Materials and methods. The study involved 40 patients with resistant arterial hypertension aged 27 to 70 years (mean age 54.91±9.77 years) while receiving three or more antihypertensive drugs (including diuretic) in optimal doses. The conditions for inclusion in the study were considered resistant arterial hypertension with blood pressure (BP)>160/100 mm Hg, intact kidney function – glomerular filtration rate (MDRD)>45 ml/min – and the absence of secondary hypertension. All patients had sympatic radiofrequency denervation of renal arteries; its efficiency later was estimated according to the clinical measurement and ambulatory blood pressure monitoring (ABPM).
Results. The level of office BP reliably differed initially and after 3 years: DSBP -34.48±6.44 mm Hg (p=0.001), DDBP – 22.29 mm Hg (p=0.001). According to ABPM results, reliable dynamics of systolic blood pressure was not observed. The data of DBP at night were significantly lower after 36 months; DDBP was -5.37±9.77 mm Hg. Conclusions. A marked decrease in the data of office SBP and DBP was observed, which proves the long-term efficiency of radiofrequency denervation of the renal arteries in patients with resistant hypertension. Accor-ding to ABPM results after 36 months, a significant decrease was registered among the DBP indicators at night and daytime.
Key words: resistant arterial hypertension, radiofrequency denervation of the renal artery, prospective ob-servation.
About the Author
Tyumen Cardiology Research Center – branch of Tomsk National Research Medical Center, Tyumen, Russia
2. Forouzanfar MH, Liu P, Roth GA еt al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA 2017; 317: 165–82.
3. Lewington S, Clarke R, Qizilbash N et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–13.
4. Gottesman RF, Albert MS, Alonso A et al. Associations between midlife vascular risk factors and 25-year incident dementia in the Atherosclerosis Risk in Communities (ARIC) cohort. JAMA Neurol 2017; 74: 1246–54.
5. Myat A, Redwood SR, Qureshi AC et al. Resistant hypertension. BMJ 2012; 345: e7473–7473.
6. Daugherty SL, Powers JD, Magid DJ et al. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation 2012; 125: 1635–42.
7. Pierdomenico SD, Lapenna D, Bucci A et al. Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens 2005; 18: 1422–8.
8. Calhoun DA, Jones D, Texto S et al. 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. Hypertension 2008; 51: 1403–19.
9. Chazova I.E., Fomin V.V., Razuvaeva M.A., Vigdorchik A.V. Rezistentnaia i nekontroliruemaia arterial'naia gipertoniia v Rossiiskoi Federatsii: epidemiologicheskaia kharakteristika i podkhody k lecheniiu (Rossiiskii registr nekontroliruemoi i rezistentnoi arterial'noi gipertonii REGATA "REzistentnaia Gipertoniia ArTeriAl'naia"). Kardiologicheskii vestn. 2011; 6 (18): 40–8 (in Russian).
10. Rosenbaum D, Villeneuve F, Gury C, Girerd X. Frequency of hypertension resistant to treatment and indication for renal denervation. Annales de Cardiologie et d'Angeiologie 2012; 61: 229–35.
11. Gupta AK, Nasothimiou EG, Chang CL et al. Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT): a risk score to identify those at high-risk. J Hypertens 2011; 29: 2004–13.
12. Achelrod D, Wenzel U, Frey S. Systematic review and meta-analysis of the prevalence of resistant hypertension in treated hypertensive population. Am J Hypertension 2015; 3: 355–61.
13. Krum H, Schlaich M, Whitbourn R et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 2009; 373 (9671): 1275–81. DOI: https://doi.org/10.1016/S0140-6736(09)60566-3
14. Esler MD, Krum H, Sobotka PA et al. Renal sympathetic denervation in patients with treatment-resistant hypertension (the SYMPLICITY HTN-2 Trial): a randomised controlled trial. Lancet 2010; 376: 1903–9.
15.Lichikaki V.F., Mordovin V.F., Pekarskii S.E. et al. Gipotenzivnaia effektivnost' renal'noi denervatsii i ee vliianie na izmenenie stepeni vyrazhennosti gipertrofii levogo zheludochka. Sib. med. zhurn. 2016; 31 (2): 15–7 (in Russian).
16. Bhatt DL, Kandzari DE, O'Neill WW et al. A Controlled Trial of Renal Denervation for Resistant Hypertension. N Engl J Med 2014; 370: 1393–401. DOI: 10.1056/NEJMoa1402670
17. Bashta D.I., Romanov A.B., Kolesnikov V.N. et al. Renal'naia denervatsiia – novye podkhody v optimizatsii gipotenzivnogo effekta. Med. vestn. Severnogo Kavkaza. 2017; 12 (4): 431–4. DOI: https://doi.org/10.14300/mnnc.2017.12121 (in Russian).
18.Bolotov P.A., Semitko S.P., Klimov V.P., Vertkina N.V. Transcatheter sympathetic renal denervation for resistant arterial hypertension: the current state. Consilium Medicum. 2018; 20 (5): 40–9. (in Russian).
19. Shishehbor MH, Hammad TA, Thomas G. Renal denervation: What happened, and why? Cleveland Clin J Med 2017; 84 (9): 681–6.
20. Grigin V.A., Danilov N.M., Sagaydak O.V. et al. Methods of sympathetic activity evaluation in patients with systemic refractory hypertension. Systemic Hypertension. 2014; 11 (4): 21–6 (in Russian).
21. Kandzari DE, Kario K, Mahfoud F et al. The SPYRAL HTN Global Сlinical Trial Program: Rationale and design for studies of renal denervation in the absece (Spyral HTN OFF-Med) and presence (Spyral HTN ON-MED) of antihypertensive medications.
22. Resistant Hypertension: Detection, Evaluation, and Management. A Scientific Statement From the American Heart Association. Hypertension 2018; 72: e53–e90. DOI: 10.1161/HYP.0000000000000084
23. Mahfoud F, Bakris G, Bhatt DL et al. Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry. Eur Heart J 2016; 38 (2): 93–100. DOI: 10.1093/eurheartj/ehw325
24. Gapon L.I., Mikova E.V., Savel'eva N.Iu. et al. Gipotenzivnyi effekt radiochastotnoi denervatsii pochechnykh arterii u patsientov s rezistentnoi arterial'noi gipertoniei. Klinicheskaia praktika. 2017; 3: 25–31 (in Russian).
25. Kushkhova R.R. Rezistentnaia arterial'naia gipertenziia: morfofunktsional'nye izmeneniia serdechno-sosudistoi sistemy. Vestn. novykh meditsinskikh tekhnologii. 2016; 23 (2): 148–52 (in Russian).
26. Glybochko P.V., Svetankova A.A., Rodionov A.V. et al. Renal'naia denervatsiia pri rezistentnoi arterial'noi gipertenzii: rezul'taty 5-letnego nabliudeniia. Therapeutic Archive. 2018; 9: 88–91. DOI: 10.1430/mnnc.2017.12121 (in Russian).
For citation:Savelyeva N.Yu., Zherzhova A.Yu., Mikova E.V. et al. Radiofrequency denervation of the renal arteries in patients with resistant arterial hypertension: 3 years of observation experience. Systemic Hypertension. 2019; 16 (4): 65–69.DOI: 10.26442/2075082X.2019.4.190596