A 3-YEAR DURABILITY OF POWERFUL BLOOD PRESSURE LOWERING EFFECT OF DISTAL RENAL DENERVATION

Abstract

Objective: To evaluate efficacy and safety of anatomically optimized distal renal denervation (RDN) in segmental branches of renal artery. Design and method: We performed a double blind, randomized control study of the efficacy and safety of distal RDN versus conventional main trunk treatment in patients with true resistant hypertension (NCT02667912) with 3 year follow-up period. The efficacy of the RDN was evaluated by changes in ambulatory and office BP at 6, 12 and 36 month. The safety was assessed by a number of procedure-related adverse events, changes in the 24-h protein excretion, serum creatinine and eGFR during the same time periods. Results: Of 55 randomized patients who undergone RDN (28 - distal denervation vs 27 - main trunk treatment) 51 completed 6 month (27 vs 24), 47 - 12 month (23 vs 24), and 39 - 36 month follow-up (21 vs 18). There was a powerful significant decrease in 24-h mean ambulatory systolic BP at 6 month after distal RDN that was, also, maintained throughout the follow-up, and remained statistically significant at the end of the study, -21.1 (95% CI -28.9;-13.3), -18 (95% CI -27.6;-8.5), -16.9 (95% CI -27.3;-6.5), mmHg, at 6, 12, and 36 month, respectively. In group of conventional main trunk treatment the same BP decreased substantially less at all study periods, and lost significance at 36 month. -10.3 (95% CI -17.8;-2.8), -12.1 (95% CI -19.2;-5.0), -8.7 (95% CI -19.7;2.2). Other ambulatory BP indices changed accordingly. eGFR decreased in group of distal RDN at 1 year post-procedure -8.9 (95% CI -14.8;-3.1), mL/min/sq.m, however, slightly increased during next 2 years with finally non-significant change at the end of the study, -6.5 7 (95% CI -13.2;0.3). In contrast, in group of main trunk treatment eGFR remained unchanged during 1st year, -1.3 (95% CI -6.6;4.0) but progressed to statistically significant decrease at 3-year post-procedure, -5.0 (95% CI -9.6;-0.3). Conclusions: Anatomical optimization of renal denervation by redistributing treatments to segmental branches of renal artery produces a durable increase in the efficacy of the intervention without additional risk to the kidney.