Renal Sympathetic Denervation Reduces Left Ventricular Hypertrophy and Improves Cardiac Function in Patients With Resistant Hypertension

Objectives This study investigated the effect of catheter-based renal sympathetic denervation (RD) on left ventricular hypertrophy (LVH) and systolic and diastolic function in patients with resistant hypertension. Background LVH and diastolic dysfunction are associated with elevated sympathetic activity and increased morbidity and mortality. The effect of RD on LVH and LV function is unclear. Methods Forty-six patients underwent bilateral RD, and 18 patients served as controls. Transthoracic echocardiography was performed at baseline, and after 1 month and 6 months. Results Besides reduction of systolic and diastolic blood pressure (-22.5/-7.2 mm Hg at 1 month and -27.8/-8.8 mm Hg at 6 months, p < 0.001 at each time point), RD significantly reduced mean interventricular septum thickness from 14.1 +/- 1.9 mm to 13.4 +/- 2.1 mm and 12.5 +/- 1.4 mm (p = 0.007), and LV mass index from 53.9 +/- 15.6 g/m(2.7) (112.4 +/- 33.9 g/m(2)) to 47.0 +/- 14.2 g/m(2).7 (103.6 +/- 30.5 g/m(2)) and 44.7 +/- 14.9 g/m(2.7) (94.9 +/- 29.8 g/m(2)) (p < 0.001) at 1 month and 6 months, respectively. The mitral valve lateral E/E' decreased after RD from 9.9 +/- 4.0 to 7.9 +/- 2.2 at 1 month and 7.4 +/- 2.7 at 6 months (p < 0.001), indicating reduction of LV filling pressures. Isovolumic relaxation time shortened (baseline 109.1 +/- 21.7 ms vs. 85.6 +/- 24.4 ms at 6 months, p = 0.006), whereas ejection fraction significantly increased after RD (baseline: 63.1 +/- 8.1% vs. 70.1 +/- 11.5% at 6 months, p < 0.001). No significant changes were obtained in control patients. Conclusions Besides the known effect on blood pressure, our study showed for the first time that RD significantly reduces LV mass and improves diastolic function, which might have important prognostic implications in patients with resistant hypertension at high cardiovascular risk. (J Am Coll Cardiol 2012; 59: 901-9) c 2012 by the American College of Cardiology Foundation