Renal denervation in patients with resistant hypertension: six-month results.
BACKGROUND
Increased activation of the sympathetic nervous system plays a central role in the pathophysiology of hypertension (HTN). Catheter-based renal denervation (RDN) was recently developed for the treatment of resistant HTN.


OBJECTIVE
To assess the safety and efficacy of RDN for blood pressure (BP) reduction at six months in patients with resistant HTN.


METHODS
In this prospective registry of patients with essential resistant HTN who underwent RDN between July 2011 and May 2013, the efficacy of RDN was defined as ≥ 10 mm Hg reduction in office systolic blood pressure (SBP) six months after the intervention.


RESULTS
In a resistant HTN outpatient clinic, 177 consecutive patients were evaluated, of whom 34 underwent RDN (age 62.7 ± 7.6 years; 50.0% male). There were no vascular complications, either at the access site or in the renal arteries. Of the 22 patients with complete six-month follow-up, the response rate was 81.8% (n=18). The mean office SBP reduction was 22 mm Hg (174 ± 23 vs. 152 ± 22 mm Hg; p<0.001) and 9 mm Hg in diastolic BP (89 ± 16 vs. 80 ± 11 mm Hg; p=0.006). The number of antihypertensive drugs (5.5 ± 1.0 vs. 4.6 ± 1.1; p=0.010) and pharmacological classes (5.4 ± 0.7 vs. 4.6 ± 1.1; p=0.009) also decreased significantly. Of the 24-hour ambulatory BP monitoring and echocardiographic parameters analyzed, there were significant reductions in diastolic load (45 ± 29 vs. 27 ± 26%; p=0.049) and in left ventricular mass index (174 ± 56 vs. 158 ± 60 g/m(2); p=0.014).


CONCLUSIONS
In this cohort of patients with resistant HTN, RDN was safe and effective, with a significant BP reduction at six-month follow-up.
Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal. Electronic address: heldores@hotmail.com.
Hélder
H
Dores
Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal; Centro Cardiovascular, Hospital da Luz, Lisboa, Portugal.
Manuel
M
de Sousa Almeida
Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal; Centro Cardiovascular, Hospital da Luz, Lisboa, Portugal.
Pedro
P
de Araújo Gonçalves
Serviço de Nefrologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal.
Patrícia
P
Branco
Serviço de Nefrologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal.
Augusta
A
Gaspar
Serviço de Nefrologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal.
Henrique
H
Sousa
Serviço de Anestesiologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal.
Angela
A
Canha Gomes
Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal.
Maria João
MJ
Andrade
Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal.
Maria Salomé
MS
Carvalho
Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal; Centro Cardiovascular, Hospital da Luz, Lisboa, Portugal.
Rui
R
Campante Teles
Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal; Centro Cardiovascular, Hospital da Luz, Lisboa, Portugal.
Luís
L
Raposo
Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal; Centro Cardiovascular, Hospital da Luz, Lisboa, Portugal.
Henrique
H
Mesquita Gabriel
Centro Cardiovascular, Hospital da Luz, Lisboa, Portugal.
Francisco
F
Pereira Machado
Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal.
Miguel
M
Mendes
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012077:Renal Artery / Q000294:innervation*; D013562:Sympathectomy; D013997:Time Factors; D016896:Treatment Outcome
Desnervação renal; Hipertensão arterial resistente; Hipertrofia ventricular esquerda; Left ventricular hypertrophy; Renal denervation; Resistant hypertension