Sympathetic renal denervation: elimination of «white coat» effect

С.Е. Пекарский, А.В. Баев, В.Ф. Мордовин, Т.М. Рипп, Г.В. Семке, А.Ю. Фальковская, Е.С. Ситкова, В.А. Личикаки, А.Л. Крылов, С.В. Попов

Authors: S.E. Pekarskiy, A.E. Baev, v.F. Mordovin, T.M. Ripp, G.v. Semke, A.Y. Falkovskaya, E.S. Sitkova, v.A. Lichikaki, A.L. Krylov, S.v. Popov

Place: Tomsk, Russia

Institution: Research Institute of Cardiology SB RAMS

Abstract:

Objective. To test the hypothesis that sympathetic renal denervation (RD) may eliminate «white coat» effect (WCE). Design and methods. The office and ambulatory blood pressure (BP) were assessed at baseline, 1 week, 6 and 12 months after RD in patients with resistant essential hypertension who underwent bilateral transcatheter radiofrequency RD in single-arm prospective clinical study (ClinicalTrial.gov, NCT01499810). Results. Fifty three patients were included (aged 53,8 ± 9,6 years, 28 males), 46 (87 %) and 39 (74 %) patients completed 6 and 12 months follow-up, respectively. Office BP at baseline was significantly higher than mean 24-h BP: 176,3/102,4 vs 158,2/93,3 mmHg, for systolic and diastolic BP, respectively, but rapidly decreased to its level 1 week after RD: 143,6/86,9 vs 145,9/87,3 mmHg. During the rest of follow-up period the office and ambulatory BP remained almost equal: 149,1/88,2 vs 148,5/87,2 mmHg at 6 months and 146,4/87,3 vs 145,7/85,6 mmHg at 12 months follow-up. Both office and ambulatory BP decreased significantly after RD, however, the effects were substantially different: -32,7/-15,5 vs -12,9/-7,0 mm Hg (office vs mean 24-h BP) at 1 week, -27,1/-13,3 vs -10,3/6,2 mmHg at 6 months and -30,9/-15,1 vs -12,2/-7,8 mm Hg at 12 months after RD. At all follow up assessments the difference was almost equal to the baseline WCE. Conclusions. Besides true BP reduction sympathetic RD also leads to the inhibition of WCE in patients with resistant hypertension. The difference between the decreases of office and ambulatory BP after RD may be totally explained by the elimination of significant baseline WCE. Inhibition of excessive BP reactivity to psychoemotional stress may have additional benefits.  

Keywords: arterial hypertension, daily monitoring of blood pressure, sympathetic system

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