Effects of Renal Sympathetic Denervation on Exercise Blood Pressure, Heart Rate, and Capacity in Patients With Resistant Hypertension

Renal denervation reduces office blood pressure in patients with resistant hypertension. This study investigated the effects of renal denervation on blood pressure, heart rate, and chronotropic index at rest, during exercise, and at recovery in 60 patients (renal denervation group=50, control group=10) with resistant hypertension using a standardized bicycle exercise test protocol performed 6 and 12 months after renal denervation. After renal denervation, exercise blood pressure at rest was reduced from 158 +/- 3/90 +/- 2 to 141 +/- 3/84 +/- 4 mm Hg (P<0.001 for systolic blood pressure/P=0.007 for diastolic blood pressure) after 6 months and 139 +/- 3/83 +/- 4 mm Hg (P<0.001/P=0.022) after 12 months. Exercise blood pressure tended to be lower at all stages of exercise at 6- and 12-month follow-up in patients undergoing renal denervation, although reaching statistical significance only at mild-to-moderate exercise levels (75-100 W). At recovery after 1 minute, blood pressure decreased from 201 +/- 4/95 +/- 2 to 177 +/- 4/88 +/- 2 (P<0.001/P=0.066) and 188 +/- 6/86 +/- 2 mm Hg (P=0.059/P=0.01) after 6 and 12 months, respectively. Heart rate was reduced after renal denervation from 71 +/- 3 bpm at rest, 128 +/- 5 bpm at maximum workload, and 96 +/- 5 bpm at recovery after 1 minute to 66 +/- 2 (P<0.001), 115 +/- 5 (P=0.107), and 89 +/- 3 bpm (P=0.008) after 6 months and to 69 +/- 3 (P=0.092), 122 +/- 7 (P=0.01), and 93 +/- 4 bpm (P=0.032) after 12 months. Mean exercise time increased from 6.59 +/- 0.33 to 8.4 +/- 0.32 (P<0.001) and 9.0 +/- 0.41 minutes (P=0.008), and mean workload increased from 93 +/- 2 to 100 +/- 2 (P<0.001) and 101 +/- 3 W (P=0.007) at 6- and 12-month follow-up, respectively. No changes were observed in the control group. In conclusion, renal denervation reduced blood pressure and heart rate during exercise, improved mean workload, and increased exercise time without impairing chronotropic competence.