Renal denervation in patients with resistant hypertension - single centre report

Among patients with resistant hyperten-sion, it is very important to select patients most likely to benefit from renal sympa-thetic 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 measure-ments of blood pressure and secondary causes of hypertension. 

Renal sympathetic denervation has been demonstrated as an antihypertensive treat-ment 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 hyperten-sion and stage 2-3 chronic kidney disease. Blood pressure reduction after renal sym-pathetic denervation was sustained at con-secutive follow-up visits one, three and six months when compared to the baseline: office systolic blood pressure was signifi-cantly lower (144 ± 13, 140 ± 17, 141 ± 15 mmHg, p<0.001). 

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

resistant hypertension, stepwise screening protocol, renal denervation

1. Mahfoud F, Schlaich M, Kindermann I, et al. Effect of renal sympathetic denervation on glucose metabolism in patients with resist-ant hypertension: a pilot study. Circulation 2011;123:1940-6

2. Witkowski A, Prejbisz A, Florczak E et al. Effects of renal sympathetic denervation on blood pressure, sleep apnea course, and glycemic control in patients with resistant hypertension and sleep apnea. Hypertension. 2011; 58: 559–565.

3. Hering D, Mahfoud F, Walton AS, et al. Renal denervation in moderate to severe CKD. J Am Soc Nephrol 2012; 23:1250-7.

4. Prkačin I, Ožvald I, Cavrić G, Balenović D, Bulum T, Flegar-Meštrić Z. Importance of urinary NGAL, serum creatinine standardi-zation and estimated glomerular filtration rate in resistant hypertension. Coll Antropol 2013; 37 (3): 821-825.

5. Hering D, Esler MD, Schlaich MP. Chronic kidney disease: role of sympathetic nervous system activation and potential benefits of renal denervation. EuroIntervention 2013; 9 (Suppl R): R127-35.

6. Hermida RC, Ayala DE, Portaluppi F. Circadial variation of blood presuure: the basis for the chronotherapy of hypertension. Adv  Drug Deliv Rev 2007; 59:904-922. 

7. de Jager RL, Blankestijn PJ. Pathophysiology I: the kidney and the sympathetic nervous system. Euro Intervention 2013; 9 (Suppl R): R42-7.

8. Papademetriou V, Tsioufis C, Doumas M. Renal Denervation and Symplicity HTN-3: „Dubiom Sapientiae Initium“ (Doubt is the Beginning of Wisdom). Circ Res 2014; 115 (Supl. 2): 211-214.