Aggressive renal sympathetic denervation approach to treating resistant hypertension: A fresh start?

Abstract

A multivariable analysis identified predictors of systolic blood pressure change in SYMPLICITY HTN-3 trial. Additional analyses examined the influence of medication changes, results in selected subgroups and procedural factors. Greater reductions in office and ambulatory systolic blood pressure, and heart rate were observed with a higher number of ablations and energy delivery in a four-quadrant pattern. Based on this information, we selected a white patient with baseline office systolic blood pressure >180 mmHg, using aldosterone antagonist, non-using vasodilators, and performed an aggressive RSD approach.Male patient, 40 years old, white, referred by the attending physician to our service due to a complaint of dyspnea, dizziness, and headache. Resistant hypertensive patient, already being tested various therapeutic regimens. The procedure did not show any vascular complications and the patient was discharged after 24 h hospitalization, clinically stable, walking without difficulty, and presenting mean office blood pressure levels during the 24 h post procedure in 130/82 mmHg. After 6 months of follow-up, the office blood pressure was 140/89 mmHg, and the 24-h ABPM values were: mean = 132/83 mmHg, awake = 135/86 mmHg, and sleeping = 126/75 mmHg, and did not present any symptoms.