Effects of multielectrode renal denervation on cardiac and neurohumoral adaptations in resistant hypertension with cardiac hypertrophy: an EnligHTN I substudy

Objective: This EnligHTN I nonrandomized substudy investigated the effect of multielectrode renal denervation (RDN) on cardiac and neurohumoral adaptations. Methods: Eighteen patients with true drug-resistant hypertension [age: 56 +/- 10 years, 12 men, BMI: 33.6 +/- 5.4 kg/m(2), office blood pressure (BP) by automatic device (Omron): 182 +/- 19/97 +/- 18mmHg and ambulatory BP (Spacelabs): 153 +/- 16/87 +/- 15mmHg receiving 4.5 antihypertensive drugs/day] and left ventricular hypertrophy underwent multielectrode RDN (EnligHTN system; St. Jude Medical), whereas 10 patients served as controls. Both groups were followed-up for 6 months. Results: Demographic data were homogenous between both patient groups. In addition to reduction of office (-42/-17 mmHg, P < 0.001) and ambulatory (-19/-9 mmHg, P < 0.001) BP, RDN contributed to attenuation of left ventricular mass index from 140.0 +/- 17.0 g/m(2) (57.9 +/- 7.9 g/m 2.7) to 126.7 +/- 19.2 g/m(2) (52.6 +/- 8.4 g/m 2.7) (P < 0.01 for both) and left atrial diameter from 42.4 +/- 4.3 to 40.6 +/- 3.6 mm (P = 0.004) at 6 months. Up to 56% of the RDN-group patients achieved a target of less than 140/90 mmHg in the office BP; proportion of RDN-group patients with concentric left ventricular hypertrophy had decreased by 39%; mitral lateral E/E' ratio decreased from 14.8 +/- 6.1 to 12.0 +/- 3.2 (P = 0.016); isovolumic relaxation time shortened from 109.8 +/- 16.2 to 100.8 +/- 17.1 ms (P = 0.003); and N-terminal pro B-type natriuretic peptide levels reduced from 84.9 +/- 35.9 to 57.2 +/- 38.8 pg/ml (P < 0.001) significantly at 6 months post-RDN. Control patients exhibited no significant changes in all the above parameters (P > 0.05) at 6 months. Conclusion: Multielectrode RDN contributes to improvement of diastolic dysfunction, reduction of left ventricular mass and attenuation of NT-proBNP, suggesting additional cardiovascular benefits in drug-resistant hypertension associated with left ventricular hypertrophy.