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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Renal denervation in patients with resistant hypertension – single centre report

Abstract

Among patients with resistant hypertension, it is very important to select patients most likely to benefit from renal sympathetic denervation, because they represent a very mixed group of diagnoses.

Prior to diagnosing a patient as having resistant hypertension, it is important to document adherence and exclude white-coat hypertension, inaccurate measurements of blood pressure and secondary causes of hypertension.

Renal sympathetic denervation has been demonstrated as an antihypertensive treatment in resistant hypertension patients with additional positive effects on glucose metabolism and insulin sensitivity in type 2 diabetes.

We report a single centre report of renal sympathetic denervation effects in a small cohort of patients with resistant hypertension and stage 2-3 chronic kidney disease.

Blood pressure reduction after renal sympathetic denervation was sustained at consecutive follow-up visits one, three and six months when compared to the baseline: office systolic blood pressure was significantly lower (144 ± 13, 140 ± 17, 141 ± 15 mmHg, p<0.001).

Randomized clinical trials are required to assess the impact of the reported changes.

Key words: resistant hypertension, stepwise screening protocol, renal denervation

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Renal denervation in patients with resistant hypertension-beyond blood pressure reduction

Abstract

Renal sympathetic denervation (RDN) has been demonstrated as an antihypertensive treatment in resistant hypertension patients, and triggers additional positive effects on glucose metabolism and insulin sensitivity in type 2 diabetes. The clinical implications of RDN in patients with type 2 diabetes, diabetic nephropathy and resistant hypertension have not yet been fully defined.
We hypothesized that the small antihypertensive effects of RDN treatment will induce additional benefits on renal function in CKD patients with type 2 diabetes and resistant hypertension.
We report the effects of RDN in two patients with type 2 diabetes, diabetic nephropathy, stage 3 chronic kidney disease and resistant hypertension. The blood pressure (BP) reduction after RDN was an 8-9% reduction of ABPM (sustained at consecutive follow-up visits at 3 and 6 months when compared to the baseline) and restoration of the night time dipping pattern was associated with amelioration of albuminuria (UAR).
As proteinuria may accelerate kidney disease progression to end-stage renal failure, recognition of the antiproteinuric treatment is essential for providing renoprotection.  Therefore, randomized clinical trials are required to assess the impact of reported changes.

Key words: resistant hypertension, renal denervation

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