FEATURES OF THE BLOOD PRESSURE DYNAMICS AND PRO-INFLAMMATORY CYTOKINES IN PATIENTS WITH RESISTANT HYPERTENSION AND CORONARY ATHEROSCLEROSIS AFTER RENAL DENERVATION

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Objective: Inhibition of sympathetic activity via renal denervation (RDN) is associated with a reduction of blood pressure and variety of inflammatory markers in patients with resistant hypertension (RH). The purpose of this study was to investigate the effects of RDN on BP, TNF-alpha and hs-CRP in patients with confirmed atherosclerosis, to compare the studied parameters in revascularized and conservatively treated patients groups. Design and method: In 35 patients with RH associated with CAD and confirmed by coronary angiography atherosclerosis, levels of 24-h BP, TNF-alpha and hs-CRP analyzed by ELISA were identified before and 12 months after RDN. Baseline 24-h systolic (SBP), diastolic (DBP) and pulse (PBP) BP were 154 ± 12 mmHg, 82 ± 13 mmHg and 73 ± 13 mmHg respectively. Then patients retrospectively where divided into two groups according to the severity of coronary artery disease (CAD): the first group underwent coronary stenting or coronary artery bypass grafting, the second had no need for revascularization and was treated conservatively. Results: 12 month after RDN all the patients had significant (p < 0,05) 24-h SBP (144 ± 15 mmHg), DBP (77 ± 11 mmHg) and PBP (67 ± 14 mmHg) and TNF-alpha from 7,0 ± 3,4 ng/ml to 6,6 ± 3,0 ng/ml, p = 0,03 reduction and downward trend in hs-CRP from 4,0 ± 3,5 ng/ml to 2,8 ± 2,4 ng/ml, p = 0,07, that correlated with PBP reduction (r = 0,47, p < 0,05). It was no difference between SBP and hs-CRP levels in the two groups. In the first group baseline levels of PBP and TNF-alpha where higher than in the second: 78,9 ± 12,8 mmHg vs 69,0 ± 12,1 mmHg, p = 0,03; 9,0 ± 1,2 ng/ml vs 5,7 ± 3,7 ng/ml, p = 0,01. Downward trend in TNF-alpha and hs-CRP persisted in both groups. In conservatively treated group there was significant 24-h SBP/DBP reduction 12 months after RDN (p < 0,05) on 15 (3; 23) / 7 (4; 16) mmHg, whereas in the revascularized group SBP, DBP and PBP did not change (p > 0,05). Conclusions: Patients with RH associated with CAD have significant TNF-alpha reduction, downward trend in hs-CRP 12 months after RDN. Patients with severe coronary atherosclerosis have higher levels of TNF-alpha and are non-responders for RDN.