Invasive aortic pulse wave velocity as a marker for arterial stiffness predicts outcome of renal sympathetic denervation

Aims: A recurrent finding of trials on renal sympathetic denervation is a certain percentage of non-responders. The aim of this study was to examine the influence of arterial stiffness to predict response. Methods and results: Eighty-eight patients were included in the study. Arterial stiffness was measured by invasive pulse wave velocity. Antihypertensive medication had to be unchanged during followup. Ambulatory blood pressure measurement (ABPM) was used to record blood pressure before and six months after denervation. Fifty-eight patients without changes in medication were included in the final analysis. Responders (n= 37; blood pressure reduction -12.8 +/- 6.4 mmHg) had a significantly lower pulse wave velocity (14.4 +/- 4.4 m/s versus 17.7 +/- 4.5 m/s; p= 0.009) compared to non-responders (n= 21; blood pressure reduction + 3.0 +/- 4.5 mmHg; p< 0.001 for comparison with responders). In multivariate analysis, invasive pulse wave velocity was the only significant predictor of blood pressure reduction after denervation (odds ratio 1.15, 95% confidence interval [CI] 1.014-1.327; p= 0.03). Patients with increased stiffness were older (p= 0.001), had a higher prevalence of diabetes (p= 0.008), more often had isolated systolic hypertension (p= 0.007), and had a higher invasive pulse pressure (p< 0.001). Conclusions: Patients with lower pulse wave velocity showed a significantly better response to denervation. These findings emphasise that pulse wave velocity might be used as a selection criterion for renal denervation.