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Renal Denervation: An Early Decrease in Ambulatory and Home Blood Pressure

The primary goal of the hypertension specialist is to determine which patients with resistant hypertension require renal denervation procedure. We investigate the characteristics of early changes of blood pressure in true resistant hypertension patients undergoing renal denervation and the predictors of ambulatory blood pressure monitoring response and home blood pressure measurements early after procedure. From a total of patients in Hypertension unit, only patients with refractory resistant hypertension (10.4%) were included in study, from which 12% have criteria for new method. All subjects have ambulatory blood pressure measurement before and after renal denervation. Patients age were 60±6 years, 6.7±1 for number of antihypertensive drug classes included spironolactone use in doses from 50-100 mg, BMI 36±3 kg/m2, estimated GFR CKD-EPI was 63±28 mlmin-1 1.73m2. Arterial stiffness was determined using pulse wave velocity in patients with resistant hypertension, evaluated using the noninvasive Agedio B900 device from Germany. Renal denervation significantly reduced continuously 24 h blood pressure measurement from maximum value 252/142 mmHg (average 169/103 mmHg) to minimal value 131/78 (average 144/91mmHg) 24 h after procedure (p<0.001). Significant reduction was found in continuously blood pressure measurement 24 h after (-21/12 mmHg) and home blood pressure measurements (-23/11 mmHg) 72 h after renal denervation in patients with normal (p<0.001) or moderate (p<0.05) elevated pulse wave velocity (for age 55-65y normal value is 6.5-7.7m/s). The mean value of the total measured pulse wave velocity value was higher than reference for age in older and diabetics and was 8.14 m/s. There was no deterioration in kidney function after renal denervation with follow up of one year. Renal denervation is an innovative procedure designed to achieve a reduction of blood pressure of 10 mmHg in a short period of time. The purpose is not a complete cessation of antihypertensive medication but lowering the cardiovascular risk and mortality. In choosing patients for renal denervation is to determine arterial stiffness using pulse wave velocity measurements as a predictor of cardiovascular mortality, associating elevated pulse wave velocity that reference value for age, with poorer response to renal denervation procedures.

renal denervation ; resistant hypertension

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