Abstract
Aim. To develop an optimized scientifically based approach to medical and diagnostic measures before renal denervation. Methods. 91 patients with a previously diagnosed primary arterial hypertension aged 54.2 (52.0, 69.3) years history of arterial hypertension was 11.4±4.2 years. 57 (62.6%) patients had asymptomatic lesions of target or-gans. 34 (37.4%) were present with associated clinical conditions. The average number of classes of antihyper-tensive drugs taken by patients was 4±1.2. 18 patients (19.8%) received aldosterone antagonists. All patients were included in the study. The duration of the positive underwent standard clinical, laboratory and instrumental tests. The quality of life was assessed using the SF-36 questionnaire. Patients’ adherence to treatment was eval-uated using the Morisky-Green test. After therapy optimi-zation and a number of additional diagnostic procedures, true resistant arterial hypertension was detected in 19 pa-tients, of whom 9 were excluded from the study. 4 patients were excluded because of specific anatomy, and 5 patients were allergic to the contrast media. Results. Optimization of the diagnostic and medical algorithm for managing patients with arterial hy-pertension allowed identifying patients with secondary arterial hypertension, accounted to 8.8% of the study sample, as well as achieving significant reduction of blood pressure according to the 24-hour blood pressure monitoring findings: SBP by 34 ± 12 mm Hg, and DBP by 12 ± 4 mm Hg, compared to the initial values (p = 0.046). The obtained results are comparable in the groups with high and low adherence. 54 patients (77.1%) achieved blood pressure targets. The study groups demonstrated significant improvements of the quality of life and adherence to treatment. The proportion of patients with true resistant arterial hypertension has been identified. Conclusion. The presented algorithm of selecting patients for renal denervation allows to optimize the management strategy inpatients, who are suspected to suffer from resistant arterial hypertension, and to per-form targeted interventions.
Highlights
91 patients with a previously diagnosed primary arterial hypertension aged 54.2 (52.0, 69.3) years were included in the study
After therapy optimi zation and a number of additional diagnostic procedures, true resistant arterial hypertension was detected in 19 pa tients, of whom 9 were excluded from the study. 4 patients were excluded because of specific anatomy, and 5 patients were allergic to the contrast media
Optimization of the diagnostic and med ical algorithm for managing patients with arterial hy pertension allowed identifying patients with secondary arterial hypertension, accounted to 8.8% of the study sample, as well as achieving significant reduction of blood pressure according to the 24-hour blood pres sure monitoring findings: SBP - by 34 ± 12 mm Hg, and DBP - by 12 ± 4 mm Hg, compared to the initial val ues (p = 0.046)
Summary
91 patients with a previously diagnosed primary arterial hypertension aged 54.2 (52.0, 69.3) years were included in the study. The duration of the positive history of arterial hypertension was 11.4±4.2 years. 57 (62.6%) patients had asymptomatic lesions of target or gans. 34 (37.4%) were present with associated clinical conditions. The average number of classes of antihyper tensive drugs taken by patients was 4±1.2. All patients underwent standard clinical, laboratory and instrumen
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