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Renal sympathetic denervation in patients with resistant arterial hypertension: technical approach and follow-up

Session HFA Discoveries - ePosters

Speaker Associate Professor Daniil Maximkin

Event : HFA Discoveries 2020

  • Topic : hypertension
  • Sub-topic : Hypertension - Other
  • Session type : ePosters

Authors : Z Shugushev (Moscow,RU), A Chepurnoy (Moscow,RU), D Maximkin (Moscow,RU)

Authors:
Z Shugushev1 , A Chepurnoy1 , D Maximkin1 , 1Peoples Friendship University of Russia (RUDN University) - Moscow - Russian Federation ,

Citation:

AIMS: today we are in search of the most effective and safe technique and device percutaneous renal denervation.It is known that with age degenerative changes occur in the nervous system, including in the sympathetic nerve fibers. So, it can be assumed that the antihypertensive effect of denervation in elderly patients is worse. The aim of study: assess the efficacy and safety of catheter-basedradiofrequency renal denervation (RDN) for the treatment of uncontrolled hypertension.
METHODS:
64 patients with resistant hypertension were searched for clinical studies between January 26, 2015, and May3, 2018.All patients were randomized in two groups - younger (n=33) and older than 65 years (n=31). All patients underwent combined (proximal and distal) denervation with different devises(Vessix- Boston Scientific, Simplisity or Spyral - Medtronic) and with a lot of ablation points (min 16) in eachcase. Drug therapy remained unchanged during the study. The primary endpoints were major adverse events. The secondary endpoints included changes in 24-hour ambulatory and office blood pressure (BP).
RESULTS:
By the third year of the study, there was a decrease in the average number of drugs taken to 2.1 and 2.7, respectively, from 4.7 in both groups. Analyses indicated that RDN in first group was associated with a significantly greater cumulativereduction of 24-hour systolic BP (mean difference [MD], -4.2 mm Hg; 95% CI, -5.2 to -2.7; P<0.05) and office systolic BP (MD, -8.1 mm Hg; 95% CI, -12.5 to -4.3; P<0.05) than patients from group II. Similarly, in group I RDN reduced 24-hour diastolic BP (MD, -2.2 mm Hg; 95% CI, -3.3 to -1.1; P<0.05) and office diastolic BP (MD, -4.5 mm Hg; 95% CI, -6.6 to -2.5; P<0.05). Combined radiofrequency RDN was not associated with an increased risk of major adverse events (relative risk, 1.06; 95% CI, 0.72 to 1.57; P<0.05).

CONCLUSIONS Catheter-based radiofrequency RDN results in significant reduction in BP and therapeutic effects are sustained >3 years, without increasing major adverse events.Thus, the "cumulative" antihypertensive effect was observed mainly in patients younger than 65 years of age.

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