POS-413 MANAGEMENT OF HYPERTENSION AFTER RENAL SYMPATHETIC DENERVATION IN MALE PATIENTS

Abstract

Renal sympathetic denervation (RSD) is a catheter-based medical procedure that uses radiofrequency ablation on the renal sympathetic nerves to attenuate cardiac pulse pressure as well as juxtaglomerular renin release through beta-1 adrenergic receptor stimulation. Early studies on RSD demonstrated a marked benefit in the patients who underwent the procedure, but early cases have left more to be desired due to heterogeneity of clinical trial designs. Currently, the International Consensus Statement on Renal Denervation reports the need for further evaluation of RSD efficacy and suggested that RDN should not be offered to patients outside of clinical trials. Despite the International Consensus Statement recommendations, there are a number of reported peer-reviewed case reports of hypertensive patients undergoing renal denervation, yet there is currently no literature or systematic review on these case reports determining if the patient outcomes have produced similar results to the current literature of RSD clinical trials. Therefore, the aim of this study is to evaluate the efficacy of RSD treatment in attenuating hypertension among patients. A systematic review of the literature was performed on MEDLINE, Google Scholar, and the Cochrane Database of Systematic Reviews for renal denervation case studies. This study methodology was registered by PROSPERO International prospective register of systematic reviews (National Institute for Health Research). The search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. Twenty-four male patients were found to be undergoing renal sympathetic denervation for hypertension treatment. The mean age of the patient population was 48.75 (CI: 41.68 - 55.82). The mean body mass index (BMI) was 31.02 (CI: 24.69 - 37.34). The reported duration of an ablation varied among each study, noting the shortest duration at 10 seconds, and the longest duration at 120 seconds. At post-RSD treatment, the mean 24-hour post-operative systolic blood pressure of reported cases was 144.40 mmHg (CI: 114.03 - 174.77). At 1-month follow-up, the mean systolic blood pressure was 142.00 mmHg (CI: 117.91 - 166.10). At 3-month follow-up, mean systolic blood pressure decreased to 126.25 mmHg (CI: 117.21 - 135.29). At 6-month follow-up, the mean systolic blood pressure increased to 160.00 mmHg. At 1-year follow-up, the mean systolic blood pressure of reported cases decreased to 131.00 mmHg. After RSD treatment, patient follow-up histories reported a mean number of 3.00 antihypertensive medications (CI: 1.96 - 4.04). On average, the severity of hypertension declined from borderline-malignant hypertension to stage I hypertension. The resulting reduction in blood pressure during these follow-up visits is consistent with the results of larger renal denervation registry studies, which addresses the International Consensus Statement’s desire for further evidence. However, one of the concerns posed in the literature regarding renal sympathetic denervation was the lack of reliable improvements in blood pressure over a prolonged period of time. Areas of interest that merit further study include tracking blood pressure changes beyond one year, monitoring for complications, and following changes in all-cause mortality.