SPONTANEOUS, INDEPENDENT, SINGLE-CENTER RDN REGISTRY OF A RESISTANT HYPERTENSION MULTIDISCIPLINARY TEAM

Abstract

Objective: Uncontrolled resistant hypertension (URH) is defined as Systolic Blood Pressure above 140mmHg despite at least 3 maximally tolerated doses of antihypertensive drugs including a diuretic. Renal sympathetic denervation (RDN) has proved efficacy in the sponsored SPYRAL and RADIANCE studies. However, little evidence is available from independent studies. Furthermore, patients with glomerular filtrate rate <45ml/min have been systematically excluded. This study aims to evaluate the safety and the efficacy of catheter-based radiofrequency RDN in patients with URH, including those with renal impairment. Design and method: Consecutive unselected patients with URH undergoing RDN were enrolled, assessed in a multidisciplinary team involving cardiologist, nephrologist and hypertension specialists, that excluded secondary forms. Efficacy was defined as change of office (OBP) and ambulatory blood pressure monitoring (ABPM) after RDN, safety as the absence of device-related major complication (BARC classification), end-stage renal disease, stroke, acute myocardial infarction and any cause of death within 1 month. 107 patients underwent RDN from 2012 to December 2023. The population had multiple comorbidities: 45% were smokers, 43% diabetic, 35% had peripheral artery disease, 30% coronary artery disease, 57% CKD. The average number of antihypertensive medications was 4.83±1.2 Baseline ABPM and OBP were 151.18±20,97/87,88±14,39mmHg and 155,92±24/85,25±15,5 mmHg, respectively Results: . At 12-month a significant reduction of systolic OBP and ABPM, respectively by -17.51±3.70 mmHg (P=0.001) and -7.03±3.37 mmHg (P=0.04) was noticed. BP reduction at 12-month follow-up was observed also among eGFR <45 ml/min, with a reduction by -18.73±7.14mmHg (P=0.02) in systolic OBP and by -17.81±7.49 (P=0.03) in ABPM. The therapeutic burden was slightly reduced baseline to 4 (3-5) at follow-up (p<0.01). No major complications were observed and renal function was stable up to 12 months, compared to baseline (1.87±2.37 vs. 2.44±3.56; -0.57±0.32; p=0.08). Conclusions: RDN on top of medical therapy is safe and feasible in patients with URH, even in a high-risk CKD population with multiple comorbidities. A significant reduction of SBP also in this subgroup up to 12 months was reported without undesired effects. Furthermore, our experience underlines the central role of multidisciplinary team evaluation for the appropriate management of URH.