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Renal Nerve Stimulation as Procedural End Point for Renal Sympathetic Denervation

  • Secondary Hypertension: Nervous System Mechanisms (M Wyss, Section Editor)
  • Published:
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Abstract

Purpose of Review

Renal sympathetic denervation (RDN) as treatment option for hypertension has a strong rationale; however, variable effects on blood pressure (BP) have been reported ranging from non-response to marked reductions in BP. The absence of a procedural end point for RDN is one of the potential factors associated with the variable response. Studies have suggested the use of renal nerve stimulation (RNS) to adequately address this issue. This review aims to provide an overview of the clinical and experimental data available regarding the effects of RNS in the setting of RDN.

Recent Findings

Animal studies have shown that high-frequency electrical stimulation of the sympathetic nerves in the adventitia of the renal arteries elicits an increase in BP and leads to an increased norepinephrine spillover as a marker of increased sympathetic activity and these effects of stimulation were attenuated or blunted after RDN. In a human feasibility study using RNS both before and after RDN, similar BP responses were observed. Moreover, in patients with resistant hypertension, RNS-induced changes in BP appeared to be correlated with 24-h BP response after RDN. These data suggest that RNS is a useful tool to identify renal sympathetic nerve fibers in patients with treatment-resistant hypertension undergoing RDN, and to predict the likely effectiveness of RDN treatments.

Summary

In acute procedural settings both in animal and human models, RNS elicits increase in BP and HR before RDN and these effects are blunted after RDN. Up to now, there is preliminary evidence that the RNS-induced BP changes predict 24-h ABPM outcome at follow-up in patients with resistant hypertension. Of note, studies are small sized and results of large trials comparing conventional RDN to RNS-guided RDN are warranted.

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Abbreviations

ABPM:

Ambulatory blood pressure measurements

BP:

Blood pressure

DBP:

Diastolic blood pressure

HR:

Heart rate

RDN:

Renal nerve denervation

RNS:

Renal nerve stimulation

SBP:

Systolic blood pressure

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

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Authors and Affiliations

  1. Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands

    Annemiek F. Hoogerwaard, Mark R. de Jong & Arif Elvan

Authors
  1. Annemiek F. Hoogerwaard
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  2. Mark R. de Jong
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  3. Arif Elvan
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Correspondence to Arif Elvan.

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This article is part of the Topical Collection on Secondary Hypertension: Nervous System Mechanisms

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Hoogerwaard, A.F., de Jong, M.R. & Elvan, A. Renal Nerve Stimulation as Procedural End Point for Renal Sympathetic Denervation. Curr Hypertens Rep 20, 24 (2018). https://doi.org/10.1007/s11906-018-0821-y

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