[LB.03.06] ATTENUATION OF SPLANCHNIC AUTOTRANSFUSION FOLLOWING NON-INVASIVE ULTRASOUND RENAL DENERVATION | doi.page

[LB.03.06] ATTENUATION OF SPLANCHNIC AUTOTRANSFUSION FOLLOWING NON-INVASIVE ULTRASOUND RENAL DENERVATION

Journal of Hypertension2017Vol. 35(Supplement 2), pp. e77–e78

Manish Saxena, T. Shour, Mussadiq Shah, C. B. Wolff, David Collier, Vikas Kapil, Armida Balawon, Jane Pheby, A. Zak, Peter O.O. Julu, Benjamin O’Brien, R.E. Schmieder, Melvin D. Lobo

Abstract

Objective: In the Valsalva manoeuvre, autotransfusion in Phase IIi arises from sympathetically mediated capsular contraction of intra-abdominal organs including the kidneys. We hypothesised that following successful renal nerve ablation this response would be attenuated and could serve as a marker of procedural success. Design and method: 23 patients (mean age 59.4 ± 10.5 years; BMI 30.2; anti-hypertensive medication 4.2; 65% males and 35% females) with resistant HTN (On 3 or more anti-hypertensive drugs including a diuretic) were enrolled in the double-blind, sham controlled KONA Wave IV study. They were randomised either to bilateral RDN using therapeutic levels of ultrasound energy (n = 12, 75% male, mean age 57.2 ± 10.3 years) or the sham procedure using bilateral application of diagnostic levels of ultrasound energy (n = 11, 55% male, mean age 61.9 ± 10.6 years). Within group changes in autonomic parameters, office blood pressure (OBP) and ambulatory BP (ABP) were compared between baseline and 6 months in a double blind manner. Results: There was significant OBP reduction in both treatment (16.1 ± 27.3 mmHg, p < 0.05) and sham groups (27.9 ± 15.0 mmHg, p < 0.01). In the treatment group, heart rate (HR) was significantly reduced following RDN both at rest (4.3 ± 6.6 bpm, p < 0.05) and in response to postural changes. During phase IIi Valsalva, RDN resulted in substantial and significant reduction in MAP (21.8 ± 25.2 mmHg, p < 0.05) with no significant changes in the sham group.Conclusions: BP reduction per se is not necessarily a marker of renal nerve ablation. Reduction in splanchnic auto-transfusion following RDN has not been previously demonstrated and denotes attenuation of (renal) sympathetic efferent activity and could serve as a marker of procedural success. Sham therapy results in clinically meaningful BP reduction that has implications for future trial design.

Abstract

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