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Brain & Heart RDN guided by novel blood pressure responses

Table 1. Demographic and baseline characteristics of were summarized in Table 2. Different trends in BP
patients (n=14) changes, including falling and rising, could be observed
successively. Generally, the drop was before the elevation
Values (mean±SD or n) of SBP in type 2 (14.2 ± 3.5 s vs. 23.4 ± 9.5s, P < 0.001)
Age, years old 43±9 and type 3 (17.9 ± 6.3 s vs. 31.1 ± 13.1 s, P < 0.001).
Females 3 SBP in 121 sites (46.5%) eventually increased by at least
Body mass index, kg/m 2 26.1±2.2 5 mmHg, compared to baseline. It is worth noting that
Smoking 6 some (Type 2) actually showed a decrease before the SBP
OBP, mmHg increase. Selective ablation was performed at these sites. 4
SBP 157±24 (IQR: 4 – 5) sites were ablated at the left renal artery and
DBP 101±19 4.5 (IQR: 4 – 5) at the right. The increase of SBP during
repeated electrical stimulation was significantly blunted,
ABP, mmHg but SBP elevation in type 2 had a similar reduction but
24-h, SBP 141±12 with a greater standard deviation (7.4 ± 14.2 mmHg vs.
24-h, DBP 94±9 7.2 ± 9.3 mmHg) as compared with the sites with type 1
Daytime, SBP 143±13 (Figure 3). One patient was found to have occlusion of
Daytime, DBP 95±9 the right superficial femoral artery on postoperative day 2
Nighttime, SBP 138±11 and received stent implantation. No other adverse events
Nighttime, DBP 92±13 occurred.
Heart rates, beats/min 77±8 Office BP decreased rapidly from 157 ± 24/101 ± 19 mmHg
Serum creatinine, µmol/L 80±28 at baseline to 137 ± 16/89 ± 15 mmHg at 2 h postoperatively
eGFR, mL/min/1.73 m 2 103±25 (SBP: P<0.001, Diastolic BP (DBP): P = 0.013) and
continued to drop within 24 h. The ABP also showed a
Comorbidity consistent decrease at 5 – 7 days and 6 – 12 months after
Hyperlipemia 3 RDN (Figure 4A and B). SBP decreased by 10.9 mmHg (95%
Type 2 diabetes 2 confidence interval (CI): −6.2 – −15.6 mmHg, P < 0.001)
Hypertensive heart disease 9 and 13.8 mmHg (95% CI, −7.7 – −19.9 mmHg, P < 0.001),
Coronary atherosclerotic heart disease 0 respectively; DBP decreased by 9.4 mmHg (95% CI,
Atrial fibrillation 0 −4.7 – −14.2 mmHg, P = 0.001) and 9.6 mmHg (95% CI,
Antihypertensive medication therapy −4.0 – −15.2 mmHg, P = 0.003), respectively. Daytime
ABP also continued to decline, and SBP decreased by
No. of antihypertensive drugs 3 11.9 mmHg (95% CI, −7.3 – −16.6 mmHg, P < 0.001) and
Diuretic 6 14.5 mmHg (95% CI, −7.9 – −21.1 mmHg, P = 0.009),
Calcium channel blockers 13 respectively. DBP dropped by 9.4 mmHg (95% CI, −4.5
Beta adrenoceptor-blocking agents 11 – −14.4 mmHg, P = 0.001) and 9.5 mmHg (95% CI, −3.2
ACE-Is/ARB 10 – −15.8 mmHg, P = 0.006). Nighttime SBP decreased by
Alpha adrenoceptor-blocking agents 2 10.8 mmHg (95% CI, −3.2 – −18.3 mmHg, P = 0.009)
Abbreviations: ABP: Ambulatory blood pressure; ACE-Is: and 15.7 mmHg (95% CI, −6.4 – −25 mmHg, P = 0.003),
Angiotensin-converting enzyme inhibitors; ARBs: Angiotensin receptor respectively. DBP also decreased by 10.9 mmHg (95% CI,
blockers; DBP: Diastolic blood pressure; eGFR: Estimated glomerular −4.5 – −17.2 mmHg, P = 0.003) and 12.1 mmHg (95%
filtration rate; OBP: Office blood pressure; SBP: Systolic blood pressure. CI, −5.9 – −18.2 mmHg, P = 0.001). Heart rate fell from
77 ± 8 bpm at baseline to 71 ± 5 bpm (−5.3 bpm, 95% CI,
v. Type 5: BP persistently dropped below the baseline. −1.3 – −9.2 bpm, P = 0.01 for 5 – 7 days) and 72 ± 7 bpm
(−4.3 bpm, 95% CI, −0.1 – −8.5 bpm, P = 0.043 for 6 –
SBP in 18 sites (6.9%) continued to drop during RNS. 12 months), respectively. A reduction in antihypertensive
The valley SBP dropped markedly and was lower than medications was observed in six of 14 patients during the
the baseline by 12.5 ± 7.4 mmHg. Terminal SBP was follow-up period. Five patients were able to reduce one
higher than the valley by 1.1 ± 1.1 mmHg, which was type of medication, and one patient even reduced four
−11.4 ± 7.3mmHg above the baseline. types of antihypertensive drugs. The average number of
The minimum, maximum, and end-stimulation antihypertensive medications dropped numerically from
SBP changes and their respective occurrence times 2.9 ± 1.3 at baseline to 2.4 ± 1.2 at 6 – 12 months (Table 3).

Volume 1 Issue 2 (2023) 5 https://doi.org/10.36922/bh.0384