Renal Sympathetic Denervation for the Treatment of Difficult-to-Control or Resistant Hypertension

Hypertension represents a major health problem with an appalling annual toll. Despite the plethora of antihypertensive drugs, hypertension remains resistant in a considerable number of patients, thus creating the need for alternative strategies, including interventional approaches. Recently, catheter-based renal sympathetic denervation has been shown to be fairly safe and effective in patients with resistant hypertension. Pathophysiology of kidney function, interaction and crosstalk between the kidney and the brain, justifies the use of renal sympathetic denervation in the treatment of hypertension. Data from older studies have shown that sympathectomy has effectively lowered blood pressure and prolonged life expectancy of hypertensive patients, but at considerable cost. Renal sympathetic denervation is devoid of the adverse effects of surgical sympathectomy, due to its localized nature, is minimally invasive, and provides short procedural and recovery times. This paper outlines the pathophysiological background for renal sympathetic denervation, describes the past and the present of this interventional approach, and considers several future potential applications.

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Abstract 15206: Sustained Beneficial Effects of Multi-Electrode Renal Sympathetic Denervation on Cardiac Adaptations in Resistant Hypertension: A 24-months Follow-Up Study

Circulation ◽

10.1161/circ.132.suppl_3.15206 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Kyriakos Dimitriadis ◽

Costas Tsioufis ◽

Alexandros Kasiakogias ◽

Panayiotis Vasileiou ◽

Aggelos Papanikolaou ◽

...

Keyword(s):

Diastolic Function ◽

Resistant Hypertension ◽

Interventricular Septum ◽

Left Ventricular ◽

Sympathetic Denervation ◽

Renal Sympathetic Denervation ◽

Number Of Patients ◽

Lv Mass ◽

Renal Sympathetic

Introduction: The favorable impact of renal sympathetic denervation (RDN) on cardiac parameters such as on left ventricular (LV) morphology, geometry and function has been shown up to 6 months after the procedure using diverse ablation systems. Hypothesis: Multi-electrode catheter-based renal sympathetic RDN may have favorable effects on LV structural and functional indices in patients with resistant hypertension after a follow-up of 24 months. Methods: Twenty patients with resistant hypertension [age: 57±10 years, 13 males, office blood pressure (BP): 182/97±19/18 mmHg under 4.5±0.6 drugs] who underwent RDN were followed-up for 24 months. A full transthoracic echocardiographic study was performed in all patients and LV mass was calculated using the Devereux formula and was indexed for body surface area and height. Results: Average office BP was reduced to 148±21/85±14 mmHg at 12 months and to 143±23/80±14 mmHg at 24 months (p<0.001 for all). In the RDN group, LV mass index was significantly reduced from 136±20.1 g/m 2 (56.5±8.7 g/m 2.7 ) to 121±16.6 g/m 2 (50.6±6 g/m 2.7 ) at 12 months and to 115.6±23.3 g/m 2 (48.8±9.3 g/m 2.7 ) at 24 months (p<0.01 for all). RDN decreased mean interventricular septum thickness from 12.1±1.2 mm to 11.4±0.9 mm at 12 months and to 11.3±0.9 mm at 24 months (p<0.05 for all). After RDN, the number of patients with concentric LV hypertrophy (i.e. relative wall thickness >0.42 and LV mass >48 g/m 2.7 for male and >44 g/m 2.7 for female) decreased from 16 patients (80%) at baseline to 10 patients (50%) at 12 months, and to 7 patients (36.8%) at 24 months. Regarding diastolic function RDN caused an increase in mitral valve E'/A' ratio from 0.62±0.28 to 0.70±0.25 at 12 months and to 0.84±0.32 at 24 months (p<0.05 for all) and a decrease in the E/E' ratio from 14.8±6.1 to 11.8±3.7 at 12 months and to 9.7±4 at 24 months (p<0.05 for all). Conclusions: This the first study to show that multi-electrode RDN results in a significant and sustained improvement of diastolic function and attenuation of LV mass index in increased cardiovascular risk resistant hypertensive patients after a follow-up of 24 months. These results suggest long-term pleiotropic cardiovascular benefits of RDN therapy in the setting of resistant hypertension.

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Criteria for selecting patients with resistant hypertension for a renal sympathetic denervation

Terapevticheskii arkhiv ◽

10.17116/terarkh201688814-18 ◽

2016 ◽

Vol 88 (8) ◽

pp. 14-18 ◽

Cited By ~ 1

Author(s):

T M Ripp ◽

T Yu Rebrova ◽

V F Mordovin ◽

S A Afanasiev ◽

S E Pekarsky ◽

...

Keyword(s):

Blood Pressure ◽

Radiofrequency Ablation ◽

Resistant Hypertension ◽

Antihypertensive Drugs ◽

Sympathetic Denervation ◽

Erythrocyte Membranes ◽

Renal Sympathetic Denervation ◽

Endovascular Radiofrequency Ablation ◽

Renal Sympathetic ◽

Observation Results

Aim. To define and develop a procedure that can select patients with resistant hypertension (RH) for a renal sympathetic denervation (RSD) procedure, by being orienting to the specific initial values of β-adrenoreactivity (β-AR) and systolic blood pressure (SBP). Subjects and methods. The analysis included 23 RH patients receiving the maximally tolerable doses of 4 antihypertensive drugs. The investigations involving BP control and a Russian spectrophotometric procedure for determining β-AR in terms of the change in the osmoresistance of erythrocyte membranes (EM) were performed at baseline and 4 and 24 weeks. RSD was carried out using endovascular radiofrequency ablation of the renal arteries. The therapy was not changed during the observation. Results. If SBP was >170 mm Hg and β-AR of EM >40 conditional units (CUs) at baseline, ΔSBP was 17.68±3.24 mm Hg and the efficiency of RSD was 100%. When SBP was

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