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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Central blood pressure and pulse wave velocity in patients with resistant hypertension

Abstract

Background. The measurement of brachial pressure (BP) has passed been on for ages, but the central pressure detection could only be possible with invasive techniques, until recently non-invasive and modern technology was introduced into the clinical setting. Studies described that the increase in central blood pressure (CBP) is an indicator of future cardiovascular or target organ damage. Compared with the general population, cardiorenal morbidity is much higher in patients with resistant hypertension (RH). We investigated for the first time the value of CBP and pulse wave velocity (PWV) in a group of RH patients.

Materials and Methods. Data from 80 patients with RH (resistance to 3 or more drugs, one is diuretic) without chronic kidney disease, at University hospital Merkur, Zagreb from the period of June 2017 to January 2018 were analysed. The pulse wave velocity (PWV), mean arterial pressure (MAP), vessels age (older than biological age), pulse pressure (PP), central blood pressure (CBP), brachial pressure (BP) were evaluated using the noninvasive Agedio B900 device (Germany).

Results. The median age was 58.75 (SD-15.3). 27 (35%) of patients were male (avg 53.9 y). BP and CBP were elevated in all RH patients (53 F/27M). The difference between the median value of BP (145.9/90.52mmHg, F=146.4/89.5, M=145/92) and CBP (132.16/91.78mmHg, F=132/90, M 131/94) was statistically significant for systolic BP (p<0.01). The mean value of the total measured PWV value was higher than reference for age in all RH and was 8.84 m/s. The mean value of PP and MAP was higher than reference (60.11 and 123,87 mmHg). The difference between sex was statistically significant higher for PWV in females than males (M/F= 8.1/9.2m/s, p<0.01). The difference between MAP median concentration (M/F=125.83/123) and PP (M/F=56/62mmHg) was not statistically significant (p>0.01).

Conclusion. Currently no gold standard technique is available to measure the CBP. Future studies should address that the cuff method could be a promising device in every day practice for this high risk population.

Key words: resistant hypertension, central blood pressure

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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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