Aims A comparison influence of renal denervation versus pharmacological treatment with sympathetic nervous system blockers on blood pressure in patients with resistant hypertension. Methods 125 patients with resistant hypertension without comorbidities after a 3-week standardized treatment with Losartan 100 mg, Amlodipine 10 mg and Indapamid 1,5 mg and confirmation of their resistance were randomly assigned into three groups, depending on medication supplemented to previously administered: IM group – selective I1-imidazoline agonist Moxonidine, IIB group – cardioselective beta-blocker Bisoprolol and IIID group – renal artery denervation. Patients were assessed by ambulatory blood pressure monitoring at baseline, 3, 6 and 12 month follow-up. The compliance to drug treatment was confirmed by 8-item Morisky Medication Adherence Scale. Renal denervation was performed with a Symplicity Spyral catheter. Results The mean 24 hour systolic blood pressure (SBP m/24 h) at baseline were 179.0±2.02 mmHg in IM group versus 177.96±2.44 mmHg in IIB group and 176.92±1.97 mmHg in IIID group, p>0.05. Statistically significant dynamics was recorded starting with 3 months of evaluation in all three groups, the group of patients undergoing denervation of the renal arteries demonstrating a net superior effect compared with pharmacological treatment: −6.48±0.81 mmHg in I M group versus −6.2±0.88 mmHg in II B group and −23.28±1.9 mmHg in III D group, p<0.001. The beneficial effect was maintained until the end of the study, when in observational group supplemented with Moxonidine SBP m/24 h were 159.6±1.72 mmHg with a total reduction of −19.9±0.7 mmHg from baseline, in Bisoprolol group −164.08±1.93 mmHg with a reduction of −13.88±1.13 mmHg and 141.76±0.77 mmHg in renal denervation group with a total reduction of −35.16±2.23 mmHg, p<0.001. The mean 24 hour diastolic blood pressure (DBP m/24 h) increased at baseline in all three groups (105.52±1.28 mmHg in IM versus 108.6±1.6 mmHg in IIB and 107.24±0.92 mmHg in IIID, p>0.05) similar to SBP m/24 h noted a significantly reduction at 3 month follow-up: −4.8±0.96 mmHg in IM group versus −3.64±0.47 mmHg in IIB group and −12.08±0.63 mmHg in IIID group, p<0.001. The maximum reduction in DBP m/24 h were registered at 12 month follow-up, a comparative analyses of dynamics between groups showing a presence of statistical difference due to superiority of renal denervation treatment in amelioration of this parameter: −13.68±0.83 mmHg in IM group versus −10.72±0.64 mmHg in IIB group and −20.2±1.28 mmHg in IIID group, p<0.001. Conclusions The application of all three treatment regimens has been shown to be effective in reducing SBP and DBP values m/24 hours in patients with resistant hypertension, with a superior but comparable effect of Moxonidine to Bisoprolol and the absolute superiority of renal denervation treatment versus both pharmacological treatment regimens. Funding Acknowledgement Type of funding source: None

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Objective: Evaluation of effects of RDN on left ventricle remodeling in patients with resistant hypertension and heart failure with preserved ejection fraction. Design and method: The study enrolled 125 hypertensive patients, who after 3-week of standardized treatment with Losartan, Amlodipine and Indapamide and confirmation of their drug resistance, were randomly assigned into three groups depending on medication supplemented to previously administered: group I - selective I1-imidazoline agonist Moxonidine, group II - cardioselective beta-blocker Bisoprolol and group III - renal denervation. All patients underwent a transthoracic echocardiogram at baseline, one, two and three years follow-up. Renal denervation was performed in the main renal arteries and their branches. Results: Transthoracic echocardiography at baseline revealed LV hypertrophy in all patients. The majority of patients in all three research groups had concentric hypertrophy (52% versus 60% and 56% in group I, II and III, respectively), the normal pattern not being recorded in any group. An authentic reduction in LV mass index was noted from 1-year follow-up in all three observational groups, the progressive reduction being maintained until the end of the study, the group of patients undergoing renal denervation manifested a net superior effect to both pharmacological groups. So, at 3-years follow-up LV mass index was 128,57±4,91 g/m2 in Moxonidine group versus 126,0±5,34 g/m2 in Bisoprolol group and 94,44±3,90 g/m2 in RDN group, p < 0.001. Analyzing the impact of various therapeutic regimes on the geometric pattern of the LV, we can note the fact that both treatment schemes with SNS blockers and RDN favored LV reverse remodeling, its normal pattern being regained by 5 (10%) patients from group I and 7 (28%) patients from group III. This time as well RDN demonstrated absolute superiority over both pharmacological treatment regimens (Figure 1). Conclusions: The obtained data confirm the benefit of RDN treatment on the reverse remodeling of the LV by significantly reduction in LV mass index and inducing the recovery of its normal physiological pattern in practically a third of treated patients at 3 years post-procedurally.