EFFECT OF RENAL DENERVATION ON CARDIO ANKLE VASCULAR INDEX IN SUBJECTS WITH RESISTANT HYPERTENSION

Abstract

Objective: The aim of the study was to determine the clinical characteristics of patients with increased arterial stiffness (AS) undergoing renal sympathetic denervation (RSD) and to examine the role of CAVI measurement as a surrogate for AS in predicting the outcome of RSD. Design and method: Consecutive patients with resistant hypertension who underwent RSD workout at the University Hospital Saint Anna, Sofia, ESH Excellence center of hypertension, between January 2014 and December 2020 were included. RSD was performed on the grounds of resistant hypertension defined as mean daytime systolic BP = > 135 mmHg or diastolic BP = > 85 mmHg in 24-hr ambulatory blood pressure measurement (ABPM) despite the intake of at least three antihypertensive agents, including a diuretic. CAVI was measured using the VaSera system (Fukuda Denshi Co, Japan). RSD was performed with the Symplicity Flex catheter (Medtronic, Minneapolis, MN, USA) according to a standardized protocol. Results: The study included 62 patients with treatment-resistant hypertension, after out of office blood pressure measurement and intensification of therapy, renal denervation was performed in 32 (51.6%). Patients with increased arterial stiffness, defined as CAVI> median of 8.3, were older, with a larger waist circumference and previous cardiovascular events. A long-term effect of the RSD, reported as a reduction in 24-hour systolic blood pressure above 10 mmHg at month 12, was found in 22 patients (68.8%). The median of the observed reduction of the 24-hour systolic blood pressure was -16 mmHg at 95% confidence interval -9.1 to -21 mmHg. Despite similar baseline out-of-office and office blood pressure and concomitant antihypertensive therapy, patients with lower arterial stiffness had a more significant blood pressure effect of renal denervation, a result that persisted within 12 months of follow-up. In contrast, the effect of the procedure was clinically insignificant among patients with baseline CAVI values above 8.3. Conclusions: These findings hold the promise that AS might be used as a selection criterion for RSD, thereby improving outcome following RSD.