Article Type Correspondence

Correspondence
Article Type
Response to Letter Regarding Article,
“Ambulatory Blood Pressure Changes After
Renal Sympathetic Denervation in Patients With
Resistant Hypertension”
We received a letter by Jin et al on our article published recently in
Circulation.1 The following points should be clarified:
It was argued that we did not measure, but extrapolated, cardiovascular risk. We neither extrapolated nor measured risk in the article. We
only reported blood pressure data. Jin et al argue that the proportions
of patients at 3, 6 and 12 months are different. This is due to different
follow-up periods, as stated in the article as a potential limitation.1 We
reported that no major differences existed in medications before and
after renal denervation but did not provide doses and drug classes. The
study was not aimed to provide an in-depth analysis of drug classes
or doses. Jin et al claim that we provided different classifications in
the abstract and Methods section. Classification of patients was done
in classic way.1 Jin et al also claim that there are contradictions in
the summary statistics. They mention that Table 3 provides only the
odds that office blood pressure declined by >10 mm Hg. This was a
defined criterion of response and was evaluated as described in the
article. They argue that there is a disproportion between the responses
in office and ambulatory blood pressures. These were the data, which
correspond to most of the drug trials in hypertension.
The assertion that our center would have performed >600 renal
denervations is incorrect; it was ≈200 at that time of Der Spiegel
publication.2 Health insurances would cover renal denervation in
some countries. Most of the procedures were not reimbursed because
patients were treated in trials or investigative protocols. Today, there
is indeed a reimbursement, which does not cover the costs of the procedure and the materials. Many centers, at least in Germany, pay the
cost of this procedure from their own scientific budgets.
In conclusion, our study aimed to investigate the effects of renal
denervation on 24-hour blood pressure. Therefore, the involved centers pooled their data and shared their experiences.1,3 The goal is to
facilitate and improve the design of randomized and controlled trials, being well aware that these investigations cannot substitute them.
The authors of the letter acknowledge concerns already raised by the
authors themselves.4,5
Disclosures
Drs Mahfoud, Ukena, and Böhm are supported by the Ministry
of Science and Economy of the Saarland and Deutsche
Forschungsgemeinschaft (KFO 196). Dr Mahfoud is supported by the
Deutsche Hochdruckliga and Deutsche Gesellschaft für Kardiologie.
Dr Schlaich is supported by a National Health and Medical Research
Council Senior Research Fellowship. Dr Sobotka was an employee
of Medtronic Ardian Inc. All authors received scientific support and
speaker honorarium from Medtronic Ardian Inc.
Felix Mahfoud, MD
Christian Ukena, MD
Universitätsklinikum des Saarlandes
Klinik für Innere Medizin III
Kardiologie, Angiologie und Internistische Intensivmedizin
Homburg/Saar, Germany
Roland E. Schmieder, MD
Universität Erlangen-Nürnberg
Medizinische Klinik 4
Nürnberg, Germany
Bodo Cremers, MD
Universitätsklinikum des Saarlandes
Klinik für Innere Medizin III
Kardiologie, Angiologie und Internistische Intensivmedizin
Homburg/Saar, Germany
Lars C. Rump, MD
Oliver Vonend, MD
Universitätsklinikum Klinik für Nephrologie
Düsseldorf, Germany
Joachim Weil, MD
Medizinische Klinik II
Universität Schleswig-Holstein
Campus Lübeck
Lübeck, Germany
Martin Schmidt, MD
Städtisches Klinikum München GmbH
München, Germany
Uta C. Hoppe, MD
Klinik III für Innere Medizin
Universität zu Köln
Köln, Germany
Thomas Zeller, MD
Herz-Zentrum Bad Krotzingen
Bad Krotzingen, Germany
Axel Bauer, MD
Universitätsklinikum Tübingen Medizinische UNI-Klinik und
Poliklinik Abt. Innere Medizin III
Tübingen, Germany
Christian Ott, MD
Medizinische Klinik 4
Nephrologie und Hypertensiologie
Universitätsklinikum Erlangen
Erlangen, Germany
Erwin Blessing, MD
Uni-Klinikum Heidelberg
Medizinische Klinik
Innere Medizin III
Kardiologie, Angiologie und Pneumologie
Heidelberg, Germany
Paul A. Sobotka, MD
Ohio State University
Columbus, OH
Henry Krum, MBBS, PhD
Monash University/Alfred Hospital
Melbourne, Victoria, Australia
Markus Schlaich, MD
Murray Esler, MBBS, PhD, FRACP
Baker IDI Heart and Diabetes Institute
Victoria, Australia
Michael Böhm, MD
Universitätsklinikum des Saarlandes
Klinik für Innere Medizin III
Kardiologie, Angiologie und Internistische Intensivmedizin
Homburg/Saar, Germany
(Circulation. 2014;129:e500-e501.)
© 2014 American Heart Association, Inc.
Circulation is available at http://circ.ahajournals.org
DOI: 10.1161/CIRCULATIONAHA.114.008029
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e500
Correspondence e501
References
1. Mahfoud F, Ukena C, Schmieder RE, Cremers B, Rump LC, Vonend
O, Weil J, Schmidt M, Hoppe UC, Zeller T, Bauer A, Ott C, Blessing
E, Sobotka PA, Krum H, Schlaich M, Esler M, Böhm M. Ambulatory
blood pressure changes after renal sympathetic denervation in patients
with resistant hypertension. Circulation. 2013;128:132–140.
2. Blech J. Vergebens verbrutzelt. Der Spiegel. 2013;28:102–103.
3. Mahfoud F, Cremers B, Janker J, Link B, Vonend O, Ukena C, Linz D,
Schmieder R, Rump LC, Kindermann I, Sobotka PA, Krum H, Scheller
B, Schlaich M, Laufs U, Böhm M. Renal hemodynamics and renal
function after catheter-based renal sympathetic denervation in patients
with resistant hypertension. Hypertension. 2012;60:419–424.
4.Mahfoud F, Lüscher TF, Andersson B, Baumgartner I, Cifkova R,
Dimario C, Doevendans P, Fagard R, Fajadet J, Komajda M, Lefèvre
T, Lotan C, Sievert H, Volpe M, Widimsky P, Wijns W, Williams B,
Windecker S, Witkowski A, Zeller T, Böhm M; European Society of
Cardiology. Expert consensus document from the European Society
of Cardiology on catheter-based renal denervation. Eur Heart J.
2013;34:2149–2157.
5. Mahfoud F, Kjeldsen S. Catheter-based renal denervation: a word of caution. EuroIntervention. 2013;8:997–998.
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Response to Letter Regarding Article, ''Ambulatory Blood Pressure Changes After Renal
Sympathetic Denervation in Patients With Resistant Hypertension''
Felix Mahfoud, Christian Ukena, Roland E. Schmieder, Bodo Cremers, Lars C. Rump, Oliver
Vonend, Joachim Weil, Martin Schmidt, Uta C. Hoppe, Thomas Zeller, Axel Bauer, Christian
Ott, Erwin Blessing, Paul A. Sobotka, Henry Krum, Markus Schlaich, Murray Esler and
Michael Böhm
Circulation. 2014;129:e500-e501
doi: 10.1161/CIRCULATIONAHA.114.008029
Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231
Copyright © 2014 American Heart Association, Inc. All rights reserved.
Print ISSN: 0009-7322. Online ISSN: 1524-4539
The online version of this article, along with updated information and services, is located on the
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http://circ.ahajournals.org/content/129/20/e500
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