Criteria for selecting patients with resistant hypertension for a renal sympathetic denervation

Ripp, T.; Rebrova, Т. Yu.; Реброва, Т. Ю.; Mordovin, V.; Mordovin, V.; Afanasiev, S. A.; Афанасьев, С. А.; Pekarsky, S.; Пекарский, С. Е.; Semke, G.; Falkovskaya, A.; Фальковская, А. Ю.; Lichikaki, V.; Tsymbalyuk, E V; Цымбалюк, Е В

doi:10.17116/terarkh201688814-18

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…В литературе последних 2 лет активно обсуждают и анализируют результаты исследований SYMPLICITY HTN-2 и SYMPLICITY HTN-3 [13,14,16]. Среди факторов, которые могли бы повлиять на «негативные» результаты, авторы указывают на несовершенство отбора больных, адекватность их ведения и оценки в послеоперационном периоде, а также неполную или недостаточно эффективно выполненную денервацию ПА [17,[19][20][21]. Так, у многих пациентов, отобранных на вмешательство, проводили только офисное измерение АД, что не соответствовало критериям принадлежности больного к группе с резистентной АГ.…”

Section: Discussionunclassified

“…Наши данные совпали с данными M. Jaff [20], Т. М. Рипп и соавт. [21], которые указывали на необходимость отбора «правильных» больных на данную процедуру с документальной объективизацией резистентности АГ. Только это позволяет прогнозировать успешный результат ренальной десимпатизации [21].…”

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Selection of Patients with Resistant Arterial Hypertension for the Catheter-Based Renal Sympathetic Denervation

et al. 2019

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Purpose: elaboration of algorithm for selection of patients with resistant arterial hypertension (AH) for Catheter-Based Renal Sympathetic Denervation (CBRSD). Materials and methods. We examined 284 patients with resistant AH. On stage 1 we excluded most frequent causes of secondary AH. In 247 patients (86.9 %) we established secondary character of AH, in 37 patients (13.1 %) AH was found to be essential. On stage 2 patients with essential AH were given 3–5 component hypotensive therapy. At the background of this therapy we conducted 24‑hour ambulatory blood pressure monitoring (ABPM). CBRSD procedure was considered indicated if according to ABPM average 24‑hour blood pressure (BP) was above 150 and 100 mm Hg, and 24‑hour elevated BP load exceeded 60 %. In 13 of 37 patients (35 %) BP level satisfied these conditions. For CBRSD we used high frequency generator. Ablation was performed using the Symplicity Catheter. Results were assessed in 1, 2, 9, 12, and 28 months. Results.Target BP level at the background of minimal doses of hypotensive drugs was achieved in 11 patients (85 %), what was confirmed by ABPM data. Levels of mean 24–4 hour systolic and diastolic BP significantly decreased from 173.9±14.9 to 143±21.3, р<0.05, and from 108.2±8.7 to 91.4±13.8 mm Hg., р<0.05, respectively. Index of elevated systolic BP time decreased from 78.2±14.6 to 49.8±29.6 %, р<0.05. Best effect was achieved in patients with AH duration before the procedure less than 7 years. None of the patients had episodes of cerebral vascular insufficiency or heart failure progression. Conclusion. While determining indications to bilateral CBRSD one should be governed by such criteria as exclusion of symptomatic AH and objective proofs of AH resistance (according to ABPM at the background of hypotensive therapy).

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Selection of Patients with Resistant Arterial Hypertension for the Catheter-Based Renal Sympathetic Denervation

et al. 2019

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“…Для решения проблемы отбора больных предлагается выполнение исходного более детального их обследования для выявления симптоматических форм и псевдорезистентности [5,6]. В настоящее время разработан способ отбора пациентов для выполнения процедуры РД и получения выраженного антигипертензивного эффекта, учитывающий, помимо исходного уровня АД, уровень бета-адренореактивности мембран эритроцитов (бета-АРМ) [7]; кроме того, возможно прогнозирование краткосрочного эффекта процедуры по изменению уровня бета-АРМ через 7 дней после вмешательства [8].…”

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Erythrocyte membranes beta-adrenoreactivity changes after renal denervation in patients with resistant hypertension, relationship with antihypertensive and cardioprotective intervention efficacy

et al. 2021

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Aim To study the functional condition of sympathoadrenal system as evaluated by beta-adrenoreactivity of erythrocyte membranes (beta-ARM) during two years following renal denervation (RD) in patients with resistant arterial hypertension (RAH) and to determine the relationship of this index with long-term antihypertensive and cardioprotective effectivity of this invasive treatment.Material and methods The study included 48 patients (mean age, 57.2±8.7 years, 18 men) with RAH on a stable antihypertensive therapy. Averaged daily systolic and diastolic blood pressure (SBP and DBP) and levels of beta-ARM were determined at baseline and in 7 days and 2 years following RD. Measurement of beta-ARM was based on beta-adrenoblocker inhibition of erythrocyte hemolysis induced by exposure to hypo-osmotic environment. The beta-adrenoblocker binds to erythrocyte membrane beta-adrenoceptors to prevent the erythrocyte destruction. Increased values of beta-ARM reflect a decrease in the number of functionally active erythrocyte membrane beta-adrenoceptors associated with long-term sympathetic hyperactivity.Results For two years of follow-up, values of average daily BP decreased from 160.4±16.0 / 88.1±14.6 to 145.3±19.3 / 79.4±13.6 mm Hg. At 7 days, the number of beta-ARM had decreased in the group of RD responders (р=0.028) who at two years had decreased their BP by 10 mm Hg or more, while in the group of non-responders, the number of beta-ARM remained unchanged. At one week, beta-ARM values correlated with changes in SBP and DBP (r= –0.54; р<0.05) and with left ventricular myocardial mass (LVMM) (r= –0.36; р<0.05) at two years of follow-up whereas beta-ARM delta at one week was interrelated with the renin concentration in the long-term (r= –0.44; р<0.05). At two years, the content of beta-ARM was increased in both groups.Conclusion The decrease in beta-ARM content at 7 days after RD shows the procedure efficacy and allows an expectation of clinically significant decreases in BP and LVMM in the long-term after the surgical treatment. At two years after the intervention, the content of beta-ARM increased, and the BP decrease was apparently due to some other mechanisms.

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“…При величине данного показателя ≥2 проведение РДН может быть нецелесообразным [33]. В 2016 г. опубликованы результаты одноцентрового исследования, где анализ 23 пациентов продемонстрировал, что оценка исходных значений САД и b-адренореактивности позволяет определить целесообразность выполнения РДН с целью снижения АД [34].…”

Section: опыт проведения рдн в рфunclassified

Russian medical society on arterial hypertension (RMSAH) Consensus of Experts on the use of radiofrequency denervation of the renal arteries in patients with arterial hypertension

et al. 2021

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Hyperactivity of the sympathetic nervous system is one of the basic mechanisms in the development of arterial hypertension (AH). Transcatheter renal artery denervation is aimed to destroy the renal sympathetic afferent and efferent nerves to achieve a sustained reduction in blood pressure. Since 2017, all II generation studies have demonstrated that sympathetic denervation provides clinically significant BP reduction. Russian Medical Society for Arterial Hypertension (RMSAH) experts consider SD as a possible addition to the antihypertensive strategy in patients with uncontrolled AH and recommend denervation of the renal arteries in registers and clinical trials. On the basis of existing randomized clinical trials, as well as the experience of radiofrequency denervation in Russia, the experts of RMSAH present a consensus and view of the current situation in the field of renal denervation.

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Criteria for selecting patients with resistant hypertension for a renal sympathetic denervation

Abstract: The overall estimate of baseline SBP and β-AR of EM in patients with RH could determine the expediency of the RSD procedure in order to lower BP. The proposed procedure can optimize the selection of patients and enhance the efficiency of RSD in the treatment of RH.

Cited by 7 publications

References 12 publications

Selection of Patients with Resistant Arterial Hypertension for the Catheter-Based Renal Sympathetic Denervation

Selection of Patients with Resistant Arterial Hypertension for the Catheter-Based Renal Sympathetic Denervation

Erythrocyte membranes beta-adrenoreactivity changes after renal denervation in patients with resistant hypertension, relationship with antihypertensive and cardioprotective intervention efficacy

Russian medical society on arterial hypertension (RMSAH) Consensus of Experts on the use of radiofrequency denervation of the renal arteries in patients with arterial hypertension

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