Renal Artery Denervation Research Articles

An Update on the Role of Renal Artery Denervation in the Treatment of Hypertension

An Update on the Role of Renal Artery Denervation in the Treatment of Hypertension

Comparing the Efficacy of Renal Artery Denervation in Uncontrolled Hypertension: A Systematic Review and Network Meta-Analysis.

The study aims to compare the outcomes of different renal denervation (RDN) procedures in the treatment of uncontrolled hypertension. We searched Scopus, PubMed, Web of Science, and Cochrane for RCTs evaluating different procedures of RDN for hypertension. The outcomes of this study were systolic blood pressure (SBP) daytime, diastolic blood pressure (DBP) daytime, SBP nighttime, DBP nighttime, SBP 24-hour, DBP 24-hour, SBP home, DBP home, SBP office, and DBP office. We did a frequentist network meta-analysis of 38 published RCTs evaluating the efficacy of different renal artery denervation procedures for uncontrolled hypertension compared to sham procedures or standardized stepped-care antihypertensive treatment (SSAHT). Radiofrequency (RF) alone showed a statistically significant reduction in DBP (24 hours), DBP (daytime), and DBP (nighttime): standardized mean difference (SMD): -2.01 (95% CI: (-3.34; -0.68)), SMD: -4.36 (95% CI: (-8.28; -0.44)), and SMD: -3.50 (95% CI: (-6.23; -0.76)), respectively, and showed a statistically significant reduction in SBP (24 hours), SBP (daytime), and SBP (nighttime): SMD: -3.93 (95% CI: (-6.01; -1.84)), SMD: -5.88 (95% CI: (-9.91; -1.85)), and SMD: -5.79 (95% CI: (-10.0; -1.58)), respectively. RF added to SSAHT has statistical significance in the reduction of DBP (nighttime), SBP (daytime), SBP (home), and SBP (nighttime) with a SMD of -7.63 (95% CI: (-14.21; -1.06)), SMD of -10.56 (95% CI: (-21.03; -0.08)), SMD of -23.20 (95% CI: (-36.72; -9.26)), and SMD of -14.03 (95% CI: (-25.43; -2.63)), respectively. We found that renal denervation, especially by RF, when added to SSAHT may be a promising therapeutic option for patients with treatment-resistant hypertension, particularly in cases where medication alone fails to achieve adequate blood pressure control.

MODERN VIEW ON RADIOFREQUENCY DENERVATION OF RENAL ARTERIES

Today, arterial hypertension is one of the most important health problems. It is also the main cause of cardiovascular complications and death. Despite significant success of modern antihypertensive pharmacotherapy, 10 % of the entire patient population with high blood pressure have extremely low sensitivity to core drugs aimed at BP correction. According to large clinical studies, the risk of myocardial infarction, stroke and other adverse cardiovascular outcomes in individuals with resistant hypertension is several times higher than in patients with controlled blood pressure. The purpose of this work is to analyze scientific literature on the history of development, effectiveness and safety of catheter radiofrequency denervation of renal arteries in patients with resistant arterial hypertension. The authors used articles from Pubmed, eLIBRARY, etc. for their analysis. The results of clinical studies show that patients with resistant arterial hypertension, in contrast to patients with controlled blood pressure, have more pronounced sympathetic activity. Hyperactivity of this part of the nervous system may be one of the main pathogenetic factors causing development of resistance to pharmacotherapy. Thus, radiofrequency renal denervation, modulating the tone of the sympathetic nervous system, is of particular interest.

Renal denervation in secondary arterial hypertension therapy: clinical case

Introduction. Renovascular hypertension is one of the most severe types of hypertension in terms of the choice of treatment strategy. Recent studies have not provided a clear answer to the question of which treatment approach (conservative or surgical) is most appropriate for these patients.Brief description. The presented case describes a female patient with a longterm uncontrolled hypertension, whose examination revealed bilateral renal artery stenosis. Considering the debatable clinical effectiveness of revascularization of renal artery stenosis, the patient underwent distal renal artery denervation using multielectrode catheters. A decrease in blood pressure was shown. Follow-up of the patient demonstrated stable antihypertensive effect of the procedure, as well as its safety in case of impaired renal function.Discussion. This clinical demonstrates the third way in the treatment of patients with renal arteries stenosis and resistant hypertension — renal sympathetic denervation. This method requires a separate controlled study with individuals with renal dysfunction, including renovascular origin.

Comparative assessment of the impact of renal denervation on blood pressure values in resistant hypertensive patients with and without type 2 diabetes

Randomized clinical trial data confirm the effectiveness of renal artery denervation (RDN) not only among hypertensive patients, but also in other pathologies associated with increased SNS activity, such as type 2 diabetes, heart failure and others. Aim. Evaluation of the impact of RDN on blood pressure values in two categories of patients - resistant hypertension with and without type 2 diabetes. Materials and methods. The randomized prospective clinical study was designed that enrolled 250 resistant hypertensive patients divided into two equal groups of 125 patients depending to the presence of DM. The patients in the first two subgroups of each group were given standardized treatment supplemented with SNS blockers Moxonidine and Bisorpolol , while patients from subgroups III and VI underwent RDN. Patients were evaluated by dynamic ambulatory BP monitoring for a period of 3 years. Results. Authentic reduction of office SBP and DBP was noted starting from 6 months of assessment in all research groups, the comparative analysis of dynamics of office SBP at all stages of evaluation demonstrating a clear superiority of groups of minimally invasive treatment by RDN versus pharmacological treatment with the SNS blockers Moxonidine and Bisoprolol in improving these parameters. At the same time, a statistically significant reduction in the average values of SBP and DBP 24 hours was recorded in both the pharmacological and interventional treatment groups independent ofthe presence of type 2 diabetes, the maximum antihypertensive effect being expressed at 36 months of evaluation. Diabetic and non-diabetic patient groups undergoing RDN demonstrated superiority to both pharmacotherapeutic regimens at all follow-up stages.Conclusions. The obtained results demonstrated the comparable antihypertensive efficacy of RDN in resistant hypertensive patients with or without type 2 diabetes. At the same time, the groups of diabetic and non-diabetic patients undergoing RDN showed superiority over both pharmacotherapeutic regimens with SNS blockers in reducing blood pressure values, the beneficial effect being maintained for a three-year follow-up period.

New perspectives in taming resistant hypertension

Resistant hypertension represents a significant burden for healthcare systems worldwide due to its association with extremely high cardiovascular risk and remains a therapeutic challenge driven by complex and inadequately addressed by conventional therapy pathophysiological pathways. Several drugs in various stages of investigation could potentially have a significant impact on the ultimate treatment of resistant hypertension. In addition to pharmacological therapy, studies show promising evidence regarding renal artery denervation in managing resistant hypertension. Better usage of currently approved therapies and the integration of emerging therapies are welcomed additions to the anti-hypertensive therapeutic arsenal.

Catheter-Based Renal Artery Denervation

Catheter-Based Renal Artery Denervation

FOLLOW-UP OF RENAL DENERVATION IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION

Objective: Aim. Determining the long-term efficacy and safety of RDN the results of a 10-year follow-up Design and method: We selected 1146 patients with resistant arterial hypertension (RAH) who received 3 or more antihypertensive drugs. 16 patients were selected for renal artery denervation. RDN was performed in 8 patients (0.70%). 8 patients refused the procedure. The age was 52.13 ± 3.88 years (40–66), the duration of hypertension was 16.75 ± 2.17 (12–25) years. The number of antihypertensive drugs was 5.5 ± 0.18 (patients was in refractory hypertension). Office SBP/DBP on optimization of therapy was 156.88/95.00 ± 2.98 mm Hg and heart rate - 68.88 ± 3.28 beats/min. 24SBP/DBP was 149.16 ± 5.40/86.98 ± 5.08 mm Hg. 24HR was 70.12 ± 2.94 beats/min. All patients tolerated the procedure well. Results: The decrease in office SBP/DBP in the dynamics of 1 month, 12 months, 2 years, 5 years and 10 years were -12,59/-10,0, -11,17/-2,57, -20,31/-11,71, -27,71/-13,33 and -30,21/-16,67 mm Hg, respectively. The office heart rate (HR) decreased, its dynamics were -3.74 bpm, -4.68 bpm, -1.45 bpm, - 2.13 bpm. -4.21 bpm, - 3.88 bpm., respectively. The decrease in 24SBP/DBP was -14,45/-6,95, -8,70/-10,01, -19,45/-12,37, -19,91/-11,24, -29,93/-13,61 and -26,13/-23,35 mm Hg. (p<0.05 for all values). 24HR dynamics: -3.16 bpm, - 4.19 bpm, + 1.43 bpm. -1.51 bpm, -4.46 bpm, and -5.49 bpm, respectively. After 2, 5, and 10 years, all patients reached the target blood pressure level both in the office and with ABPM. Patients reduced the number of antihypertensive drugs from 5.50±0.18 to 3.50±0.30 - after 5 years and 3.67±0.18 - after 10 years after RDN. GFR change over 10 years from 76.10±5.62 to 64.60±1.93 ml/min/1.73m2, p>0.05. One patient died of thyroid cancer 2 years later. All other patients are alive and have not had any cardiovascular event or death during 10 years. Conclusions: Long-term results of renal artery denervation showed no cardiovascular events or cardiovascular death over 10 years. RDN contributed to a reduction in the number of antihypertensive drugs from 5.5 to 3.67 after 10 years of therapy. All patients achievement of the target BP level.

Controversies related to renal artery denervation and devices.

This review article discusses the controversies, strengths, and limitations of the current literature on renal artery denervation in the management of resistant hypertension, as well as the future directions of this intervention. There have been conflicting data from the different randomized control trials assessing the efficacy of renal artery denervation in the management of resistant hypertension. Renal artery denervation is achieved by ablating the sympathetic nerves surrounding the renal arteries using endovascular ultrasound, radiofrequency, or alcohol. Our review article highlights that renal artery denervation is generally effective in improving blood pressure in patients with resistant hypertension. The Food and Drug Administration (FDA) has recently approved the ReCor Medical Paradise system, and the Symplicity Spyral RDN systems for renal artery denervation.

Five-year dynamics adrenergic reactivity of erythrocytes after radio-frequency sympathic denervation of renal arteries in patients with resistant arterial hypertension

To study the initial state of adrenergic reactivity and the five-year dynamics of the beta-adrenergic reactivity index of erythrocyte membranes and the manifestation of the antihypertensive effect of the procedure for radiofrequency destruction of sympathetic structures of the renal artery in patients with resistant arterial hypertension. The analysis included 42 patients with resistant arterial hypertension (RH). The renal denervation (RD) procedure of the kidneys was performed by endovascular bilateral transcatheter radiofrequency ablation of the renal arteries. The study of 24-hour blood pressure monitoring (BPM) and the determination of β-adrenoreactivity of erythrocytes (β-ARM) by changes in the osmoresistance of erythrocyte membranes were performed initially, 1 week, 6 months, 1, 2, 3 and 5 years after RD. Patients retrospectively, at a follow-up period of 6 months after RD, were divided into responders (decrease in blood pressure by 10 or more mm Hg) and non-responders (decrease in blood pressure less than 10 mm Hg). 6 months after the RD, the number of responders was 28 people (66.7%), after 5 years - 31 people (73.8%). At the time of inclusion in the study, the median β-ARM in the group of non-responders was not significantly higher than in the group of responders. After 6 months after the RD procedure, the β-ARM indicator in the non-responder group was significantly lower than in the responder group (p = 0.043). With further follow-up in the group of responders, an increase in the median β-ARM was noted, which reached significant differences relative to the baseline values in the group at follow-up periods of 1 year (p = 0.036) and 5 years (p = 0.004) after RD. The change in the β-ARM indicator in the non-responder group was wavy in nature, the changes did not reach the significance criteria. Renal denervation in 73.8% of cases is accompanied by a stable antihypertensive response for 5 years of observation and an increase in β-ARM, which may indicate the implementation of compensatory mechanisms in conditions of increasing activity of the sympathoadrenal system in response to a decrease in blood pressure.

TCT-3 Renal Artery Denervation Combined With Pulmonary Vein Isolation in Patients With Heart Failure and Atrial Fibrillation: Pilot Study

TCT-3 Renal Artery Denervation Combined With Pulmonary Vein Isolation in Patients With Heart Failure and Atrial Fibrillation: Pilot Study

Long-term effectiveness of radiofrequency renal denervation in patients with resistant arterial hypertension (10-year follow-up results)

The aim – to determine the long-term efficacy and safety of renal denervation (RDN) at 10-year follow-up.Materials and methods. We selected 1146 patients with resistant arterial hypertension (RAH) who received 3 or more antihypertensive drugs. 16 patients were selected for renal artery denervation. RDN was performed in 8 patients (0.70 %). 8 patients refused the procedure. The age was 52.13 ± 3.88 years (40–66), the duration of hypertension was 16.75 ± 2.17 (12–25) years. The number of antihypertensive drugs was 5.5 ± 0.18. Office SBP/DBP on optimization of therapy in patients was 156.88/95.00 ± 2.98 mm Hg and heart rate – 68.88 ± 3.28 beats/min. 24SBP/DBP was 149.16 ± 5.40/86.98 ± 5.08 mm Hg. 24HR was 70.12 ± 2.94 beats/min. All patients tolerated the procedure well.Results and discussion. The decrease in office SBP/DBP was –12.59/–10.0 mm Hg; –11.17/–2.57 mm Hg; –20.31/–11.71 mm Hg, –27.71/–13.33 mm Hg and –30.21/–16.67 mm Hg, in the dynamics of 1 month, 12 months, 2 years, 5 years and 10 years, respectively, p <0.05 for all values compared to the initial. The office heart rate at the stages of 1 month, 6, 12 months, 2 years, 5 and 10 years decreased, its dynamics were –3.74 bpm, –4.68 bpm, –1.45 bpm, –2.13 bpm, –4.21 bpm, –3.88 bpm, respectively. The decrease in 24SBP/DBP was –14.45/–6.95 mmHg, –8.70/–10.01 mm Hg, –19.45/–12.37 mm Hg, –19.91/–11.24 mm Hg, –29.93/–13.61 mm Hg. and –26.13/–23.35 mm Hg (p<0.05 for all values). 24HR dynamics: –3.16 bpm, – 4.19 bpm, + 1.43 bpm, –1.51 bpm, –4.46 bpm, and –5.49 bpm, respectively. After 2, 5, and 10 years, all patients reached the target blood pressure level both in the office and with ABPM. Patients reduced the number of antihypertensive drugs from 5.50 ± 0.18 to 3.50 ± 0.30 – after 5 years and 3.67 ± 0.18 – after 10 years after RDN. GFR practically did not change over 10 years from 76.10 ± 5.62 to 64.60 ± 1.93 ml/min/1.73m2, p>0.05. One patient died of thyroid cancer 2 years later. All other patients are alive and have not had any cardiovascular event or death during 10 years.Conclusion. Long-term results of renal artery denervation showed no cases of cardiovascular events, development of diabetes or cardiovascular death over 10 years. RDN contributed to a reduction in the number of antihypertensive drugs from 5.5 to 3.67 after 10 years of therapy against the background of 100 % achievement of the target BP level.

Catheter-based renal artery denervation: facts and expectations

Catheter-based renal artery denervation (RAD) is entering a new era. After the disappointing results of SYMPLICITY-HTN 3 trial in year 2014, several technical and methodological advancements led to execution of important SHAM-controlled randomized trials with promising results. Now, the 2023 ESH Guidelines give RAD a class of recommendation II with a Level of Evidence B. Currently, catheter-based RAD has two main areas of application: (a) Hypertensive patients who are still untreated, in whom RAD is a sort of a first-line treatment; (b) Difficult-to-control or true resistant hypertensive patients. Notably, randomized SHAM-controlled trials met their primary end-point in both these conditions. So far, we do not dispose of established predictors of the antihypertensive response to RAD. Some data suggest that younger patients with systo-diastolic hypertension, absence of diffuse atherosclerosis and evidence of sympathetic nervous system overactivity experience a better BP response to the procedure. We reviewed the available data on catheter-based RAD and included an updated meta-analysis of the results of the available SHAM-controlled trials. Overall, the reduction in 24-h systolic blood pressure (BP) after RAD exceeded that after SHAM by 4.58 mmHg (95% CI 3.07–6.10) in untreated patients, and by 3.82 mmHg (95% CI 2.46–5.18) in treated patients, without significant heterogeneity across trials, patient phenotype (untreated versus treated patients) and technique (radiofrequency versus ultrasound). There were no important safety signals related to the procedure. Notably, some data suggest that RAD could be an effective additional approach in patients with atrial fibrillation and other conditions characterized by sympathetic nervous system overactivity.

Effects of renal denervation on cardiac function after percutaneous coronary intervention in patients with acute myocardial infarction

ObjectiveTo observe the effect of renal artery denervation (RDN) on cardiac function in patients with acute myocardial infarction after percutaneous coronary intervention (AMI-PCI). MethodsThis is a single-centre, prospective randomized controlled study. A total of 108 AMI-PCI patients were randomly assigned to the RDN group or the control group at 1:1 ratio. All patients received standardized drug therapy after PCI, and patients in the RDN group underwent additional RDN at 4 weeks after the PCI. The follow-up period was 6 months after RDN. Echocardiography-derived parameters, cardiopulmonary exercise testing (CPET) data, Holter electrocardiogram, heart rate variability (HRV) at baseline and at the 6 months-follow up were analyzed. ResultsBaseline indexes were similar between the two groups (all P > 0.05). After 6 months of follow-up, the echocardiography-derived left ventricular ejection fraction was significantly higher in the RDN group than those in the control group. Cardiopulmonary exercise test indicators VO2Max, metabolic equivalents were significantly higher in the RDN group than in the control group. HRV analysis showed that standard deviation of the normal-to-normal R–R intervals, levels of square root of the mean squared difference of successive RR intervals were significantly higher in the RDN group than those in the control group. ConclusionsRDN intervention after PCI in AMI patients is associated with improved cardiac function, improved exercise tolerance in AMI patients post PCI. The underlying mechanism of RDN induced beneficial effects may be related to the inhibition of sympathetic nerve activity and restoration of the sympathetic-vagal balance in these patients.

Renal excretory function in patients with resistant arterial hypertension after radiofrequency kidney denervation at three-year follow-up

It is generally accepted that the true-resistant hypertension (RH) currently remains critical issue. At present there is some published evidence that catheter renal denervation prosedure showed effectiveness at randomized clinical trials. The assessment of renal function after the technique is crucial.THE AIM of the study was to estimate renal function after renal artery denervation procedure in patients with uncontrolled hypertension in 3 – years follow-up.PATIENTS AND METHODS. The diagnosis of RH was made in the absence of any evidence of secondary hypertension. 40 patients (20 male and и 20 female), aged 55,5± 7,2 years, with office systolic blood pressure (BP) 180 ±26,1 mm Hg, and diastolic BP 107,4±13,9 mm Hg were examined. Glomerular filtration rate (GFR, MDRD) and microalbuminuria level was determined by averaging all measurements performed during hospitalization. Ambulatory blood pressure monitoring (BPM) was performed in all patients.RESULTS. BPM has revealed the significant decrease of systolic daytime blood pressure (at baseline 161,1±16,9 mm Hg and at follow-up 155,4±20,8 mm Hg; р= 0,024) and decrease of diastolic daytime BP (at baseline 95,6 ±11,8 mmHg and at follow -up 90,2 ±12,4 mm Hg; р=0,002). During 3 -year of follow-up the serum creatinine level has increased at baseline 69,5±16,4 μmol/l and at follow-up 78,7±19,5 μmol/l; р<0,0001). The Glomerular filtration rate has scaled down (at baseline 98,2±18,7 ml/min and at follow-up 85,1±17,9 ml/min; р< 0,0001). The level of daily excretion of albumin has also decreased (at baseline 30,4 [14,6; 52,9] mg and at follow-up 14,1 [11,9; 42,4] mg correspondingly; р= 0,03) .CONCLUSION. Although BP profile changes have demonstrated the effectiveness of RDN, therefore the future investigation of exact patho-physiological significance of glomerular filtration level after the treatment of RH should be of provided.

Efficacy and safety of renal denervation in resistant hypertension: two years follow-up

Hypertension remains a major cause of cardiovascular morbidity and mortality globally. Difficulties faced by clinicians to obtain adequate blood pressure control in patients with resistant hypertension have led to the development of alternative device-based treatment methods, one of which is renal artery denervation. In the current paper, the results of the study carried out in the Hypertension Department of the Institute of Cardiology regarding the evaluation of the effectiveness and safety of renal artery denervation in patients with resistant HTN two years post-procedural are presented.

Left Renal Vein Decompression and Left Renal Artery Denervation Is a Novel Treatment for Nutcracker Syndrome and Shows Improvement in Quality of Life and Chronic Pain

Left Renal Vein Decompression and Left Renal Artery Denervation Is a Novel Treatment for Nutcracker Syndrome and Shows Improvement in Quality of Life and Chronic Pain

745 INTERDISCIPLINARY EVALUATION IN RESISTANT ARTERIAL HYPERTENSION

Abstract Background Arterial hypertension is a complex and in most cases multifactorial pathology. Despite the numerous pharmacological treatments available, it is estimated that in Europe only 25%-39% of hypertensive patients achieve adequate blood pressure (BP) control. Renal arteries denervation (RDN) is an additional therapeutic weapon, complementary to Optimal Medical Therapy (OMT) in patients with resistant or refractory primary (or essential) arterial hypertension. In order to improve patients management and select those who are eligible for renal denervation, our Center has established the Interdisciplinary Group for the Treatment of Resistant Arterial Hypertension (G.I.T.I.A.R.), including Cardiologists, Nephrologists, Internists and Geriatricians. Methods From January 2018 to July 2022 the G.I.T.I.A.R. held twelve meetings evaluating 62 patients with resistant or refractory forms of arterial hypertension, contraindications or intolerance to antihypertensive drugs, suspected secondary or pseudoresistant forms (i.e. linked to poor patient compliance, drugs and/or inadequate dosages, concomitant intake of substances with hypertensive effect, incorrect measurements). For each of them, medical therapy was optimized and the need for second level diagnostic tests, multi-specialist follow-up and RDN candidacy were assessed. After three, six, twelve months and then annually following RDN, the patients underwent clinical and multi-specialist evaluation (where deemed appropriate), blood tests monitoring and 24-hour ambulatory blood pressure monitoring (ABPM). Results Of the 62 patients evaluated by the G.I.T.I.A.R., 64.5% (n=40) were male. The mean age at the time of evaluation was 64 years (range 18-87). After the first collegial discussion, 46.8% (n=29) have been declared eligible for RDN, while 53.2% (n=33) of the patients was initially rejected: 39.4% of these (n=13) for suspected or ascertained secondary hypertension, 12.1% (n=4) for the possibility of further optimization of medical therapy, 48.5% (n=16) for the presence of inclusion or exclusion criteria of ongoing studies design. Among the excluded patients, six presented moderate renal artery stenosis on non-invasive imaging: in two patients (33.3%) the stenosis turned out to be hemodynamically significant on angiographic and functional evaluation (Pd/Pa measurement), so renal angioplasty was performed; RDN was performed in the remaining 66.7% (n=4), in which a hemodynamic significance of the stenosis was excluded. Of the subgroup who had optimized medical therapy, one patient (25%) was subsequently referred to RDN for failure of all pharmacological strategies, while 3 of 4 (75%) achieved adequate BP control. Conclusions Resistant arterial hypertension is associated with an increased risk of development and progression of cardiovascular and renal diseases, with a significant impact on mortality and morbidity. Renal denervation has proved to be an effective and safe therapeutic strategy, complementary to OMT, whose selection of the ideal patient actually represents one of the greatest challenges. The integrated multidisciplinary approach improves the management of the hypertensive patient, the individualization of therapy and allows the identification of subjects who may benefit from RDN.

Renal artery denervation: unsolved questions about mechanisms of changes of systemic hemodynamics

In the review we discussed the clinical and physiological aspects of the use of renal artery denervation as an interventional method of treatment of refractory essential arterial hypertension. The application of radiofrequency denervation may be considered as an additional treatment to drug therapy in patients with arterial hypertension. At the same time, the main emphasis in the performed experimental and clinical studies was made on the assessment of changes in blood pressure, cardiac output and the calculated index of total peripheral resistance. However, there is no satisfactory data in the literature about changes of the venous return, as well as superior and inferior venae cavae flows. To assess the effectiveness of renal artery denervation on arterial and venous vessels resistance shifts, it is necessary to carry out experimental studies with perfusion of isolated organs in the conditions of modeling arterial hypertension in animals. The question of the extent to which denervation of the renal arteries leads to shifts in the reactions of organ venous vessels in response to pressor reflex stimuli also requires further studies on experimental models. There are practically no data in the literature on the degree of influence of renal artery denervation on orthostatic tolerance. To understand the mechanisms of changes in systemic hemodynamics in response to denervation of the renal arteries, it is also necessary to perform further research on the mechanisms of shifts in the capacitive and resistive functions of the pulmonary circulation with an assessment of pulmonary microcirculation.

Long-term antihypertensive effect of renal denervation in resistant hypertension: three years follow-up

Abstract Background Recent studies have shown proven efficacy of renal denervation in arterial hypertension, but there is a continuing need to assess the duration of antihypertensive effect. Purpose Evaluation of the long-term antihypertensive effect of renal denervation in patients with resistant hypertension. Methods 125 apparently resistant patients without comorbidities after a 3-week standardized treatment with Losartan 100 mg, Amlodipin 10 mg and Indapamid 1.5 mg and confirmation of their resistance were randomly assigned into three groups depending on treatment supplemented to previously administered: group I - selective I1-imidazoline agonist Moxonidine, group II - cardioselective beta-blocker Bisoprolol and group III – renal artery denervation. The compliance to treatment was confirmed using 8-item Morisky Medication Adherence Scale. Renal denervation was performed in the main renal arteries and their branches. Patients were assessed by ambulatory blood pressure monitoring at baseline, 3, 12, 24 and 36 months follow-up. Results The mean 24 hour systolic blood pressure (SBP) at baseline were 179.0±2.02 mmHg in group I versus 177.96±2.44 mmHg in group II and 176.92±1.97 mmHg in group III, p>0.05. A statistically significant reduction in SBP m/24 h was noted in all three groups starting at 3 months, the group of patients undergoing renal denervation showing superiority over both groups of pharmacological treatment: −6.48±0.81 mmHg in group I versus −6.2±0.88 mmHg in group II and −23.28±1.9 mmHg in group III, p<0.001. The progressive improvement continued until the end of the study, so at 3 years of evaluation in observational group supplemented with Moxonidine SBP m/24 h were 146.36±1.36 mmHg with a total reduction of −32.64±1.56 mmHg from baseline, in Bisoprolol group −152.88±1.56 mmHg with a reduction of −25.08±1.65 mmHg and 133.16±0.73 mmHg in renal denervation group with a total reduction of −282±1.30 mmHg in group III, p<0.001. The mean 24 hour diastolic blood pressure (DBP) increased at baseline in all three observational groups (105.52±1.28 mmHg in group I versus 108.6±1.6 mmHg in group II and 107.24±0.92 mmHg in group III, p>0.05) similar with SBP m/24 h noted an authentic reduction at 3 months follow-up. The maximum reduction in DBP m/24 h were registered at 3 years of evaluation, a comparative analyses of dynamics between groups showing a presence of statistical difference due to superiority of renal denervation in amelioration of this parameter: −18.36±1.88 mmHg in group I versus −16.84±1.76 mmHg in group II and −28.2±1.30 mmHg in group III, p<0.001. Conclusions All three regimens have been shown to be effective in reducing SBP and DBP m/24 h in patients with resistant hypertension, with a superior but comparable effect of Moxonidine to Bisoprolol and the absolute superiority of renal denervation treatment, the beneficial effect being maintained for a period of 3 years. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Agency for Research and Development