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Hyperactivity of the sympathetic nervous system is one of the basic mechanisms in the development of arterial hypertension (AH). Transcatheter renal artery denervation is aimed to destroy the renal sympathetic afferent and efferent nerves to achieve a sustained reduction in blood pressure. Since 2017, all II generation studies have demonstrated that sympathetic denervation provides clinically significant BP reduction. Russian Medical Society for Arterial Hypertension (RMSAH) experts consider SD as a possible addition to the antihypertensive strategy in patients with uncontrolled AH and recommend denervation of the renal arteries in registers and clinical trials. On the basis of existing randomized clinical trials, as well as the experience of radiofrequency denervation in Russia, the experts of RMSAH present a consensus and view of the current situation in the field of renal denervation.

Design and method: In the 3A registry, a non-randomized, non-interventional registry, 899 physicians included 14.988 patients whose blood pressure (BP) was not controlled (> = 140/90 mmHg) and in whom the physician decided to initiate or escalate antihypertensive medication. Office BP and 24-hour ambulatory BP (ABP) were measured at baseline and at 1 year follow-up (FU) with validated devices. TRH was defined as uncontrolled BP at baseline despite treatment with at least 3 antihypertensive drugs. For this analysis TRH patients were classified by office BP (> = or < 140/90 mmHg) and 24-hour ABP (> = or < 130/80 mmHg) at 1 year FU. Results:After 1 year FU, i.e. after intensification of antihypertensive therapy, office and ABP was available in 1628 subjects. The cross-sectional analysis showed that nearly half of patients had controlled hypertension according to office BP. Masked (office BP < 140/90 mmHg and ABP > = 130/80 mmHg) and white coat hypertension (office BP > = 140/90 mmHg and ABP < 130/80 mmHg) effects at 1 year FU were the following: Conclusions:After 1 year FU 2/3 of the apparently controlled hypertensives (office BP < 140 mmHg) had masked hypertension, and of the patients with apparent TRH (office BP >= 140/90 mmHg despite being on 3 drugs) 1/10 had white coat hypertension. Our data suggest the inclusion of 24-hour ABP for the treatment management.Objective: Takayasu's arteritis (TA) is a chronic, idiopathic, inflammatory disease affecting the aorta and its branches. Abdominal aortic thrombosis due to TA was rare. To date, only one case has been reported in English literatures. Design and method: Case report.Results: During the procedure, there was a severe pain (10 points on a numeric rating scale) and several episodes of vasovagal reactions -blood pressure decreased to 60/30 mm Hg, and heart rate decreased to 19, which required stopping RF exposures. In the first days after RDN a marked hypotensive effect with the development of orthostatic hypotension, office blood pressure decrease from 180/100 mmHg to 110/68 mmHg, and mean 24 h ambulatory blood pressure decrease from 158/96 mmHg to 109/64 mmHg, demand reduction of antihypertensive therapy to 2 drugs. The hypotensive effect persists up to the present time.Conclusions: In our experience, vasovagal reaction in response to severe pain during radiofrequency denervation of the renal arteries, proved a predictor of effectiveness of the procedure. This is probably due to the pronounced vagal innervation branches along the renal arteries.Objective: Nowadays there are more and more novel invasive methods in the therapy of high blood pressure. Here we present two cases with dual invasive sympatholytic therapeutic procedures of each one.Design and method: Patient 1 is a 60-year old man with obesity, impaired glucose tolerance, secondary hyperparathyeroidism, secondary hyperaldosteronism, severe obstructive sleep apnoe syndrome. Many of target organ damages are also known like left ventricular hypertrophy and hypertensive angiopathy. Patient 2 is a 37-year old...

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hypertension. Among patients with TRHT, patients with the increased RRI were characterized by older age (52,2 ± 4,9 vs.47,3 ± 10,6 ys, p < 0,05), higher body mass index (32,8 ± 6,0 vs. 29,7 ± 4,5 kg/m2, p < 0,05), as well as lower 24 h, daytime and nighttime diastolic blood pressure values (77,8 ± 6,1 vs. 85,8 ± 12,9 mmHg, p < 0,01; 80,6 ± 7,7 vs. 89,8 ± 13,0 mmHg, p < 0,05; 72,1 ± 4,9 vs. 78,2 ± 12,3 mmHg, p < 0,01, respectively) as compared to patients with RRI < 0,7. The both groups did not differ in respect of renal function. Conclusions:Our study showed that the patients with TRHT were characterized by higher RRI values as compared to the subjects with well-controlled HT.Objective: No consensus has been established which is the best fourth-line agent in patients with RHT. We previously demonstrated that bioimpedance-guided reduction of extracellular volumen with intensification of diuretic therapy can control BP in patients with RHT. To assess the effect of intensifying diuretic treatment with a loop diuretic (furosemide) or an aldosterone antagonist (spironolactone) on control of BP in patients with RHT.Design and method: Study population comprised 30 patients with RHT (mean of 4.1 ± 0.9 antihypertensive drugs/patient) who were divided into 2 treatment arms according to clinical criteria. Fifteen patients received furosemide 40 mg/day and 15 patients spironolactone 25 mg/day in combination with habitual medication. Ambulatory BP monitoring was performed baseline, 3 months, and 6 months.Results: Baseline BP was 162 ± 8/90 ± 6 mmHg, 70%men, age 63.3 ± 9.1 years, and 56.1% diabetic. Baseline glomerular filtration rate (eGFR-CKD-EPI) was 55.8 ± 16.5 mL/min/1.73m 2 . No significant differences were found between groups at baseline in age, gender, % diabetics, eGFR, BP, number of antihypertensive drugs, or aldosterone levels. At 6 months, systolic BP decreased 24 ± 9.2 mmHg (from 163.6 ± 8.6 to 139.6 ± 8.1 mmHg) in spironolactone group, compared with 13.8 ± 2.8 mmHg (from 162 ± 7.9 to 148 ± 6.4 mmHg) in furosemide group(p < 0.01). Diastolic BP fell 11 ± 8.1 mmHg in spironolactone group compared with 5.2 ± 2.2 mmHg in furosemide group (p < 0.01). Forty percent of patients in spironolactone group reached the BP target (<140/90 mmHg) at 6 months compared with only 13% in furosemide arm. No significant changes in eGFR in any group during follow up. A significant reduction in urinary albumin creatinine ratio (from 173 ± 268 to 14 ± 24 mg/g, p < 0.01) was observed in spironolactone group at 6 months, but not in furosemide group. Multiple regression analysis showed that only treatment with spironolactone was associated with control of BP < 140/90 mmHg at 6 months. No severe adverse events were recorded. Mild hyperkalemia was observed in 2 patients on spironolactone.Conclusions: Spironolactone is more effective than furosemide for control of BP in RHT patients, with positive added effect on albuminuria. Spironolactone is safe in patients with mild kidney impairment, although serum potassium should be closely monitored, ...