Objective:50% of the RFA procedures in patients with treatment-resistant hypertension (TRH) are ineffective or have ambiguous results. The most significant challenge is to find differential diagnostic predictors of the RFA efficacy in these patients.Our purpose was to assess the MRI potential for efficacy prediction and real-world prospective control of the brain as a target organ in patients with RH during a course of treatment.Design and method: We studied 176 patients with RH (124 men and 51 women, aged 55.65 ± 8.99 years). All of them underwent an MRI brain scan before RFA, six months and one year after the procedure. The patients were divided into 2 groups: patients who had the average daytime BP drop by > 10 mmHg (Group 1) and patients whose BP decreased by < 10 mmHg or increased (Group 2). Using brain MRI, the CSF system measurements, including the linear measurements of the cerebral lateral ventricles and the external subarachnoid spaces in 6 regions (in the right and left frontal, parietal, and occipital lobes), sizes of the third and fourth ventricles, dimensions of intracerebral cisterns (quadrigeminal, prepontine, and chiasmatic), the presence of periventricular leukoaraiosis and focal changes in the brain were evaluated.Results:The methodology was based on a logistic regression model. fx180 If the p-value is< 0.5, the prognosis for the patient is “no effect’’; if the p-value is > 0.5, the prognosis is “a positive effect’’. The operating characteristics of the test on the training set amounted to 80.6% sensitivity, 85.4% specificity, and 83.3% diagnostic accuracy. The most significant brain MRI measures in hypertensive patients have been identified, which affect the RFA efficacy: the transverse dimensions of the quadrigeminal and prepontine cisterns and the fourth ventricle, the third ventricle width, the presence of lacunar infarcts, the presence of lacunae in II region—the area of the basal ganglia (thalamus, internal capsule), as well as age, DBP, and SBP.Conclusions: Quantitative indices are suitable for dynamic prospective assessment of the RFA efficacy in patients with TRH. Changes in MRI tomographic indices have prognostic significance.
Objective:The purpose of this single-centre, prospective, comparative study was to evaluate the pattern and severity of the brain structural changes in patients with resistant hypertension (RH) based on MRI assessments and their changes one year after renal denervation (RDN).Design and method:The study comprised 58 patients with RH, aged 52.1 ± 9.1 years, who underwent RDN. Patients underwent office blood pressure measurements, 24-hour blood pressure monitoring, and brain MRI scanning. Using brain MRI, the cerebrospinal fluid (CSF) system measurements, the presence of periventricular leukoaraiosis and focal changes in the brain white matter were evaluated.Results:Initially, patients with RH had a high incidence of the structural brain alterations: 75% with fine focal brain lesions, 75% with impaired CSF dynamics, 23% with sulcal widening, and 90% with periventricular oedema. After RDN, a significant hypotensive effect was noted. According to brain MRI, the number of patients without impaired CSF dynamics did not change significantly: 25% initially, and 20% a year later (χ2 = 0.63 p = 0.43, and χ2 = 0.72 p = 0.40). The number of patients with grade I impaired CSF dynamics after 6 months significantly increased after 12 months from 50% to 64% (χ2 = 4.00, p = 0.046) due to lowering the number of patients without impaired CSF dynamics and patients with grade II impaired CSF dynamics (χ2 = 1.56, p = 0.21). The number of patients with sulcal widening significantly decreased: from 23% to 8% one year following RDN (χ2 = 40.21 p = 0.000). The incidence of periventricular cerebral oedema did not significantly change one year after the procedure; however, the incidence of fine focal brain lesions significantly decreased (from 75 to 60%, p = 0.02).Conclusions:Thus, it has been revealed that patients with RH are characterised by a high incidence of structural brain alterations based on MRI assessments. A year after bilateral renal denervation, there are significant improvement in intracranial hypertension signs and decrease in the incidence of fine focal brain lesions, without a significant change in the CSF dynamics parameters (Table 1). Figure 1 shows a clinical example of a decrease in the number of fine focal brain lesions after the intervention.
ObjectiveTo assess the effect of renal denervation (RDN) on renal vascular resistance and renal function in patients with drug-resistant hypertension (HTN) and type 2 diabetes mellitus (T2DM).Materials and methodsFifty-nine patients (mean age 60.3 ± 7.9 years, 25 men) with resistant HTN [mean 24-h ambulatory blood pressure (BP) 158.0 ± 16.3/82.5 ± 12.7 mmHg, systolic/diastolic] and T2DM (mean HbA1c 7.5 ± 1.5%) were included in the single-arm prospective study and underwent RDN. Renal resistive index (RRI) derived from ultrasound Doppler; estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration formula), office and 24-h ambulatory BP were measured at baseline, 6, and 12 months after RDN to evaluate the respective changes in renal vascular resistance, renal function, and BP during treatment.ResultsForty-three patients completed 12 months follow-up. The RRI changed depending on the baseline value. Specifically, the RRI decreased significantly in patients with elevated baseline RRI values ≥ 0.7 {n = 23; −0.024 [95% confidence interval (CI): −0.046, −0.002], p = 0.035} and did not change in those with baseline RRI < 0.7 [n = 36; 0.024 (95% CI: −0.002, 0.050), p = 0.069]. No significant change was observed in eGFR whereas BP was significantly reduced at 12 months after RDN by −10.9 (95% CI: −16.7, −5.0)/−5.5 (95% CI: −8.7, −2.4) mmHg, systolic/diastolic. No relationship was found between the changes in RRI and BP.ConclusionOur study shows that RDN can decrease elevated renal vascular resistance (RRI > 0.7) and stabilize kidney function in patients with RHTN and T2DM independently of its BP-lowering effect.
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