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

https://doi.org/10.26442/2075082X.2021.3.201090

Abstract

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 54.30±10.19 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 (p>0.05). Mean duration of AH was 18.63±8.96 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 ΔSBP was 17.36±9.31 mmHg (p<0.001), the average day-time ΔSBP was 17.18±10.53 mmHg (p<0.001), the average night-time ΔSBP was 19.22±10.76 mmHg (p<0.001). 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 (p<0.05), decrease in microalbuminuria (p<0.05), decrease in velocity in segmental (p<0.05) and interlobar renal arteries (p<0.01). Conclusion. RAD in patients with RAH had not only antihypertensive effect but also positive effect on target organs of AH (heart, kidneys).

About the Authors

L. I. Gapon
Tyumen Cardiology Research Center - Branch of the Tomsk National Research Medical Center
Russian Federation


E. V. Mikova
Tyumen Cardiology Research Center - Branch of the Tomsk National Research Medical Center
Russian Federation


D. V. Krinochkin
Tyumen Cardiology Research Center - Branch of the Tomsk National Research Medical Center
Russian Federation


N. Yu. Savelyeva
Tyumen Cardiology Research Center - Branch of the Tomsk National Research Medical Center
Russian Federation


A. Yu. Zherzhova
Tyumen Cardiology Research Center - Branch of the Tomsk National Research Medical Center
Russian Federation


E. L. Aleksandrovich
Tyumen Cardiology Research Center - Branch of the Tomsk National Research Medical Center
Russian Federation


References

1. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36(10):1953-2041.

2. Boitsov SA, Balanova IuA, Shalnova SA, et al. Arterialnaia gipertoniia sredi lits 25–64 let: rasprostranennost, osvedomlennost, lechenie i kontrol. Po materialam issledovaniia ESSE. Kardiovaskuliarnaia terapiia i profilaktika. 2014;13(4):4-14 (in Russian). doi: 10.15829/1728-8800-2014-4-4-14

3. Arterial hypertension in adults. Clinical guidelines. Moscow: Russian Society of Cardiology, 2020 (in Russian).

4. Sakakura K, Ladich E, Cheng Q. Anatomic assessment of sympathetic peri-arterial renal nerves in man. J Am Coll Cardiol. 2014;64(7):635-43.

5. Grigin VA, Danilov NM, Matchin YuG, Chazova IE. Radiofrequency denervation of the renal arteries. Myth or Reality? Systemic Hypertension. 2015;12(3):39-44 (in Russian).

6. Danilov NM, Elfimova EM, Savchenko AP, Chazova IE. Renovaskuliarnaia arterialnaia gipertenziia, diagnostika i lechenie. Vestnik rentgenologii i radiologii. 2010;3:32-41 (in Russian).

7. Krum H, Schlaich MP, Sobotka PA, et al. Percutaneous renal denervation in patients with treatment-resistant hypertension: final 3-year report of the Symplicity HTN-1 study. Lancet. 2014;383(9917):622-96.

8. Symplicity HTN-2 Investigators; 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.

9. Danilov NM, Matchin IuG, Chazova IE. Endovaskuliarnaia radiochastotnaia denervatsiia pochechnykh arterii – innovatsionnyi metod lecheniia refrakternoi arterialnoi gipertonii. Pervyi opyt v Rossii. Angiologiia i sosudistaia khirurgiia. 2012;18(1):51-4 (in Russian).

10. Ripp TM, Mordovin VF, Pekarskii SE, et al. Simpaticheskaia denervatsiia pochechnykh arterii dlia lecheniia rezistentnoi gipertenzii, ultrazvukovoi kontrol bezopasnosti metoda. Arterialnaia gipertenziia. 2013;19(2):2-8 (in Russian).

11. Zvartau NE, Zverev DA, Konradi AO. Renalnaia denervatsiia pri rezistentnoi arterialnoi gipertenzii – byt ili ne byt? Arterialnaia gipertenziia. 2014;20(2):155-6 (in Russian). doi: 10.18705/1607-419x-2014-20-2-125-126

12. Zvartau NE, Konradi AO. Interventsionnye podkhody k lecheniiu arterialnoi gipertenzii. Arterialnaia gipertenziia. 2015;21(5):450-8 (in Russian). doi: 10.18705/1607-419Х-2015-21-5-450-458

13. Pocock SJ, Bakris G, Bhatt DL, et al. Regression to the Mean in SYMPLICITY HTN-3: Implications for Design and Reporting of Future Trials. J Am Coll Cardiol. 2016;68(18):2016-25.

14. Agaeva RA, Danilov NM, Schelkova GV, et al. New possibilities of renal denervation. Terapevticheskii Arkhiv (Ter. Arkh.). 2020;92(6):84-8 (in Russian). doi: 10.26442/00403660.2020.06.000588

15. Lichikaki VA, Mordovin VF, Pekarskii SE, et al. Gipotenzivnaia effektivnost renalnoi denervatsii i ee vliianie na izmenenie stepeni vyrazhennosti gipertrofii levogo zheludochka. Sibirskii zhurnal klinicheskoi i eksperimentalnoi meditsiny. 2016;31(2):15-8 (in Russian). doi: 10.29001/2073-8552-2016-31-2-15-18

16. Kandzari DE, Böhm M, Mahfoud F, et al; SPYRAL HTN-ON MED Trial Investigators. SPYRAL. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet. 2018;391:2346-55. doi: 10.1016/S0140-6736(18)30951-6

17. Ostroumova OD, Borisova EV, Ostroumova TM, Kochetkov AI. Variabelnost arterialnogo davleniia v techenie sutok: prognosticheskoe znachenie, metody otsenki i vliianie antigipertenzivnoi terapii. Kardiologiia. 2017;57(12):62-72 (in Russian).

18. Rodionov AV. Vysokaia variabelnost arterialnogo davleniia – dopolnitelnyi faktor riska serdechno-sosudistykh oslozhnenii. Ratsionalnaia farmakoterapiia v kardiologii. 2020;16(1):94-8 (in Russian). doi: 10.20996/1819-6446-2020-02-02

19. Kikuya M, Ohkubo T, Metoki H, et al. Day-by-Day Variability of Blood Pressure and Heart Rate at Home as a Novel Predictor of Prognosis. The Ohasama Study. Hypertension. 2008;52(6):1045-50. doi: 10.1161/HYPERTENSIONAHA.107.104620

20. Stevens SL, Wood S, Koshiaris C, et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ. 2016;354:i4098. doi: 10.1136/bmj.i4098

21. Ostroumova OD, Kochetkov AI, Lopukhina MV, Pavleeva EE. Gipersimpatikotoniia v razvitii gipertrofii miokarda levogo zheludochka i vozmozhnosti beta-blokatorov dlia regressa. Rossiiskii kardiologicheskii zhurnal. 2018;(9):77-88 (in Russian). doi: 10.15829/1560-4071-2018-9-77-88

22. Schlaich MP, Kaye DM, Lambert E, et al. Relation between cardiac sympathetic activity andhypertensive left ventricular hypertrophy. Circulation. 2003;108:560-5. doi: 10.1161/01.CIR.0000081775.72651.B6

23. Brandt MC, Mahfoud F, Reda S, et al. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol. 2012;59(10):901-9. doi: 10.1016/j.jacc.2011.11.034.24

24. Schirmer SH, Sayed MM, Reil JC, et al. Improvements in left ventricular hypertrophy and diastolic function following renal denervation. J Am Coll Cardiol. 2014;63(18):1916-23. doi: 10.1016/j.jacc.2013.10.073.25

25. Sulimov VA, Rodionov AV, Svetankova AA. Renalnaia denervatsiia za predelami lecheniia rezistentnoi arterialnoi gipertenzii: perspektivy primeneniia. Arterialnaia gipertenziia. 2015;21(5):468-76 (in Russian). doi: 10.18705/1607-419X-2015-21-5-468-476

26. Sitkova ES, Mordovin VF, Ripp TM, et al. Polozhitelnoe vliianie renalnoi denervatsii na gipertrofiiu i subendokardialnoe povrezhdenie miokarda. Arterialnaia gipertenziia. 2019;25(1):46-59 (in Russian). doi: 10.18705/1607-419X-2019-25-1-46-59

27. Sulimov VA, Rodionov AV, Svetankova AA. Renalnaia denervatsiia v lechenii rezistentnoi arterialnoi gipertenzii: rezultaty odnogodichnogo issledovaniia. Ratsionalnaia farmakoterapiia v kardiologii. 2015;11(3):304-8 (in Russian).

28. Salman IM, Sattar MA, Abdullah NA, et al. Renal functional & haemodynamic changes following acute unilateral renal denervation in Sprague Dawley rats. Indian J Med Res. 2010;131:76-82.

29. Ripp TM, Mordovin VF. Renalnaia denervatsiia: vzgliad kardiologa. Kardiologiia: novosti, mneniia, obuchenie. 2017;2(13):31-8 (in Russian).

30. Ott C, Mahfoud F, Schmid A, et al. Improvement of albuminuria after renal denervation. Int J Cardiol. 2014;173(2):311-5.

31. Zhang ZH, Yang K, Jiang FL, et al. The effects of catheter-based radiofrequency renaldenervation on renal function and renal artery structure in patients with resistant hypertension. J Clin Hypertens (Greenwich). 2014;16(8):599-605.

32. Serdechno-sosudistyi risk i khronicheskaia bolezn pochek: strategii kardio-nefroprotektsii. Natsionalnye rekomendatsii. Rossiiskii kardiologicheskii zhurnal. 2014;8(112):7-37 (in Russian).

33. Pearce JD, Craven TE, Edwards MS, et al. Associations between renal duplex parameters and adverse cardiovascular events in the elderly: a prospective cohort study. Am J Kidney Dis. 2010;55(2):281-90. doi: 10.1053/j.ajkd.2009.10.044

34. Hanamura K, Tojo A, Kinugasa S, Pontremoli R. The resistive index is a marker of renal function, pathology, prognosis, and responsiveness to steroid therapy in chronic kidney disease patients. Int J Nephrol. 2012;2012:139565-74. doi: 10.1097/hjh.0b013e328365b29c

35. Martynov SA, Shvetsov MYu, Kutyrina IM, et al. The role of Doppler ultrasound using an acute pharmacological test with captopril in the assessment of renal hemodynamics in chronic glomerulonephritis. Terapevticheskii Arkhiv (Ter. Arkh.). 2003;75(6):41-6 (in Russian).

36. Bruno RM, Salvati A, Barzacchi M, et al. Predictive value of dynamic renal resistive index (DRIN) for renal outcome in type 2 diabetes and essential hypertension: a prospective study. Cardiovasc Diabetol. 2015;14:63. doi: 10.1186/s12933-015-0227

37. Prejbisz A, Warchoł-Celińska E, Florczak E, et al. Renal resistive index in patients with true resistant hypertension: results from the RESIST-POL study. Kardiol Pol. 2016;74(2):142-50.

38. Zmitrovich OA. Ultrasound diagnostics in numbers: a reference and practical guide. 3rd ed. Saint Petersburg: SpetsLit, 2017 (in Russian).


Review

For citations:


Gapon L.I., Mikova E.V., Krinochkin D.V., Savelyeva N.Yu., Zherzhova A.Yu., Aleksandrovich E.L. Renal artery denervation in patients with resistant arterial hypertension: clinical and organ-protective effect. Systemic Hypertension. 2021;18(3):153-160. (In Russ.) https://doi.org/10.26442/2075082X.2021.3.201090

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