Results Analysis Of Selective Renal Sympathetic Denervation For Hypertension

Objective: Through the changes in blood pressure during renal nerve stimulation(RNS),the afferent nerves distributed around the renal artery can be explored,and the effectiveness of renal sympathetic denervation(RDN)can be improved.This article aims to analyze the type of immediate blood pressure response of RNS and the antihypertensive effect of selective RDN guided by RNS,and to determine the appropriate ablation site during RDN.Methods: This study included hypertensives receiving RNS combined with RDN in our center.We analyzed the baseline blood pressure before stimulation,minimum blood pressure during stimulation,maximum blood pressure during stimulation,blood pressure at the end of stimulation and their occurrence time at each site.The positive sites with increase in systolic blood pressure beyond baseline 5mm Hg were selectively ablated.Univariate repeated measures analysis of variance was used to evaluate the blood pressure change at each time after RDN.Results: A total of 237 RNS sites in 13 patients were analyzed,and we summarized five types of blood pressure response.(1)74(31.2%)sites showed systolic BP persistently elevated above 5mm Hg.(2)31(13.1%)sites showed the BP dropped beyond-5mm Hg and then elevated above5 mm Hg.(3)39(16.5%)sites showed the systolic BP dropped beyond-5mm Hg and then recovered but not elevated above 5mm Hg.(4)72(30.4%)sites showed systolic BP fluctuated but not exceed ±5mm Hg.(5)21(8.9%)sites showed the systolic BP persistently dropped beyond-5mm Hg.After selective ablation of the sites(1)and(2),The ambulatory BP continued to drop from 142±12/95±8 mm Hg at baseline to 128±13/83±10 mm Hg at3-12 month postoperatively(systolic blood pressure: P=0.013,diastolic blood pressure: P=0.005),office BP dropped rapidly from 158±24/102±19mm Hg at baseline to 137±16/89±15mm Hg at 2 hours postoperatively(systolic blood pressure: P<0.001,diastolic blood pressure: P=0.013)Conclusions: RNS causes five types of blood pressure reactions: blood pressure elevates persistently,blood pressure drops and then increases beyond baseline,blood pressure drops and then back to baseline,blood pressure unchanged,blood pressure drops persistently.Selective ablation of sites where blood pressure continued to rise or blood pressure drops and then increases beyond baseline can produce rapid and sustained antihypertensive effect.It suggests that these two types of effective sites should be carefully searched and ablated.