The Effects of Mean of Visit-to-Visit Blood Pressure on Incident Brain Vascular Lesions and Functional-Cognitive Decline

2021 ◽  
pp. 1-12
Author(s):  
Bibek Gyanwali ◽  
Celestine Xue Ting Cai ◽  
Christopher Chen ◽  
Henri Vrooman ◽  
Chuen Seng Tan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Decline ◽  
Hippocampal Volume ◽  
Intracranial Stenosis ◽  
Vascular Lesions ◽  
Linear Regression Models ◽  
Volume Functional ◽  
Mri Scans ◽  
The Mean

Background: Cerebrovascular disease (CeVD) is an underlying cause of cognitive impairment and dementia. Hypertension is a known risk factor of CeVD, but the effects of mean of visit-to-visit blood pressure (BP) on incident CeVD and functional-cognitive decline remains unclear. Objective: To determine the association between mean of visit-to-visit BP with the incidence and progression of CeVD [white matter hyperintensities (WMH), infarcts (cortical infarcts and lacunes), cerebral microbleeds (CMBs), intracranial stenosis, and hippocampal volume] as well as functional-cognitive decline over 2 years of follow-up. Methods: 373 patients from a memory-clinic underwent BP measurements at baseline, year 1, and year 2. The mean of visit-to-visit systolic BP, diastolic BP, pulse pressure, and mean arterial pressure were calculated. Baseline and year 2 MRI scans were graded for WMH, infarcts, CMBs, intracranial stenosis, and hippocampal volume. Functional-cognitive decline was assessed using locally validated protocol. Logistic and linear regression models with odds ratios, mean difference, and 95%confidence interval were constructed to analyze associations of visit-to-visit BP on CeVD incidence and progression as well as functional-cognitive decline. Results: Higher mean of visit-to-visit diastolic BP was associated with WMH progression. Higher tertiles of diastolic BP was associated with WMH progression and incident CMBs. There was no association between mean of visit-to-visit BP measures with incident cerebral infarcts, intracranial stenosis, change in hippocampal volume, and functional-cognitive decline. Conclusion: These findings suggest the possibility of hypertension-related vascular brain damage. Careful monitoring and management of BP in elderly patients is essential to reduce the incidence and progression of CeVD.

scholarly journals A longitudinal analysis of the progression from normal blood pressure to stage 2 hypertension: A 12-year Korean cohort

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eun Sun Yu ◽  
Kwan Hong ◽  
Byung Chul Chun
Keyword(s):  
Blood Pressure ◽  
Health Insurance ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Normal Blood ◽  
Normal Blood Pressure ◽  
The Mean ◽  
Stage 1

Abstract Background The study aimed to estimate the incidence of and period of progression to stage 2 hypertension from normal blood pressure. Methods We selected a total of 21,172 normotensive individuals between 2003 and 2004 from the National Health Insurance Service-Health Screening and followed them up until 2015. The criteria for blood pressure were based on the American College of Cardiology/American Heart Association 2017 guideline (normal BP: SBP < 120 and DBP < 80 mmHg, elevated BP: SBP 120–129 and DBP < 80 mmHg, stage 1 hypertension: SBP 130–139 or DBP 80–89 mmHg, stage 2 hypertension: SBP ≥140 or DBP ≥ 90 mmHg). We classified the participants into four courses (Course A: normal BP → elevated BP → stage 1 hypertension→ stage 2 hypertension, Course B: normal BP → elevated BP → stage 2 hypertension, Course C: normal BP → stage 1 hypertension → stage 2 hypertension, Course D: normal BP → stage 2 hypertension) according to their progression from normal blood pressure to stage 2 hypertension. Results During the median 12.23 years of follow-up period, 52.8% (n= 11,168) and 23.6% (n=5004) of the participants had stage 1 and stage 2 hypertension, respectively. In particular, over 60 years old had a 2.8-fold higher incidence of stage 2 hypertension than 40–49 years old. After the follow-up period, 77.5% (n=3879) of participants with stage 2 hypertension were found to be course C (n= 2378) and D (n=1501). After the follow-up period, 77.5% (n=3879) of participants with stage 2 hypertension were found to be course C (n= 2378) and D (n=1501). The mean years of progression from normal blood pressure to stage 2 hypertension were 8.7±2.6 years (course A), 6.1±2.9 years (course B), 7.5±2.8 years (course C) and 3.2±2.0 years, respectively. Conclusions This study found that the incidence of hypertension is associated with the progression at each stage. We suggest that the strategies necessary to prevent progression to stage 2 hypertension need to be set differently for each target course.

Abstract WMP14: Association of Systolic Blood Pressure, LDL Cholesterol, and Hgb A1c With White Matter Hyperintensity on MRI in the ACCORDION MIND Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Tanya Turan ◽  
Rebecca Gottesman ◽  
Sharon Yeatts ◽  
Shyam Prabhakaran ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Regression Models ◽  
Ldl Cholesterol ◽  
Vascular Risk Factor ◽  
White Matter Hyperintensity ◽  
Vascular Risk ◽  
Linear Regression Models ◽  
Risk Factor Profile ◽  
The Mean

Introduction: While retrospective studies have shown that poor control of vascular risk factors is associated with progression of white matter hyperintensity (WMH), it has not been studied prospectively. Hypothesis: We hypothesize that higher systolic blood pressure (SBP) mean, LDL cholesterol, and Hgb A1c will be correlated with WMH progression in diabetics. Methods: This is a secondary analysis of the Memory in Diabetes (MIND) substudy of the Action to Control Cardiovascular Risk in Diabetes Follow-on Study (ACCORDION). The primary outcome was WMH progression, evaluated by fitting linear regression models to the WMH volume on the month 80 MRI and adjusting for the WMH volume on the baseline MRI. The primary predictors were the mean values of SBP, LDL, and A1c from baseline to month 80. We defined a good vascular risk factor profile as mean SBP <120 mm Hg and mean LDL <120 mg/dL. Results: We included 292 patients, with a mean (SD) age of 62.6 (5.3) years and 55.8% male. The mean number of SBP, LDL, and A1c measurements per patient was 17, 5, and 12. We identified 86 (29.4%) patients with good vascular risk factor profile. In the linear regression models, mean SBP and LDL were associated with WMH progression and in a second fully adjusted model they both remained associated with WMH progression (Table). Those with a good vascular risk factor profile had less WMH progression (β Coefficient -0.80, 95% CI -1.42, -0.18, p=0.012). Conclusions: Our data reinforce prior research showing that higher SBP and LDL is associated with progression of WMH in diabetics, likely secondary to chronic microvascular ischemia, and suggest that control of these factors may have protective effects. This study has unique strengths, including prospective serial measurement of the exposures, validated algorithmic measurement methodology for WMH, and rigorous adjudication of study data. Clinical trials are needed to investigate the effect of vascular risk factor reduction on WMH progression.

Abstract P606: Hemodynamic Predictors of Multiple Recurrent Strokes in the Patients With Prior Lacunar Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Alexandra Kvernland ◽  
Alen Delic ◽  
Ka-ho Wong ◽  
Nazanin Sheibani ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Failure Time ◽  
Recurrent Stroke ◽  
Cox Proportional Hazards Model ◽  
Lacunar Stroke ◽  
Blood Pressures ◽  
Recurrent Strokes ◽  
The Mean

Background: Recurrent stroke has higher morbidity and mortality than incident stroke. We evaluated hemodynamic risk factors for multiple recurrent strokes. Methods: We included patients in the SPS3 trial. The primary predictor was the top tertile, compared to the bottom tertile, of the mean systolic blood pressure (mSBP) and blood pressure variability represented as standard deviation (sdSBP) using blood pressures from day 30 of the trial to the end of follow-up. We excluded blood pressures from the first 30 days to reduce confounding from the trial’s intervention. We fit a logistic regression model to ≥2 recurrent strokes from day 30 to the end of follow-up and, to accurately analyze the multiple failure-time data, we ordered the multiple failure events to the Prentice, Williams and Peterson extension of the Cox proportional-hazards model. Results: We included 2,882 patients, of which 223 had a recurrent stroke and 41/223 had ≥2 recurrent strokes for a total of 272 strokes. The mean (SD) number of blood pressure readings was 78.0 (37.4). The etiology of the 272 strokes was 161 (59.2%) lacunar, 22 (8.1%) intracranial atherosclerosis, 10 (3.7%) extracranial atherosclerosis, 24 (8.8%) cardioembolic, and 55 (20.2%) cryptogenic or other. In both unadjusted and adjusted logistic regression models and PWP Cox models, the top tertile of sdSBP was consistently predictive of multiple recurrent strokes, while mSBP was not (Tables 1/2). Conclusions: We found that in patients with an index lacunar stroke, higher SBP variability, but not mean SBP, was predictive of multiple recurrent strokes of varying mechanisms.

Abstract P622: Racial Variation in White Matter Hyperintensity Progression in the ACCORDION MIND Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alison L Herman ◽  
Adam H De Havenon ◽  
Guido J Falcone ◽  
Shadi Yaghi ◽  
Shyam Prabhakaran ◽  
...  
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
Systolic Blood Pressure ◽  
White Matter Hyperintensity ◽  
Diabetic Patients ◽  
Patient Race ◽  
Black Patients ◽  
The Mean ◽  
White Patients

Introduction: White matter hyperintensities (WMH) are linked to cognitive decline and stroke. We hypothesized that Black race would be associated with greater WMH progression in the ACCORDION MIND trial. Methods: The primary outcome is WMH progression in mL, evaluated by fitting linear regression to WMH volume on the month 80 MRI and including the WMH volume on the baseline MRI. The primary predictor is patient race, with the exclusion of patients defined as “other” race. We also derived predicted probabilities of our outcome for systolic blood pressure (SBP) levels. Results: We included 276 patients who completed the baseline and month 80 MRI, of which 207 were white, 48 Black, and 21 Hispanic. During follow-up, the mean number of SBP, LDL, and A1c measurements per patient was 21, 8, and 15. The mean (SD) WMH progression was 3.3 (5.4) mL for blacks, 2.5 (3.2) mL for Hispanics, and 2.4 (3.3) mL for whites. In the multivariate regression model (Table 1), Black, compared to white, patients had significantly more WMH progression (β Coefficient 1.26, 95% CI 0.45-2.06, p=0.002). Hispanic, compared to white, patients did not have significantly different WMH progression (p=0.392), nor was there a difference when comparing Hispanic to Black patients (p=0.162). The predicted WMH progression was significantly higher for Black compared to white patients across a mean SBP of 117 to 139 mm Hg (Figure 1). Conclusions: Black diabetic patients in ACCORDION MIND have a higher risk of WMH progression than white patients across a normal range of systolic blood pressure.

scholarly journals Twenty-four-hour and office blood pressure measurement in a comprehensive assessment of the effectiveness of 12-week therapy with a triple fixed-dose combination of amlodipine/indapamide/perindopril in hypertensive patients in actual clinical practice

2021 ◽  
Vol 26 (5) ◽  
pp. 4498
Author(s):  
V. M. Gorbunov ◽  
Yu. A. Karpov ◽  
E. V. Platonova ◽  
Ya. N. Koshelyaevskaya
Keyword(s):  
Blood Pressure ◽  
Clinical Practice ◽  
Antihypertensive Therapy ◽  
Blood Pressure Measurement ◽  
Fixed Dose Combination ◽  
Fixed Dose ◽  
Actual Clinical Practice ◽  
Dose Combination ◽  
The Mean

Aim. To study the efficacy and safety of the triple fixed-dose combination (FDC) of amlodipine/indapamide/perindopril on blood pressure (BP) profile in patients with grade I-II hypertension (HTN) in actual clinical practice.Material and methods. Data from 54 patients with paired 24-hour ambulatory BP monitoring (ABPM) data were included in the TRICOLOR subanalysis (ClinicalTrials. gov study ID — NCT03722524). The mean 24-hour, daytime, and nighttime BP were calculated at baseline and after 12-week follow-up. We determined the proportion of patients with nocturnal HTN (≥120/70 mm Hg) and nocturnal hypotension (<100/60 and <90/50 mm Hg) initially and after 12 weeks of triple FDC therapy. Patients with nocturnal BP decrease included dippers (D; 10-20%), reduced dippers (RD; 0-10%) and extreme dippers (ED; >20%), as well as those without nocturnal BP decrease (>0%, non-dipper (ND)). The smoothness index (SI) was analyzed as the ratio of the mean hourly SBP fall to its mean standard deviation in paired ABPM. To assess the BP phenotypes, two methods were used with reference values of <130/80 and <140/90 mm Hg for ABPM and office BP, respectively. Controlled hypertension (CHT), uncontrolled hypertension (UHT), white coat hypertension (WHT) and masked ineffectiveness of antihypertensive therapy were distinguished.Results. Among 1247 participants of the TRICOLOR study, 54 patients with valid paired ABPM were selected (men, 46%; mean age, 57,7 [12,1] years; mean office BP, 150,4 [16,6]/93,3 [10,7] mm Hg; HTN duration, 8,3 [7,5] years). Initially, the mean 24-hour, daytime and nighttime BP was 141,1 [15,4]/85,9 [9,9], 144,2 [15,5]/88,8 [10,5] and 132,6 [18,0]/78,1 [9,9] mm Hg, respectively. After 12-week follow-up, the mean 24-hour, daytime and nighttime BP was 123,1 [10,5]/75,6 [8,5], 125,7 [10,9]/77,9 [8,7] and 115,4 [10,2]/68,6 [8,8] mm Hg, respectively (p<0,001). After 12-week follow-up, the proportion of patients with nocturnal hypertension decreased from 64,8% to 25,0% (2,6 times) (p<0,001). The proportion of NDs and EDs decreased from 16,7% and 7,4% to 5,8% and 0%, respectively (p=0,048); the proportion of patients with RD and D patterns increased from 42,6% and 33,3 to 57,7% and 36,5%, respectively (p=0,048). With triple FDC therapy, the SI during the day was higher than 0,73 in half of the cases. According to the two methods, the proportion of patients with UHT decreased from 81,6% to 4,4%, WHT from 12,2% to 0%. The prevalence of CHT increased from 4,1% to 57,8%, while masked ineffectiveness of antihypertensive therapy — from 2,0% to 37,8%.Conclusion. Twelve-week FDC therapy of amlodipine/indapamide/perindopril led to a significant fall in the mean 24-hour, daytime and nighttime BP values. Comprehensive analysis of two techniques (24-hour and office BP measurement) identified patients requiring further triple FGC titration.

Abstract P199: Keep Moving, Your Health Depends On It: Impact Of Improved Physical Activity And Weight Loss In A Wellness Program

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Ebenezer T Oni ◽  
Ehimen Aneni ◽  
Maribeth Rouseff ◽  
Thinh Tran ◽  
Henry Guzman ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Weight Loss ◽  
Intervention Program ◽  
South Florida ◽  
Metabolic Equivalents ◽  
Baseline Weight ◽  
The Mean ◽  
The Difference

Negative impact of CVD as the leading cause of death in the US is worsened by the significant burden of obesity and associated morbidity and concerns about the growing population inactivity. The American Heart Association has emphasized worksite-based interventions to improve CV health. We evaluated the benefits of improved physical activity(PA) and weight loss(WL) among employees of the Baptist Health South Florida enrolled in a wellness intervention program. Methods: Employees with two or more Cardio-metabolic risk factors , such as total cholesterol ≥ 200 mg/dl, systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, hemoglobin A1C ≥ 6.5%, and body mass index (BMI) ≥ 30 were enrolled in an intervention program themed “My unlimited potential”. Interventions were focused on diet and PA modifications. We defined improved physical activity as the difference in the metabolic equivalents (METs) at 12 weeks follow-up and at baseline. WL (lbs) was the difference in weight at follow-up. The relationship between WL and changes in METs was explored in an ordered logistic regression. Results: Overall 203 (48±10 years, 78% females) employees were enrolled with a retention rate of 89% (n=181) at 12 weeks follow-up. At baseline the median weights was 211 lbs., and mean METs- 8.6, while at follow-up the median weight was 200 lbs, and the mean METs 11. At 12 weeks follow up 38% had significant WL (lost >5% of baseline weight). The median WL was 8.4 (IQR 4.8-13.0) lbs and the mean change in METs was 2.4±1.8. Median WL increased with increasing tertiles of METs change; tertile1- 6.5(4-11) lbs., tertile2- 9(6-13)lbs. tertile3- 11(7-15)lbs. Increased PA was related to increased WL across BMI categories adjusting for age, gender and baseline weight. Conclusion: This study points strongly toward the benefit of increasing PA among other lifestyle modification interventions in controlling weight. Although further follow-up of this population to evaluate sustainability of change is needed, our results clearly relate improved PA and health.

scholarly journals Hippocampal Volume in Provisional Tic Disorder Predicts Tic Severity at 12-Month Follow-up

2020 ◽  
Vol 9 (6) ◽  
pp. 1715
Author(s):  
Soyoung Kim ◽  
Deanna J. Greene ◽  
Carolina Badke D’Andrea ◽  
Emily C. Bihun ◽  
Jonathan M. Koller ◽  
...  
Keyword(s):  
Symptom Severity ◽  
Structural Mri ◽  
Hippocampal Volume ◽  
Subcortical Structures ◽  
Tic Disorder ◽  
Tic Severity ◽  
Mri Scans ◽  
One Year ◽  
Important Marker

Previous studies have investigated differences in the volumes of subcortical structures (e.g., caudate nucleus, putamen, thalamus, amygdala, and hippocampus) between individuals with and without Tourette syndrome (TS), as well as the relationships between these volumes and tic symptom severity. These volumes may also predict clinical outcome in Provisional Tic Disorder (PTD), but that hypothesis has never been tested. This study aimed to examine whether the volumes of subcortical structures measured shortly after tic onset can predict tic symptom severity at one-year post-tic onset, when TS can first be diagnosed. We obtained T1-weighted structural MRI scans from 41 children with PTD (25 with prospective motion correction (vNavs)) whose tics had begun less than 9 months (mean 4.04 months) prior to the first study visit (baseline). We re-examined them at the 12-month anniversary of their first tic (follow-up), assessing tic severity using the Yale Global Tic Severity Scale. We quantified the volumes of subcortical structures using volBrain software. Baseline hippocampal volume was correlated with tic severity at the 12-month follow-up, with a larger hippocampus at baseline predicting worse tic severity at follow-up. The volumes of other subcortical structures did not significantly predict tic severity at follow-up. Hippocampal volume may be an important marker in predicting prognosis in Provisional Tic Disorder.

scholarly journals Change in Depression Symptomatology and Cognitive Function in Twins: A 10-Year Follow-Up Study

2016 ◽  
Vol 19 (2) ◽  
pp. 104-111 ◽  
Author(s):  
Inge Petersen ◽  
Matt McGue ◽  
Qihua Tan ◽  
Kaare Christensen ◽  
Lene Christiansen
Keyword(s):  
Cognitive Decline ◽  
Cognitive Abilities ◽  
Depressive Symptomatology ◽  
Twin Studies ◽  
Cognitive Change ◽  
Depression Symptoms ◽  
Cross Sectional ◽  
The Mean ◽  
Depression Symptomatology

A complex interrelation exists between change in depression symptomatology and cognitive decline. Studies indicate either that depression is a direct risk factor for cognitive change over time, or vice versa. Longitudinal twin studies provide the possibility to unravel cause and effect of correlated traits. Here, we have applied twin modeling approaches to shed light on the genetic correlation between both level and change of depression symptomatology and cognitive functioning, and to further explore the bidirectionality of any such correlation using assessments of both phenotypes at two occasions 10 years apart. The study included 2,866 Danish twins with a mean age of 56.8 years at intake (range: 45–68 years). Of these, 1,267 were intact pairs. A total number of 1,582 twins (55%), of whom 557 were intact pairs, participated in the follow-up survey. We found stable cross-sectional heritability estimates of approximately 60% for general cognitive abilities and 30% for affective depressive symptoms. There was a considerable decline in the mean cognitive performance over 10 years, whereas the mean affective depression symptoms score was stable and with no genetic contribution to any individual change. Additionally, we saw a small but significant cross-trait correlation at both occasions (-0.11 and -0.09, respectively), but cross-trait cross-occasion analysis revealed no evidence that either of the two traits predicts the other over a 10-year interval. Thus, our study was not able to detect any causal association between change in depressive symptomatology and cognitive decline in middle-aged and elderly people over a 10-year interval.

scholarly journals The association between carotid intima-media thickness and new-onset hypertension in a Chinese community-based population

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Long Zhang ◽  
Fangfang Fan ◽  
Litong Qi ◽  
Jia Jia ◽  
Ying Yang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Strong Association ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Incidence Rates ◽  
Community Based ◽  
Media Thickness ◽  
The Mean ◽  
New Onset

Abstract Background Hypertension and arterial vasculopathy may be mutual causes and effects. It is unknown whether carotid intima-media thickness (cIMT) is reliably predictive of the presence of newly developed hypertension in the Chinese population. This study evaluated the impacts of cIMT on new-onset hypertension in a community-based population without hypertension at baseline in China. Methods A total of 672 Chinese subjects who had complete data for demographics, baseline and follow-up blood pressure measurements, and cIMT measurements at baseline were included in our study. Baseline cIMT was obtained under standardized procedures using the GE Vivid 7 ultrasound system equipped with an 8-MHz linear array vascular probe (GE Medical Systems, Milwaukee, Wl, USA). The outcome was the incidence of hypertension at follow-up. Multivariate regression models were used to access the association between baseline cIMT and the risk of new-onset hypertension. Results Subjects were 51.5 ± 4.7 years old, and 32.0% were male. The mean baseline systolic blood pressure (SBP) was 122.5 ± 10.0 mmHg. The mean baseline diastolic blood pressure (DBP) was 72.4 ± 7.5 mmHg. The number of subjects with thickened cIMT (maximum ≥0.9 mm) at baseline was 198 (29.5%). After 2.3 years of follow-up, the rate of new-onset hypertension was 12.6%. The incidence rates of hypertension in the groups with thickened cIMT and normal cIMT were 19.2 and 9.9%, respectively. In the multivariable logistic regression analyses, both the average (OR = 1.69, 95% CI: 1.30–2.19, P = 0.0001) and maximum (OR = 1.55, 95% CI: 1.23–1.95, P = 0.0002) cIMT were significantly associated with new-onset hypertension after adjustment for various confounders. The group with thickened cIMT showed a higher risk for the incidence of hypertension, with an OR of 1.82 (95% CI: 1.07–3.10, P = 0.0270), compared to the normal group. Conclusion Thickened cIMT has a strong association with incident hypertension risk in a community-based population without hypertension at baseline in China.

scholarly journals Unilateral renal sympathetic denervation may reduce blood pressure in patients with refractory hypertension

2015 ◽  
Vol 9 (4) ◽  
pp. 362
Author(s):  
Aurelio Negro ◽  
Rosaria Santi ◽  
Antonio Manari ◽  
Franco Perazzoli
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Renal Denervation ◽  
Antihypertensive Drugs ◽  
Renal Sympathetic Denervation ◽  
Caucasian Woman ◽  
Left Renal Artery ◽  
Refractory Hypertension ◽  
The Mean

A 52-year-old Caucasian woman with essential resistant and refractory hypertension despite optimal medical therapy, including 6 different antihypertensive drugs was referred for the catheter-based renal denervation. Due to unfavourable anatomy because of non-critical fibromuscular dysplasia on the right renal artery, renal denervation of only the left renal artery was performed. Before and after the renal denervation, the patient’s blood pressure was monitored by <em>office</em> measurements and ambulatory blood pressure measurements (ABPM). Before the procedure, the mean <em>office</em> blood pressure was 157/98 mmHg; at ABPM, the mean blood pressure values were 145/94 mmHg. At 6 months of follow-up, the mean <em>office</em> blood pressure was 134/90 mmHg and 121/76 mmHg at ABPM. In latest 12 months of follow-up, <em>office</em> and ABPM blood pressure were 125/80 and 127/80 mmHg respectively. This unique case suggests that unilateral renal denervation may be effective in lowering blood pressure in patients with refractory hypertension and unfavorable renal arteries anatomy.

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