THREE-YEAR RESULTS OF RENAL DENERVATION: PRESERVATION OF POSITIVE TRENDS

Abstract

Objective: To assess the persistence of the beneficial effects of renal denervation (RD) over a three-year follow-up Design and method: The study included 42 patients, 27 women and 15 men (mean age 57,2 ± 7,9 years) with resistant hypertension. 24-hour blood pressure (24-h BP) monitoring, echocardiography with left ventricular mass (LVM) determination, and blood sampling from a peripheral vein for pro-inflammatory cytokines by ELISA and creatinine level determination with a calculation of the glomerular filtration rate (GFR) were performed at baseline and 3 years after RD Results: The number of antihypertensive drugs did not change significantly from 4,0 ± 0,9 to 4,3 ± 0,9 (p > 0.05). The studied indicators dynamics after 3 years was as follows: 24-h BP decreased from 159,9 ± 16,5 / 88,0 ± 13,4 mmHg to 143,3 ± 17,2 / 79,0 ± 13,5 mmHg (p = 0,000); LVM - from 251,9 ± 64,1 g to 229,7 ± 61,9 g (p = 0,015). Tumor necrosis factor alpha changed from 4,1 ± 3,6 ng/ml to 2,5 ± 2,2 ng/ml (p = 0,042); interleukin-1 (IL-1) from 5,6 ± 4,4 ng/ml to 3,2 ± 2,1 ng/ml (p = 0,010); IL-6 from 3,6 ± 3,0 ng/ml to 2,7 ± 1,5 ng/ml (p > 0,05); IL-10 from 5,6 ± 3,6 ng/ml to 2,8 ± 0,7 ng/ml (p = 0,000). The creatinine level did not change significantly over 3 years from 82,1 ± 18,2 mmol/l to 85,6 ± 23,1 mmol/l (p > 0,05). GFR, determined by the CKD-EPI, decreased from 78,8 ± 16,1 to 74,5 ± 20,2 ml/min/1,73m2 for 3 years mainly by the first year due to BP decrease. No adverse events were registered Conclusions: RD is an effective and safe method for the treatment of resistant hypertension. We indicate target organ damage regression, including an LVM decrease and a slowdown in chronic kidney disease progression. There is a decrease in proinflammatory cytokines levels as well as in IL-10, probably by a feedback mechanism, which may also indicate a persistent sympathetic tone decline.