IMPACT OF POLYPHARMACY AND COMORBIDITIES TO CLINICAL OUTCOMES IN RESISTANT HYPERTENSION RENAL DENERVATION GROUP

Abstract

Objective: To analyse impact of polypharmacy to blood pressure control in resistant hypertension renal denervation group. Design and method: This prospective study included 73 selected patients with resistant hypertension and RDN (Sympathetic Renal Denervation) performed. Routine follow up was performed subsequently 1, 3, 6, 12, 24 and 48 months after the RDN. Total numbers of pills, prescibed for all diseases was registered. Two groups of patients were defined: A group- patient whom less than 7 pills prescribed and group B -more than 7 pills. Number of antihypertensive medications was analysed separately Also various characteristics were registered: age, sex, comorbidities, 24h-ABPM, arterial stiffness etc. Statistical analysis was performed using SPSS 23.0 Statistical Software. Results: A total cases of 73 patients were included. 6 patients died, 18 failed to remain in the follow up during 4 years. Remaining 49 patients data were analyzed. Median age was 55 (33–72) years old with 53,1 % (n = 26) patients being male. Two groups were similar, acoording to age, weight, office blood pressure, heart rate (p > 0,05), but there was higher numbers of diabetes melitus and coronary artery disease in group B. Mean prescribed antihypertensive drugs (A- 4,75; B- 6,52; p > 0,05). In A group we observed significantly reduced BP (sABP 162,6mmHg to 149,6mmHg, p < 0,01; dABP 100,8mmHg to 90,24mmHg, p = 0,01) during 48 months. In B group: sABP 163,76 mmHg to 152,1mmHg, p = 0,13; dABP 89,7 mmHg to 85,1 mmHg, p = 0,54). In A group we observed significantly reduced carotid-femoral aortic pulse wave velocity (AoPWV) from 11.2 m/s to 10.0 m/s in 4 years (p = 0,01). In second group AoPWV increased from 11,8 m/s to 12,8 m/s, but not significantly (p = 0.34). Conclusions: Patients with more comorbidities and receiving more pills are at higher cardiovascular risk and their blood pressure is more difficult to control, even after renal denervation procedure.