Criteria for selecting patients with resistant hypertension for a renal sympathetic denervation


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Abstract

Aim. To define and develop a procedure that can select patients with resistant hypertension (RH) for a renal sympathetic denervation (RSD) procedure, by being orienting to the specific initial values of β-adrenoreactivity (β-AR) and systolic blood pressure (SBP). Subjects and methods. The analysis included 23 RH patients receiving the maximally tolerable doses of 4 antihypertensive drugs. The investigations involving BP control and a Russian spectrophotometric procedure for determining β-AR in terms of the change in the osmoresistance of erythrocyte membranes (EM) were performed at baseline and 4 and 24 weeks. RSD was carried out using endovascular radiofrequency ablation of the renal arteries. The therapy was not changed during the observation. Results. If SBP was >170 mm Hg and β-AR of EM >40 conditional units (CUs) at baseline, ΔSBP was 17.68±3.24 mm Hg and the efficiency of RSD was 100%. When SBP was <170 mm Hg and β-AR of EM <40 CUs at baseline, ΔSBP was 0.97±4.21 mm Hg (p>0.05) and the efficiency of RSD was low. Conclusion. The overall estimate of baseline SBP and β-AR of EM in patients with RH could determine the expediency of the RSD procedure in order to lower BP. The proposed procedure can optimize the selection of patients and enhance the efficiency of RSD in the treatment of RH.

References

  1. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. J Hypertens. 2013;31(7):1295-1297. doi: 10.1016/j.rec.2013.07.015
  2. Mancia G, Laurent S, Agabiti-Rosei E at al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens. 2009;27:2121-2158. doi:10.3109/ 08037050903 450468
  3. Urban D, Ewen S, Ukena C, et al. Treating resistant hypertension: role of renal denervation. Integr Blood Press Control. 2013;11(6):119-128. doi: 10.2147/ibpc.s33958
  4. Calhoun DA, Jones D, Textor S et al; American Heart Association Professional Education Committee. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008;117(25):510-526. doi: 10.1161/hypertensionaha.108.189141
  5. Daugherty SL, Powers JD, Magid DJ et al. Resistant hypertension. Incidence and prognosis of resistant hypertension in hypertensive patients. J Circulation. 2012;125(13):1635-1642. doi: 10.1161/circulationaha.111.068064
  6. Grassi G. Assessment of sympathetic cardiovascular drive in human hypertension: achievements and perspectives. J Hypertens. 2009;54(4):690-697. doi: 10.1161/hypertensionaha.108.119883
  7. Mancia G, Grassi G, Giannattasio C et al. Sympathetic activation in the pathogenesis of hypertension and progression of organ damage. J Hypertens. 1999;34:724-728. doi: 10.1161/01.hyp.34.4.724
  8. Стрюк Р.И., Длусская И.Г. Адренореактивность и сердечно-сосудистая система. М.; 2003.
  9. Бунова С.С., Остапенко В.А., Николаев Н.А., Нелидова А.В., Кузюкова А.А., Трошкина Т.Г., Москвина. Артериальная гипертония и адренореактивность: особенности у больных с ожирением. Бюллетень СО РАМН. 2008;1(129):77-81.
  10. Krum H, Barman N, Schlaich M et al. Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months. J Hypertensn. 2011;57 (5):911-917. doi: 10.1161/hypertensionaha.110.163014
  11. Esler MD, Krum H, Sobotka PA et al. Renal sympathetic denervation in patients with treatment-resistant hypertension (the Symplicity HTN-2 trial): a randomized controlled trial. J Lancet. 2010;376:1903-1609. doi: 10.1016/s0140-6736(10)62039-9
  12. Mahfoud F, Linz D, Mancia G et al. Renal artery denervation for treatment of hypertensive patients with or without obstructive sleep apnea and resistant hypertension: results from the global symplicity registry. J Hypertens. 2015;33(Suppl 1):e108.
  13. Briasoulis A, Bakris G. Renal Denervation After SYMPLICITY HTN-3: Where Do We Go? Can J Cardiol. 2015;31(5):642-648. doi: 10.1016/j.cjca.2014.12.004
  14. Sapoval M, Azizi M. Renal artery denervation for the treatment of resistant hypertension. Update after Medtronic announcement that its Symplicity HTN3 study failed to meet its primary efficacy end point. Diagn Interv Imag. 2014;95(4):353-354. doi: 10.1016/j.diii.2014.02.022
  15. Bauer A et al. A scoring system for identification of responders to renal sympathetic denervation. Eur Heart J. 2014;35:1190.
  16. Рипп Т.М., Мордовин В.Ф., Пекарский С.Е. и совт. Кардиопротективные возможности денервации почек при лечении резистентной гипертонии, поиск предикторов эффективности. Артериальная гипертензия. 2014;20(6):28-133. doi: 10.1097/01.hjh.0000468497.97663.2a

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