1. Renal Denervation in Combination With Angiotensin Receptor Blockade Prolongs Blood Pressure Trough During Hemorrhage.
- Author
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Singh RR, McArdle Z, Booth LC, May CN, Head GA, Moritz KM, Schlaich MP, and Denton KM
- Subjects
- Angiotensin Receptor Antagonists therapeutic use, Animals, Antihypertensive Agents administration & dosage, Antihypertensive Agents therapeutic use, Hemodynamics physiology, Hypertension drug therapy, Hypertension physiopathology, Renal Insufficiency, Chronic drug therapy, Renal Insufficiency, Chronic physiopathology, Sheep, Angiotensin Receptor Antagonists administration & dosage, Benzimidazoles administration & dosage, Biphenyl Compounds administration & dosage, Blood Pressure drug effects, Hemodynamics drug effects, Hemorrhage physiopathology, Kidney innervation, Sympathectomy methods, Tetrazoles administration & dosage
- Abstract
Majority of patients with hypertension and chronic kidney disease (CKD) undergoing renal denervation (RDN) are maintained on antihypertensive medication. However, RDN may impair compensatory responses to hypotension induced by blood loss. Therefore, continuation of antihypertensive medications in denervated patients may exacerbate hypotensive episodes. This study examined whether antihypertensive medication compromised hemodynamic responses to blood loss in normotensive (control) sheep and in sheep with hypertensive CKD at 30 months after RDN (control-RDN, CKD-RDN) or sham (control-intact, CKD-intact) procedure. CKD-RDN sheep had lower basal blood pressure (BP; ≈9 mm Hg) and higher basal renal blood flow (≈38%) than CKD-intact. Candesartan lowered BP and increased renal blood flow in all groups. 10% loss of blood volume alone caused a modest fall in BP (≈6-8 mm Hg) in all groups but did not affect the recovery of BP. 10% loss of blood volume in the presence of candesartan prolonged the time at trough BP by 9 minutes and attenuated the fall in renal blood flow in the CKD-RDN group compared with CKD-intact. Candesartan in combination with RDN prolonged trough BP and attenuated renal hemodynamic responses to blood loss. To minimize the risk of hypotension-mediated organ damage, patients with RDN maintained on antihypertensive medications may require closer monitoring when undergoing surgery or experiencing traumatic blood loss.
- Published
- 2022
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