When the first and the second renal sympathetic denervation in resistant hypertensive patients failure: What to do?

Márcio Galindo Kiuchi, Shaojie Chen, Helmut Pürerfellner
2016 International Journal of Cardiology Metabolic & Endocrine  
When the first and the second renal sympathetic denervation in resistant hypertensive patients failure: What to do? As reported in the SYMPLICITY HTN-3 trial [1] , no significant differences in the 24-h ABPM were observed between 6 and 12 months in the denervation and crossover subjects. Ambulatory data were available for only 20 of 70 (29%) non-crossover subjects at 12 months, given that ABPM was not protocol-mandated for these subjects at this time point. However, in these 20 subjects, a
more » ... rn similar to that of office readings was observed, showing a larger 24-h ABPM reduction at 6 than 12 months (−11.0 ± 19.5 vs. −6.1 ± 14.4 mmHg at 6 and 12 months, respectively; P = 0.272) [1] . Moreover, we did not observe the change in 24-h ABPM as expected in our study even patients presenting resistant hypertension after antihypertensive staggered scheme and RSD and one predictor of success that is the baseline office systolic blood pressure of ≥ 180 mmHg [2] . Based on these results we performed a second RSD procedure, aiming to low the blood pressure in these resistant hypertensive patients. This prospective, longitudinal study was conducted in 27 patients with resistant hypertension who underwent percutaneous RSD. The study was approved by the Hospital e Clínica São Gonçalo Ethics Committee and was conducted in accordance with the principles of the Declaration of Helsinki. All patients signed written informed consent prior to study inclusion. We evaluated the safety and effectiveness of RSD for improvement of clinical parameters and in reducing damage to the heart, through echocardiographic parameters, and kidneys, by assessing estimated glomerular filtration rate (eGFR) and albumin:creatinine ratio (ACR), in patients with resistant hypertension. This study was conducted at the Hospital e Clínica São Gonçalo, Rio de Janeiro, Brazil, where patients were recruited from January 2014 through to July 2015 from the Artificial Cardiac Pacing Department. Patients meeting all the following criteria were consecutively enrolled: (i) office systolic BP ≥140 mmHg despite using 3 antihypertensive drugs, being one of them a diuretic; (ii) aged between 18 and 80 years; (iii) undergoing antihypertensive staggered scheme with the following drugs for at least 6 months before being subjected to the first RSD procedure: β blocker followed by spironolactone, followed by α-1 adrenergic receptor blocker and after by α-2 adrenergic receptor blocker, in case of no reduction of blood pressure; (iv) left ventricular ejection fraction N50% measured by Simpson's method in the echocardiogram; (v) sinus rhythm; (vi) eGFR determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, eGFR [3] N 60 mL/min/1.73 m 2 these patients without microalbuminuria); and (vii) able to read, understand and sign the informed consent form. Patients with any of the following criteria were excluded: (i) pregnancy; (ii) acute HF; (iii) acute coronary syndrome; (iv) valvular disease with significant hemodynamic repercussions; (v) myocardial infarction, unstable angina, stroke or transient ischemic attack within the previous 6 months; (vi) renovascular abnormalities (including severe renal artery stenosis,
doi:10.1016/j.ijcme.2016.09.006 fatcat:rebk2vwwezelbjmm4x3jbapex4