Objective: Comparative evaluation of the impact of renal denervation versus pharmacological treatment with sympathetic nervous system (SNS) blockers on blood pressure variability in patients with resistant hypertension. Design and method: 75 patients with resistant hypertension without comorbidities after a 3-week standardized treatment with Losartan, Amlodipine and Indapamide and confirmation of their resistance were randomized into three groups, depending on medication supplimented to the previously administred: group I M - selective I1-imidazoline agonist Moxonidine, group II B – cardioselective beta-blocker Bisoprolol, group III D – renal artery denervation (RDN). Blood pressure variability assessed by ambulatory blood pressure monitoring (ABPM) were determined at baseline, 3 and 6 months follow-up. Results: The media/day and media/night systolic blood pressure (SBP) variability increased at the baseline in all three groups was reduced statistically significant from 3 months of monitoring, reaching the maximum effect towards the end of the study, when its normal values were recorded in all observational groups. Although treatment group supplimented with Moxonidine demonstrated an effect superior to that with Bisoprolol, and RDN - superiority to both, all three schemes had an authentic dynamics in improving SBP at 6 months of evaluation (p < 0,001) (Fig.1). The evolution of diastolic blood pressure (DBP) media/day and media/night variability noted a beneficial effect, starting with 3 months, the improvement of this parameter being maintained until the end of the study. Although the reduction of DBP variability was statistically authentic in all three groups at all stages of evaluation, the Bisoprolol treatment group noted a smaller effect in improving this parameter, the higher net effect being manifested by the RDN patients group (p < 0,001) (Fig.2). Conclusions: RDN in patients with resistant hypertension reduced statistically significant SBP and DBP variability starting with 3 months of follow-up and reaching maximum effect at the end of the study, simultaneously demonstrating superiority over treatment with SNS blockers.
Objective:Loss of the normal circadian rhythm of blood pressure is associated with adverse cardiovascular outcomes, the activity of the sympathetic nervous system in this context having an important pathophysiological mechanism. So, the objective of the study was to evaluate the impact of sympathetic renal denervation on circadian blood pressure pattern in patients with resistant hypertension.Design and method:The study included 75 patients with resistant hypertension, without comorbidities and mean age of 49.59 ± 0.52 years. After a 3 week standardized treatment with Losartan, Amlodipine and Indapamide patients were randomly assigned into three equal groups, depending on medication supplemented to the previously administered: I M group (n = 25) – Moxonidine, II B group (n = 25) - Bisoprolol and III D group (n = 25) – renal artery denervation. AMBP was done at baseline and 6 months follow-up. Renal denervation was performed using Medtronic Spyral catheters.Results:At baseline, most patients presented a non-dipper pathological profile for both systolic and diastolic blood pressure (Table 1).At 6 months of evaluation, the improvement of the diurnal profile was recorded in all three observational groups, renal denervation demonstrating a net superior effect compared to the SNS-blockers. In this way, towards the end of the study the dipper profile for SBP was recorded in 5 (20%), 4 (16%) and 10 (40%) patients, non-dipper – in 19 (76%), 21 (84%) and 15 (60%) patients from I M, II B and III D groups, respectively; night-picker pattern was noted in 1 (4%) patient from I M group, over-dipper profile not being registered (p > 0.05, x2 = 6.28). Circadian DBP pattern noted the disappearance of pathological profiles night-picker and over-dipper, non-dipper being registered in 19 (76%), 18 (72%) and 16 (64%) patients, the physiological dipper profile was recovered by 6 (24%), 7 (28%) and 9 (36%) patients from I M, II B and III D groups, respectively (p > 0.05, x2 = 0.90).Conclusions:Renal denervation has shown efficacy in improving the circadian diurnal profile, thus reducing the risk of cardiovascular events in patients with resistant hypertension.
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