Christian Ott1, Felix Mahfoud2, Axel Schmid3, Tilmann Ditting1, Roland Veelken1, Sebastian Ewen2, Christian Ukena2, Michael Uder3, Michael Böhm2, Roland E Schmieder4. 1. Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Germany. 2. Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. 3. Department of Radiology, University of Erlangen-Nuremberg, Germany. 4. Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Germany. Electronic address: roland.schmieder@uk-erlangen.de.
Abstract
OBJECTIVES: The primary objective of this study was the effect of renal denervation (RDN) on elevated urinary albumin-to-creatinine ratio (UACR) in treatment-resistant hypertensive patients. In addition, patients were stratified according their UACR at baseline into micro- (30-300 mg/g, n=37) and macroalbuminuria (≥ 300 mg/g, <2,200 mg/g, n=22). BACKGROUND: Increased albuminuria indicates cardiovascular and renal damage in hypertension. RDN emerged as an innovative interventional approach to reduce blood pressure (BP) and may thus reduce albumin urinary excretion. METHODS: Fifty-nine treatment-resistant hypertensive patients with elevated UACR at baseline underwent catheter-based RDN using the Symplicity Flex™ catheter (Medtronic Inc., Santa Rosa, CA). RESULTS: In the whole and pre-specified subgroups both office and 24-h ambulatory BP were significantly reduced 6 months after RDN. In parallel, a significant reduction in UACR occurred in all patients (160 (65-496) versus 89 (29-319) mg/g creatinine, p<0.001) and in both subgroups (microalbuminuria: 83 (49-153) versus 58 (17-113) mg/g creatinine, p=0.001; macroalbuminuria: (536 (434-1483) versus 478 (109-1080) mg/g creatinine, p<0.001). In accordance, the prevalence of micro- and macroalbuminuria decreased significantly. Regression analysis revealed a modest positive relationship between the decrease of UACR and the fall of systolic BP (β=0.340, p=0.039) independent of renal function. Renal function remained unchanged after RDN. CONCLUSIONS: In summary, following RDN, the magnitude of albuminuria as well as the prevalence of micro- and macroalbuminuria decreased in treatment-resistant hypertensive patients. Since albuminuria is an independent renal and cardiovascular risk factor, our findings suggest a reduction of renal and cardiovascular risk in these patients.
OBJECTIVES: The primary objective of this study was the effect of renal denervation (RDN) on elevated urinary albumin-to-creatinine ratio (UACR) in treatment-resistant hypertensivepatients. In addition, patients were stratified according their UACR at baseline into micro- (30-300 mg/g, n=37) and macroalbuminuria (≥ 300 mg/g, <2,200 mg/g, n=22). BACKGROUND: Increased albuminuria indicates cardiovascular and renal damage in hypertension. RDN emerged as an innovative interventional approach to reduce blood pressure (BP) and may thus reduce albumin urinary excretion. METHODS: Fifty-nine treatment-resistant hypertensivepatients with elevated UACR at baseline underwent catheter-based RDN using the Symplicity Flex™ catheter (Medtronic Inc., Santa Rosa, CA). RESULTS: In the whole and pre-specified subgroups both office and 24-h ambulatory BP were significantly reduced 6 months after RDN. In parallel, a significant reduction in UACR occurred in all patients (160 (65-496) versus 89 (29-319) mg/g creatinine, p<0.001) and in both subgroups (microalbuminuria: 83 (49-153) versus 58 (17-113) mg/g creatinine, p=0.001; macroalbuminuria: (536 (434-1483) versus 478 (109-1080) mg/g creatinine, p<0.001). In accordance, the prevalence of micro- and macroalbuminuria decreased significantly. Regression analysis revealed a modest positive relationship between the decrease of UACR and the fall of systolic BP (β=0.340, p=0.039) independent of renal function. Renal function remained unchanged after RDN. CONCLUSIONS: In summary, following RDN, the magnitude of albuminuria as well as the prevalence of micro- and macroalbuminuria decreased in treatment-resistant hypertensivepatients. Since albuminuria is an independent renal and cardiovascular risk factor, our findings suggest a reduction of renal and cardiovascular risk in these patients.
Authors: Branko Braam; Sandra J Taler; Mahboob Rahman; Jennifer A Fillaus; Barbara A Greco; John P Forman; Efrain Reisin; Debbie L Cohen; Mohammad G Saklayen; S Susan Hedayati Journal: Clin J Am Soc Nephrol Date: 2016-11-28 Impact factor: 8.237
Authors: Christian Ott; Joanna M Harazny; Axel Schmid; Tilmann Ditting; Roland Veelken; Marek Bladowski; Georg Michelson; Michael Uder; Roland E Schmieder Journal: Clin Res Cardiol Date: 2015-04-28 Impact factor: 5.460