Impact of Renal Denervation Treatment on Left Ventricle Remodeling in Resistant Hypertensive Patients: Three Years Follow-Up

Abstract

Objective: Evaluation of effects of RDN on left ventricle remodeling in patients with resistant hypertension and heart failure with preserved ejection fraction. Design and method: The study enrolled 125 hypertensive patients, who after 3-week of standardized treatment with Losartan, Amlodipine and Indapamide and confirmation of their drug resistance, were randomly assigned into three groups depending on medication supplemented to previously administered: group I - selective I1-imidazoline agonist Moxonidine, group II - cardioselective beta-blocker Bisoprolol and group III - renal denervation. All patients underwent a transthoracic echocardiogram at baseline, one, two and three years follow-up. Renal denervation was performed in the main renal arteries and their branches. Results: Transthoracic echocardiography at baseline revealed LV hypertrophy in all patients. The majority of patients in all three research groups had concentric hypertrophy (52% versus 60% and 56% in group I, II and III, respectively), the normal pattern not being recorded in any group. An authentic reduction in LV mass index was noted from 1-year follow-up in all three observational groups, the progressive reduction being maintained until the end of the study, the group of patients undergoing renal denervation manifested a net superior effect to both pharmacological groups. So, at 3-years follow-up LV mass index was 128,57±4,91 g/m2 in Moxonidine group versus 126,0±5,34 g/m2 in Bisoprolol group and 94,44±3,90 g/m2 in RDN group, p < 0.001. Analyzing the impact of various therapeutic regimes on the geometric pattern of the LV, we can note the fact that both treatment schemes with SNS blockers and RDN favored LV reverse remodeling, its normal pattern being regained by 5 (10%) patients from group I and 7 (28%) patients from group III. This time as well RDN demonstrated absolute superiority over both pharmacological treatment regimens (Figure 1). Conclusions: The obtained data confirm the benefit of RDN treatment on the reverse remodeling of the LV by significantly reduction in LV mass index and inducing the recovery of its normal physiological pattern in practically a third of treated patients at 3 years post-procedurally.