Ambulatory Blood Pressure Monitoring & Renal Denervation

Early trials found that renal denervation had resulted in significant drops in systolic blood pressure. Renal denervation, a new, catheter-based blood pressure lowering technology, which aims at the interruption of the nerve connection to the organ or its part, might be a 'cure' for resistant hypertension and, as a result, it may also be a tool for eliminating antihypertensive drug therapy. Early trials found significant drops, in the range of 30 mmHg, however, latest analyses are about a much more modest blood pressure reduction of about 11 mmHg – according to a scientific article has recently been publised in Forbes.

According to the latest studies the blood pressure lowering effect of renal denervation has been over-estimated because recorded data were based on office blood pressure measurements instead of the far more reliable and consistent measurements of an ambulatory blood pressure monitor.

Why ambulatory blood pressure monitor measurements are more reliable?

On one hand, the ambulatory blood pressure monitor carries out more measurements and real blood pressure is reflected more accurately by repeated measurements.

In addition, the ambulatory blood pressure monitor provides a blood pressure profile away from clinical environment, thereby it allows the identification of patients with white coat hypertension. White coat hypertension is identified in patients, whose blood pressure is elevated when it is measured by an office blood pressure meter, but it is normal when an ambulatory blood pressure monitor is applied, just because their blood pressure is recorded away from clinical environment. Consequently, office blood pressure meters are misleading in people with white coat hypertension and inapropriate treatment may be applied if medical decisions are based on them.

Finally, ambulatory blood pressure measurements are more reliable because blood pressure is recorded at night-time as well.

Office blood pressure meters in the renal denervation study

Office blood pressure meters proved to be less reliable in the recent study for a number of reasons as well.

For one, medical professionals are likely to repeat blood pressure readings they think are inconsistent with their clinical impression of the patient.

Another factor is that patients are more likely to participate in such trials when they have elevated blood pressure in the office.

People with white coat hypertension cannot be filtered out with office blood pressure meters, in this case an ambulatory blood pressure monitor should be applied.

Finally, patients with resistant hypertension may not take antihypertensive drugs as prescribed. Therefore, the treatment effect in these patients may be much more significant.