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Updated: Jul 17, 2025
Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Cardiovascular outcomes improve in children with renovascular hypertension following endovascular and surgical
Emily C G Redhead1, Alicia Paessler2, Zainab Arslan2
1University College London Great Ormond Street Institute of Child Health, London, UK.
Insights
Renovascular hypertension in children can cause cardiac remodeling. Interventions improved blood pressure control and cardiac function, with many patients reducing or stopping medications.
Area of Science:
- Pediatric Cardiology
- Interventional Nephrology
- Cardiovascular Research
Background:
- Renovascular hypertension (RenoVH) in children often stems from renal artery stenosis, leading to cardiac remodeling.
- This condition activates the renin-angiotensin-aldosterone axis, impacting cardiovascular health.
Purpose of the Study:
- To describe cardiovascular changes in children with RenoVH.
- To assess improvements in cardiac remodeling following endovascular and/or surgical interventions.
Main Methods:
- A longitudinal observational study of 152 children with RenoVH.
- Data collected via retrospective review over 22 years, assessing blood pressure and echocardiographic parameters pre- and post-intervention.
Main Results:
- 54.4% achieved blood pressure control post-intervention.
- Significant improvements noted in interventricular septal thickness, posterior wall thickness, fractional shortening, left ventricular mass index, and relative wall thickness.
- 45.9% reduced antihypertensive medications, with 21.3% discontinuing all therapy.
Conclusions:
- Endovascular and/or surgical interventions improve cardiovascular outcomes in pediatric RenoVH.
- Interventions lead to significant blood pressure control and favorable echocardiographic changes.
- These treatments reduce the need for antihypertensive medications in affected children.
Background:
Renovascular hypertension (RenoVH) is a cause of hypertension in children. A common cause of RenoVH is renal artery stenosis which acts by reducing blood supply to renal parenchyma and activating the renin-angiotensin-aldosterone axis, often leading to cardiac remodelling. This longitudinal observational study aims to describe occurrence of cardiovascular changes secondary to RenoVH and also any improvement in cardiac remodelling after successful endovascular and/or surgical intervention.
Methods:
All patients with RenoVH referred to our centre, who received ≥ 1 endovascular intervention (some had also undergone surgical interventions) were included. Data were collected by retrospective database review over a 22-year period. We assessed oscillometric blood pressure and eight echocardiographic parameters pre- and post-intervention.
Results:
One hundred fifty-two patients met inclusion criteria and had on average two endovascular interventions; of these children, six presented in heart failure. Blood pressure (BP) control was achieved by 54.4% of patients post-intervention. Average z-scores improved in interventricular septal thickness in diastole (IVSD), posterior Wall thickness in diastole (PWD) and fractional shortening (FS); left ventricular mass index (LVMI) and relative wall thickness (RWT) also improved. PWD saw the greatest reduction in mean difference in children with abnormal (z-score reduction 0.25, p < 0.001) and severely abnormal (z-score reduction 0.23, p < 0.001) z-scores between pre- and post-intervention echocardiograms. Almost half (45.9%) had reduction in prescribed antihypertensive medications, and 21.3% could discontinue all antihypertensive therapy.
Conclusions:
Our study reports improvement in cardiac outcomes after endovascular + / - surgical interventions. This is evidenced by BP control, and echocardiogram changes in which almost half achieved normalisation in systolic BP readings and reduction in the number of children with abnormal echocardiographic parameters. A higher resolution version of the Graphical abstract is available as Supplementary information.
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