Aorticorenal Ganglion Ablation Enhances Blood Pressure Reduction After Renal Denervation

The aorticorenal ganglion (ARG), an upstream component of renal sympathetic fibers, may represent a novel target for autonomic modulation in hypertension. This study evaluated the effects of adjunctive ARG ablation after renal denervation (RDN) on blood pressure (BP) and its autonomic mechanisms.

Patients with uncontrolled hypertension scheduled for RDN were enrolled, and additional ablation was performed if an elevation in SBP was observed by high-frequency stimulation at the ARG region (RDN+ARG ablation). This exploratory analysis assessed the change in 24-hour average ambulatory systolic BP from baseline to 3 months. To explore the effects of ARG ablation on BP and sympathetic activity, we compared ARG ablation with RDN in a canine model.

A total of 41 patients (n=20 RDN; n=21 RDN+ARG ablation) were enrolled. At 3 months, the reduction in 24-hour average ambulatory systolic BP from baseline was -9.7±10.8 mm Hg in the RDN group and -18.2±10.8 mm Hg in the RDN+ARG ablation group, with a between-group difference of -7.5 mm Hg (95% CI, -13.9 to -1.2 mm Hg; P=0.021) after adjusting for baseline ambulatory systolic BP. No major procedure-related complications were observed in both groups. In canines, ARG ablation significantly reduced the renal sympathetic innervation and the systemic sympathetic activity compared with RDN, with enhancing SBP-lowering effect.

These results establish the ARG as a pivotal regulator of systemic sympathetic tone and a promising therapeutic target for hypertension. Additional ARG ablation to RDN may represent a more effective interventional strategy, warranting validation in large-scale clinical trials.

URL: https://www.clinicaltrials.gov; Unique identifier: NCT05590871.