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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.

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Hypertension remains the leading cause of preventable cardiovascular disease and the main problem of overall mortality globally and also in Europe. Despite pharmacological advances, the control rates of blood pressure remain low worldwide and are far from being satisfactory in Europe. The renal sympathetic denervation is an innovative method, conceived 10 years ago, that involves the disruption of afferent and efferent renal sympathetic fibers by applying radiofrequency energy, thus reducing sympathetic activity and at the same time decreasing the blood pressure. Therefore, renal denervation expands the therapeutic options as being the first goal of hypertension treatment, which means the effective reduction of blood pressure values by achieving therapeutic targets.

Congestive heart failure with preserved left ventricular systolic function is termed “diastolic heart failure” and is more prevalent in the older population, may account for one half of the older population with congestive heart failure, and may be more common in women than men. The prognosis of patients with congestive heart failure due to diastolic dysfunction is less ominous than in patients with systolic dysfunction yet the morbidity can be high with frequent treatment failures and hospital readmissions.Conclusions: Thus, the diagnosis of heart failure with preserved ejection fraction (HFpEF) on elderly (≥ 85 years old) patients is cumbersome. Diagnosis of heart failure with preserved ejection fraction is challenging in euvolemic patients with dyspnea, and no evidence-based criteria are available. Diastolic LV dysfunction is very common parameter (58 %), but without any specificity for HFpEF, its treatments should be focused on the underlying disease etiology as well as on the derangement in left ventricular diastolic function.