The effects of renal denervation on blood pressure values and diastolic dysfunction in resistant hypertension

Introduction: Despite the advances in antihypertensive drug therapy, approximately 10% of hypertensive patients remain resistant to treatment. Controlling of blood pressure values in patients with resistant hyper-tension continues to be a challenge for contemporary cardiology. In this context, denervation of renal arteries (RDN) could be a new therapeutic pathway with high promises in the treatment of resistant hypertension. The aim of the research was to evaluate the impact of RDN versus pharmacological treatment on blood pre-ssure values and diastolic function parameters in resistant hypertension.
Methods: 45 patients with essential HTN without co-morbidities (CAD, MI, AFi, stroke, DM type 2) with mean age 53,2±0,61 years who received ambulatory daily treatment with Losartan 100 mg, Amlodipine 10 mg and Indapamide 1.5 mg, then, after confirmation of the persistence of blood pressure values >140/90 mmHg, were randomized into three branches depending on the medication supplemented with the following: I M group – Moxonidine (0.6 mg/day) ; II B group – Bisoprolol (10 mg/day); III RDN group – RDN. All patients were evaluated by transthoracic echocardi-ography and ABPM measurement of blood pressure at baseline and 3-month follow-up. The diastolic function was assessed by estimating the following parameters: E/A, TDE, E/E\›. RDN was performed using the Enli-gHTN® catheters.
Results: At the baseline, 24 hours ABPM showed the following average values: SBP 148±23 mmHg and DBP 85±7 mmHg (pnth follow-up documented the reduction of blood pressure values in both drug and renal denervation groups: I M group – SBP avera-ge decrease of 11 mmHg (p<0.01) and DBP -7 mmHg (p<0.01); II B group – SBP average decrease of 8 mmHg (p<0.01) and DBP -5 mmHg (p<0.01); III RDN group
SBP average decrease of 19 mmHg (p<0.01) and DBP -9 mmHg (p<0.01). It is worth mentioning that the systolic function of LV in all subjects enrolled in the study was normal – LVEF mean 63±5%. Diastolic dys-function (DD) of varying degrees was initially diagno-sed in 100% of the patients. At 3-month follow-up, the improvement in diastolic function parameters was noted in all groups, but statistically insignificant in group I M and with a superior effect in the RDN group com-pared to the Bisoprolol group: I M group – E/A from 0.84±0.21 to 1.02±0.3, p=0.37; TDE from 251.2±29.3 to 238.7±15.8 ms, p=0.15; E/E\› from 11.0±3.3 to 10.5±3.5, p=0.22; II B group – E/A from 0.84±0.21 to 1.1±0.3, p<0.05; TDE from 251.2±29.3 to 215.8±23.1 ms, p<0.05; E/E´ from 11.0±3.3 to 9.4±1.7, p<0.05; III RDN group – E/A from 0.84±0.21 to 1.1±0.2, p<0.05; TDE from 251.2±29.3 to 220.3±24.8 ms, p<0.05; E/E´ from 11.0±3.3 to 9.3±1.3, p<0.05.
Conclusions: T he denervation of renal arteries was associated with a statistically significant decrease in both sporadic and ABPM blood pressure. Concomi-tantly, an improvement in diastolic function parame-ters has been documented in patients with resistant HTN. The benefit of RDN seems to be due to the fact that the patients enrolled in the study were very homo-geneous, without comorbidities, comparable in age, blood pressure values and degree of impairment of di-astolic function, which was not observed in most large clinical trials. The opportunity to use RDN in patients with essential HTN remains to be further investigated by enrolling a larger sample of subjects and extending the follow-up period up to 3-5 years.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)