Abstract
Objective: To evaluate the long-term effect of transcatheter renal denervation (TRD) on presence and severity of pathological structural changes of a brain in resistant hypertensive patients (ClinicalTrials.gov number NCT01499810). Design and method: Twenty three resistant hypertensive patients aged between 30–70 years were included in the study. TRD was performed as bilateral endovascular radiofrequency ablation of neural pathways adjacent to renal artery. Detailed clinical investigation, 24-h ABPM and brain MRI were performed in all patients at baseline and 12 months after TRD. Composite presence and severity of leucoaraiosis (LA), liquorodynamic disturbance, lacuna infarcts (LI) and focal white matter lesions (FWML) were scored by integrating index graded 0–8 in all patients. Results: Pathological structural brain changes were detected in 22 patients (96.7%). Periventricular leucoaraiosis was found in 20 (87%) patients (I grade – 17.4%; II grade – 43.5%; III grade - 17.4% and IY grade - 8.7%), liquorodynamic disorder in 21 (91.3%) patients. Lacunae were found in 12 (27.9%) patients and focal white matter lesions - in all patients. There was a correlation between the dynamics of the linear size of bodies and .horns of the lateral ventricles of the brain and the heart rate variability (r = 0,42–0,50; p = 0,036–0,01). According to the changes of systolic blood pressure after TRD all patients were divided in responders (16, 69.6%) and non-responders (7, 30.4%). The severity of LA decreased by 13.5% in responders (p = 0.04). Subarachnoid space of the frontal and parietal areas of the brain decreased by 7–12 %, linear sizes of lateral brain ventricles decreased by 3–7 %, integrating index of structural hypertensive encephalopathy decreased by 13.7% (p = 0.004) while LI and FWML did not change. There was no significantly change in structural brain damages after TRD in non-responders. Conclusions: Our study demonstrates that antihypertensive and cerebroprotective efficiency of renal denervation in resistant hypertensive patients is maintained even a year after the intervention.
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