Abstract
AimsTo evaluate the safety and efficacy of catheter-based radiofrequency renal sympathetic denervation (RSD) in a daily practice population of patients with uncontrolled resistant hypertension, on top of medical therapy.MethodsConsecutive unselected patients with uncontrolled resistant hypertension undergoing RSD were enrolled. Office and ambulatory blood pressure (BP) measurements were collected at baseline and 3, 6 and 12 months after RSD. Efficacy was assessed even in patients with an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73 m2. Patients were defined as responders if systolic BP decreased by at least 5 mmHg at ambulatory BP or by 10 mmHg at office BP at their last follow-up visit.ResultsForty patients with multiple comorbidities underwent RSD from 2012 to 2019. Baseline office and ambulatory BP was 159.0/84.9 ± 26.2/14.9 mmHg and 155.2/86.5 ± 20.9/14.0 mmHg, respectively. At 12-month follow up a significant reduction in office and ambulatory systolic BP, respectively by − 19.7 ± 27.1 mmHg and by − 13.9 ± 23.6 mmHg, was observed. BP reduction at 12-month follow-up among patients with eGFR < 45 mL/min was similar to that obtained in patients with higher eGFR. Twenty-nine patients (74.4%) were responders. Combined hypertension, higher ambulatory systolic BP and lower E/E’ at baseline emerged as predictors of successful RSD at univariate analysis. No major complications were observed and renal function (was stable up to 12 months), even in patients with the lowest eGFR values at baseline.ConclusionRSD is safe and feasible in patients with uncontrolled resistant hypertension on top of medical therapy, even in a high-risk CKD population with multiple comorbidities, with a significant reduction in systolic BP and a trend towards a reduction in diastolic BP lasting up to 12 months.Graphic abstract
Highlights
Uncontrolled resistant hypertension is defined as systolic blood pressure of 140 mmHg or higher despite the adherence to at least three antihypertensive medications, including a diuretic, at maximally tolerated doses [1]
In order to rule out a diagnosis of white coat hypertension, all patients were screened based on their home blood pressure diary, and in 24 patients based on basal 24-h ambulatory blood pressure monitoring (ABPM)
Baseline Office blood pressure (OBP) was 159.0/84.9 ± 26.2/14.9 mmHg, ABPM was available for 24 patients (60%) and was 155.2/86.5 ± 20.9/14.0 mmHg
Summary
Uncontrolled resistant hypertension is defined as systolic blood pressure of 140 mmHg or higher despite the adherence to at least three antihypertensive medications, including a diuretic, at maximally tolerated doses [1]. To overcome the limitations of the Symplicity HTN studies, a second generation of studies, named Spyral HTN trials, were initiated to reevaluate the efficacy of RSD by adopting both improved study methodology and a homogeneous population, as well as by using the new tetrapolar catheter and extending the treatment to the distal branches of the renal artery [15]. The results of these proof of concept studies were encouraging, showing the biological signal that RSD decreases BP [16,17,18]. Few data are available regarding daily practice, in particular for patients with CKD who were systematically excluded from the cited trials
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