DOI: https://doi.org/10.22141/2224-1485.4.36.2014.82737

Effectiveness of Renal Denervation in Patients with Resistant Hypertension Using Certified Equipment (Results of 1-Year Follow-Up)

Yu.M. Sirenko, O.L. Rekovets, Yu.M. Sokolov, A.S. Dobrohod

Abstract


Completed controlled trials have shown the safety but different effectiveness of renal denervation (RDN) in patients with resistant arterial hypertension (AH). We have carried out RDN in 8 patients. The average age of patients was 52.13 ±
± 3.88 years (40–66), mean duration of AH — 16.75 ± 2.17 (12–25) years. On admission to hospital institute, blood pressure (BP) level was 181.25/106.88 ± 4.3/4.0 mmHg (160–200/85–120 mmHg), heart rate (HR) — 70.63 ± 3.03 bpm. Optimization of treatment in a hospital in these patients led to a significant decrease in BP to 156.88/95.00 ± 2.98 mmHg (150–165/85–100 mmHg) and HR — 68.88 ± 3.28 bpm. The number of antihypertensive drugs was an average of 5.5 per patient. In ambulatory blood pressure monitoring (ABMP) on the stage of therapy optimization, the average systolic BP (SBP24) was 149.16 ± 5.40 mmHg, and diastolic (DBP24) — 86.98 ± 5.08 mmHg. Average daily heart rate (HR24) was 70.12 ± ± 2.94 bpm. All patients underwent the procedure well.
Mean reduction in the average daily BP (SBP/DBP) was in the dynamics at the stage of 7 days, 1, 6 and 12 months, respectively, –15.73/–8.52 mmHg, –11.45/–6.06 mmHg, –10.70/
–13.68 mmHg and –17.91/–13.88 mmHg. HR24 was not significantly changed. Reducing daytime SBP/DBP in the dynamics at the stages of 7 days, 1, 6 and 12 months was –14.79/–5.64,
–16.55/–5.60, –12.29/–12.79 and –20.45/–13.62 mmHg, respectively. Dynamics of decrease in nocturnal SBP/DBP at the stages of 7 days, 1, 6 and 12 months was –15.03/–8.42, –10.64/
–4.57, –9.23/–12.38 and –19.39/–14.84 mmHg, respectively. In SBP24 ≥ 160 mmHg 12 months after RDN we observed the most significant decrease in the average daily BP –30.5/–18.9 mmHg. In SBP24 ≥ 140 mmHg and < 160 mmHg 12 months after the procedure, reduction of SBP24/DBP24 was –20.1/–18.0 mmHg. When SBP24 < 140 mmHg, significant changes in BP reduction were not detected. Mean reduction in office BP was in the dynamics at the stages of 7 days, 1, 6 and 12 months, respectively, –14.38/–5.63 mmHg, –9.02/–10.71 mmHg, +3.12/–8 mmHg
and –7.88/–5.0 mmHg. Office heart rate did not change.
Estimated creatinine clearance level determined by Cockcrof- Gault equation was not significantly changed in any patient. Thus, the application of RDN in patients with resistant AH is safe and recommended only in patients with SBP140 mmHg and above, according to ABPM. Mandatory use of ABMP for selection and effective control after RDN is recommended.


Keywords


resistant hypertension; renal denervation; ambulatory blood pressure monitoring

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