Renal sympathetic denervation improves physical and mental health in resistant hypertension

Renal sympathetic denervation improves anxiety, depression, quality of life and stress in patients with resistant hypertension, according to research presented at ESC Congress 2012 by Dr Denise Fischer from Saarland University Hospital.

Arterial hypertension is often associated with several psychological comorbidities, such as and panic disorders, leading to impaired quality of life. Catheter-based renal sympathetic (RDN) is a novel treatment option for patients with resistant hypertension and has been shown to reduce local and whole-body sympathetic activity and blood pressure (BP).

The aim of the present study was to analyze quality of life, arousal level, anxiety and depression, sleeping quality, intensity of headache and stress tolerance in patients with resistant hypertension before and after RDN.

RDN was performed in 173 patients with resistant hypertension (BP 174/88±23/13mmHg and taking a median of 5 ) aged 63±10 years (53% male). Psychological status, intensity of headache, sleeping quality and were documented before and 3 months after RDN.

Patients rated their physical and mental state and arousal level on a 0-100% scale. Stress was induced by a multi tasking situation (Determination Task) and the total number of correct reactions, omissions and commission errors (responding to stimuli where it is not required) were recorded. Assessments were made of depression and anxiety using the Hospital Scale (HADS) and of quality of life using the Short Form-12 (SF-12). Insomnia and the level of regeneration achieved during sleep were assessed using a 0-100% scale and intensity of headache was measured by a visual analogous scale (VAS).

Three months after RDN was performed, office blood pressure decreased by 17/7 mmHg (p<0.01). In addition patients showed more correct reactions (p<0.0001) and less errors (p<0.05) in the multi tasking situation (Figure A shows the percentile rank (PR) score; the average percentile is 50%). Patients reported improvements in their physical state (from 55.6% to 67.2%; p<0.01), mental state (from 51.6% to 68.4%; p<0.05) and quality of life (p<0.05) (Figure B). Anxiety (p<0.0001) and depression (p<0.0001) scores decreased (Figure C). Arousal level was reduced from 49.9% to 38.9% (p<0.0001).

At baseline 32.2% of patients suffered from sleeping disorders and 60% suffered from headaches. Three months after RDN, sleeping quality improved (p<0.0001) and the intensity of headache decreased (p<0.0001) (Figure D).

"In patients with resistant hypertension overactivity of the sympathetic nervous system causes hyperarousal, leading to higher anxiety and stress levels," said Dr Fischer. "Renal denervation reduces office blood pressure and resting heart rate and does not impair psychological processes."

She added: "Renal denervation may have a positive effect on psychological processes, stress perception and processing as well as quality of life. It improves sleeping quality and may reduce the intensity of headache."

Future research should investigate long term effects of RDN on psychological processes, quality of life, rehospitalisation and mortality rates in a larger cohort of patients.

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