Renal Sympathetic Denervation: Using Baroreflex To Predict Who Might Benefit

Dr. Axel Bauer, MD, FESC, F-ISHNE Prof. Dr. med. Axel Bauer is head of the coronary care and chest pain unit and primary investigator in the research group of biosignal analysis and sudden death of the cardiology department of the Eberhard-Karls-Universität Tübingen, Germany.MedicalResearch.com Interview with:
Dr. Axel Bauer, MD, FESC, F-ISHNE
Prof. Dr. med. Axel Bauer is head of the coronary care and chest pain unit and primary investigator in the research group of biosignal analysis and sudden death of the cardiology department of the Eberhard-Karls-Universität Tübingen, Germany.

MedicalResearch.com: What are the main findings of the study?

Dr. Bauer: Catheter-based renal sympathetic denervation is a promising treatment option in patients with resistant arterial hypertension. However, it is invasive and might have presently unknown adverse side effects in the long-term. Therefore, identification of patients who benefit from RDN and, equally importantly, those who do not is of great importance.  With assessment of baroreflex sensitivity (BRS) we found a way to do that. Patients with resistant hypertension and impaired BRS at baseline benefited the most from RDN in terms of reduction of mean systolic BP on (ABPM) while RDN had no effect in patients with preserved BRS.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Bauer: We hypothesized that in patients with impaired BRS and presumably increased sympathetic tone, RDN would exhibit the most pronounced effects. Therefore, the main findings were not unexpected.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Bauer: RDN is not equally effective in every single patient. A non-invasive 30 minute measurement can help to identify patients who benefit from RDN and patients who do not. Given the invasive nature of RDN and potential presently unknown adverse side effects in the longterm these findings are important. However, findings need to be validated in independent cohorts.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Bauer: First, these findings need to be validated in independent cohorts. Future studies should test whether an individualized approach to antihypertensive treatment by RDN based on assessment of BRS translates into a better clinical outcome.

Citation: 

Impaired Cardiac Baroreflex Sensitivity Predicts Response to Renal Sympathetic Denervation in Patients with Resistant Hypertension

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Christine S. Zuern, MD; Christian Eick, MD; Konstantinos D. Rizas, MD; Sarah Bauer; Harald Langer, MD; Meinrad Gawaz, MD, FESC; Axel Bauer, MD, FESC, F-ISHNE

J Am Coll Cardiol. Published online August 21, 2013.

 

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