New opportunities of renal denervation

The purpose of this single-centre, prospective, comparative study was to evaluate the pattern and severity of the brain structural changes in patients with resistant hypertension based on MRI assessments and their changes one year after renal denervation.Material and Methods. The study comprised 53 patients with resistant hypertension (RH), aged 52.1 ± 9.1 years, who underwent renal denervation (RDN) following the Good Clinical Practice guidelines. Patients underwent office blood pressure measurements, 24-hour blood pressure monitoring (BPM), and brain MRI scanning. Using brain MRI, the cerebrospinal fluid (CSF) system measurements, the presence and severity of periventricular white matter lesion and focal changes in the brain white matter were evaluated.Results. Initially, patients with RH had a high incidence of the structural brain alterations: 43 (81%) patients with fine focal brain lesions, 43 (81%) patients with enlarged CSF spaces, and 48 (90%) patients with periventricular white matter lesions. After renal denervation, a significant hypotensive effect was noted. According to brain MRI, the number of patients without enlarged CSF spaces did not change significantly: 15 (25%) patients initially, and 12 (20%) patients a year later (χ2 = 0.63, р = 0.43 и χ2 = 0.72, р = 0.40). The incidence of periventricular white matter lesion did not significantly change one year after RDN; however, the incidence of fine focal brain lesions significantly decreased in 21 patients (81% to 60%, p = 0.02).Conclusion. Thus, it has been revealed that patients with resistant hypertension are characterised by a high incidence of structural brain alterations based on MRI assessments. Bilateral renal denervation is followed by a significant decrease in the incidence of fine focal brain lesions, without a significant change in the cerebrospinal fluid volume one year after the procedure.

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MRI in the assessment of cerebral injury and cerebroprotective effects of renal denervation in resistant hypertension

Сухарева

Falkovskaya

Ussov

et al. 2023

Medicinskaâ vizualizaciâ

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Five-year dynamics adrenergic reactivity of erythrocytes after radio-frequency sympathic denervation of renal arteries in patients with resistant arterial hypertension

Rebrova,

Falkovskaya,

Afanasiev

et al. 2023

Terapevticheskii arkhiv

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Aim. To study the initial state of adrenergic reactivity and the five-year dynamics of the beta-adrenergic reactivity index of erythrocyte membranes and the manifestation of the antihypertensive effect of the procedure for radiofrequency destruction of sympathetic structures of the renal artery in patients with resistant arterial hypertension. Subjects and methods. The analysis included 42 patients with resistant arterial hypertension (RH). The renal denervation (RD) procedure of the kidneys was performed by endovascular bilateral transcatheter radiofrequency ablation of the renal arteries. The study of 24-hour blood pressure monitoring (BPM) and the determination of -adrenoreactivity of erythrocytes (-ARM) by changes in the osmoresistance of erythrocyte membranes were performed initially, 1 week, 6 months, 1, 2, 3 and 5 years after RD. Patients retrospectively, at a follow-up period of 6 months after RD, were divided into responders (decrease in blood pressure by 10 or more mm Hg) and non-responders (decrease in blood pressure less than 10 mm Hg). Results. 6 months after the RD, the number of responders was 28 people (66.7%), after 5 years - 31 people (73.8%). At the time of inclusion in the study, the median -ARM in the group of non-responders was not significantly higher than in the group of responders. After 6 months after the RD procedure, the -ARM indicator in the non-responder group was significantly lower than in the responder group (p = 0.043). With further follow-up in the group of responders, an increase in the median -ARM was noted, which reached significant differences relative to the baseline values in the group at follow-up periods of 1 year (p = 0.036) and 5 years (p = 0.004) after RD. The change in the -ARM indicator in the non-responder group was wavy in nature, the changes did not reach the significance criteria. Conclusion. Renal denervation in 73.8% of cases is accompanied by a stable antihypertensive response for 5 years of observation and an increase in -ARM, which may indicate the implementation of compensatory mechanisms in conditions of increasing activity of the sympathoadrenal system in response to a decrease in blood pressure.

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Renal artery denervation in patients with resistant arterial hypertension: clinical and organ-protective effect

et al. 2021

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Aim. To assess the clinical efficacy of renal artery denervation (RAD) in treatment of patients with resistant arterial hypertension (RAH) compared to patients taking drug therapy (DT) at long-term follow-up and the possibility of RAD impact on target organs (heart, kidneys). Materials and methods. 80 RAH patients were examined (mean age 54.3010.19 years). Patients were divided in two groups: the basic group was comprised of 40 RAH patients taking antihypertensive DT, who underwent RAD (gr. 1) and comparison group was composed of 40 RAH patients taking only antihypertensive DT (gr. 2). Gender and age differences between groups were statistically insignificant (p0.05). Mean duration of AH was 18.638.96 years. The follow-up was carried out during one year. Results. In RAD group there was confirmed decrease not only in the office, but also in the average day-time and night-time blood pressure (BP), changes were more significant in systolic BP (SBP) indicators: the overall daytime SBP was 17.369.31 mmHg (p0.001), the average day-time SBP was 17.1810.53 mmHg (p0.001), the average night-time SBP was 19.2210.76 mmHg (p0.001). At the same time, in DT group changes in values of overall, maximum, minimum, average day-time and average night-time SBP and diastolic BP were not statistically significant in 12 months. RAD in RAH was accompanied by decrease in left ventricular hypertrophy with initial hypertrophy (p0.05), decrease in microalbuminuria (p0.05), decrease in velocity in segmental (p0.05) and interlobar renal arteries (p0.01). Conclusion. RAD in patients with RAH had not only antihypertensive effect but also positive effect on target organs of AH (heart, kidneys).

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New opportunities of renal denervation

Cited by 6 publications

References 27 publications

MRI in the assessment of cerebral injury and cerebroprotective effects of renal denervation in resistant hypertension

MRI in the assessment of cerebral injury and cerebroprotective effects of renal denervation in resistant hypertension

Five-year dynamics adrenergic reactivity of erythrocytes after radio-frequency sympathic denervation of renal arteries in patients with resistant arterial hypertension

Renal artery denervation in patients with resistant arterial hypertension: clinical and organ-protective effect

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