Effect of renal sympathetic denervation used in the treatment of resistant arterial hypertension on left ventricular hypertrophy and diastolic function

Background: Hypertension [HTN] results in structural and functional cardiac changes which increase cardiovascular morbidity and mortality. The effect of renal denervation [RD] on left ventricular hypertrophy [LVH] and left ventricular [LV] diastolic function is still unclear

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Objective: This study investigated the effect of catheter-based renal sympathetic denervation on LVH and diastolic function in patients with resistant hypertension

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Methods: We evaluated systolic and diastolic blood pressure [SBP and DBP, LV size, mass and diastolic function before and 6 months after RD in 68 patients with resistant hypertension by transthoracic echocardiography and Doppler

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Results: SBP and DBP reduced 6 months after RD [-22 +/- 3 mmHg and -10 +/- 12mmHg; P<0.0001 respectively] LV mass index decreased similarly independent on BP response [-19.37 +/- 2.6 gm/m[2]: P<0.0001]. Diastolic parameters E/A ratio, E-wave deceleration time and intra-ventricular relaxation time improved similarly in all patients after 6 months [0.89 +/- 0.04; P=0.001, -24.85 +/- 8.93 ms; P=0.007 and -6.97 +/- 2.57 ms; P=0.012 respectively]

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Conclusion: In patients with resistant hypertension and beside blood pressure lowering effect, renal denervation improves left ventricular hypertrophy and diastolic function. The relation of BP reduction effect and the improvement of cardiac hypertrophy and systolic function suggests a direct effect of sympathetic activity on LV remodeling and function which needs to be confirmed in larger prospective cohorts