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28.08.2017 | Original Paper

Impact of renal denervation on tissue Na⁺ content in treatment-resistant hypertension

verfasst von: Christian Ott, Christoph Kopp, Anke Dahlmann, Axel Schmid, Peter Linz, Alexander Cavallaro, Matthias Hammon, Tilmann Ditting, Roland Veelken, Michael Uder, Jens Titze, Roland E. Schmieder

Erschienen in: Clinical Research in Cardiology | Ausgabe 1/2018

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Abstract

Objectives

Renal denervation (RDN) has been introduced for reducing blood pressure (BP) in treatment-resistant hypertension (TRH). The precise mechanism how RDN exerts its BP-lowering effects are not yet fully understood. It is widely accepted that sodium (Na⁺) plays a crucial role in the pathogenesis of hypertensive disease. However, there is increasing evidence of osmotically inactive Na⁺ storage. We investigated the impact of RDN on Na⁺ homeostasis using estimation of salt intake, and measurement of tissue Na⁺ content.

Methods

In a study 41 patients with TRH (office BP ≥140/90 mmHg and diagnosis confirmed by 24-h ambulatory BP monitoring) underwent RDN. Tissue Na⁺ content was assessed non-invasively with 3.0 T magnetic resonance imaging before and 6 months after RDN. In addition, 24-h urinary Na⁺ excretion as an estimate of salt intake and spot urine Na⁺/K⁺ excretion were assessed. The study was registered at http://www.clinicaltrials.gov (ID: NCT01687725).

Results

There was a significant fall in BP (office: −17 ± 20/−10 ± 12 mmHg; 24-h: −11 ± 13/−6 ± 9 mmHg, all p < 0.001) 6 months after RDN. In contrast, tissue Na⁺ content of the muscle (20.1 ± 3.9 vs. 20.7 ± 4.0 mmol/L, p = 0.229) and skin (24.4 ± 6.5 vs. 24.8 ± 6.6 mmol/L, p = 0.695) did not change after RDN. Moreover, there was also no change in salt intake after RDN, whereas Na⁺/K⁺ ratio only acutely increased.

Conclusions

Although RDN resulted in a substantial reduction of BP, tissue Na⁺ content of the muscle and skin was not mobilized and reduced. These data indicate that the BP reduction after RDN is unrelated to Na⁺ homeostasis.

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Titel: Impact of renal denervation on tissue Na+ content in treatment-resistant hypertension
verfasst von: Christian Ott
Christoph Kopp
Anke Dahlmann
Axel Schmid
Peter Linz
Alexander Cavallaro
Matthias Hammon
Tilmann Ditting
Roland Veelken
Michael Uder
Jens Titze
Roland E. Schmieder
Publikationsdatum: 28.08.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Research in Cardiology / Ausgabe 1/2018
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-017-1156-4

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Impact of renal denervation on tissue Na⁺ content in treatment-resistant hypertension