With BP lowering, renal denervation may improve cardiac structure, function
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Key takeaways:
- A meta-analysis suggests renal denervation treatment improves measures of cardiac structure in addition to lowering BP.
- The findings need to be confirmed in larger studies.
Among adults with apparent resistant hypertension, treatment with renal denervation improved left ventricular hypertrophy and LV ejection fraction but had no significant effect on diastolic function, according to a new meta-analysis.
Studies have shown that renal denervation can improve BP and reduce the need for antihypertensive therapies; however, the effects of renal denervation cardiac remodeling and cardiac function are unclear, according to Bi Huang, MD, PhD, of the department of cardiology at The First Affiliated Hospital of Chongqing Medical University, China, and colleagues.
“Previous studies have demonstrated renal denervation as a promising strategy for patients with resistant hypertension, and current guidelines and consensus recommend that renal denervation may be a safe and effective method in patients with resistant hypertension,” Huang and colleagues wrote in Clinical Cardiology. “Although renal denervation can reliably lower BP, its influence on the cardiac structure and function is inconsistent in different studies due to relatively small sample size, high heterogeneity of enrolled patients, and differences in operating methods and experience among different centers.”
Huang and colleagues analyzed data from 433 adults with resistant hypertension who participated in 12 prospective renal denervation studies that reported echocardiographic data, published from 2012 to November 2022. Sample sizes across studies ranged from 13 to 66 patients; 58.4% were men; 42.9% had diabetes. Follow-up duration was either 6 or 12 months.
The researchers evaluated the effect of renal denervation on cardiac structure and function among the study participants, assessing endpoints associated with LV structure including LV mass index, end-diastolic LV internal dimension, LV end-diastolic posterior wall thickness and interventricular septum thickness, as well as endpoints associated with LV function including LVEF and E/A.
Researchers found that after renal denervation treatment, LV mass index decreased by 13.08 g/m2 (95% CI, –18.38 to –7.78; P < .00001), end-diastolic posterior wall thickness decreased by 0.6 mm (95% CI, –0.87 to –0.34; P < .00001), end‐diastolic interventricular septum thickness decreased by 0.78 mm (95% CI, –1.06 to –0.49; P < .00001), and LVEF increased by 1.8% (95% CI, 0.71-2.9; P = .001).
Researchers did not observe improvements in end-diastolic LV internal dimension and diastolic function.
“It was worth noting that compared with 6 months of follow‐up after renal denervation, after 12 months of follow‐up, some indicators, such as LV end‐diastolic posterior wall thickness and interventricular septum thickness, were not statistically different, which may be related to sympathetic nerve regeneration and central sympathetic feedback regulation,” the researchers wrote. “Therefore, it is necessary to extend the observation time to determine the long‐term effects of renal denervation on cardiac structure and function in resistant hypertensive patients. Moreover, our meta‐analysis confirms that the BP of resistant hypertensive patients was lower, and the number of antihypertensive medications taken by resistant hypertensive patients decreased after renal denervation treatment.”
The researchers noted that more studies are needed to clarify the impact of renal denervation on cardiac remodeling in patients with resistant hypertension.
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