Aorticorenal Ganglion Ablation Enhances Blood Pressure Reduction After Renal Denervation

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05590871.