart rate variability after RDN Unchanged muscle sympathetic nervous activity after RDN Reduced muscle sympathetic nervous activity after RDN Reduced Neuropeptide Y and transiently reduced brain derived neutrophic factor after RDN	None None None None None Medical None
Dörr et al[63]	2015	60/-	Inflammation	Reduced systemic inflammation after RDN	None
Mahfoud et al[65] Verloop et al[66]	2011 2015	37/13 29/-	Insulin sensitivity	Improved insulin sensitivity after RDN Unchanged insulin sensitivity	Medical None
Ewen et al[71] Ukena et al[69] Fengler et al[70]	2014 2011 2016	50/10 37/9 22/26	Exercise testing	Reduced Exercise BP after RDN	Medical Medical Sham
Lenski et al[72]	2013	36	Orthostatic reaction	None	None

BP: Blood pressure; RDN: Renal sympathetic denervation.

Table 2 Blood pressure effects of renal sympathetic denervation

Ref.	Year	Control	n (RDN/control)	Systolic office BP (mmHg)	P-value	Systolic ambulatory BP (mmHg)	P-value
Krum et al[7]	2009	None	50	-22	< 0.001a	NA	NA
Esler et al[11]	2010	RDN vs medical	106 (52/54)	-32 vs 1	< 0.00001b	-11/-7 vs -3/-1	NA
Bhatt et al[8]	2014	RDN vs sham	535 (364/171)	-14 vs -12	0.26b	-6.8 vs -4.8	0.98b
Desch et al[10]	2015	RDN vs sham	71 (35/36, intention to treat)	NA	NA	-8.5 vs -4.7	0.06b
			63 (29/34, per protocol)	NA	NA	-8.3 vs -3.5	0.04b
Rosa et al[13]	2015	RDN vs intensified medical treatment	106 (52/54)	-12 vs -14	< 0.001a/0.60b	-8.6 vs -8.1	< 0.001a/0.87b
Azizi et al[14]	2015	Stepped-care antihypertensive treatment with vs without RDN	106 (53/53)	-15 vs -9	0.15b	-15.8 vs -9.9	0.03b
Böhm et al[12]	2015	None	998	-12	< 0.00001a	-6.6	< 0.00001a

^aP-value for within group change;

^bP-value for between group change. BP: Blood pressure; RDN: Renal sympathetic denervation; NA: Not available.

Table 3 Predictors for blood pressure change after renal sympathetic denervation

Ref.	Year	Patients	Predictor
Böhm et al[12]	2015	998	Higher baseline BP predicts better BP response to RDN
Kandzari et al[73]	2015	364
Id et al[76]	2013	74	Less BP response to RDN if accessories are present
Ewen et al[89]	2015	126	Better BP response in patients with combined vs isolated systolic hypertension
Okon et al[41]	2016	58	Lower pulse wave velocity predicts BP response
Zuern et al[88]	2013	40	Better BP response in patients with impaired baroreflex sensitivity

BP: Blood pressure; RDN: Renal sympathetic denervation.