P758Acute vascular and autonomic responses of renal denervation in spontaneously hypertensive rats

Abstract

Risk stratification and prognosis after TAVI / Hypertension treatment (drugs and devices) 157rable short term outcomes. On the contrary, a better performance of SAVR compared to transfemoral TAVI for long term mortality and MACCE can be shown, at least when we refere to devices in use until 2012. Objectives: This randomised, multicentre study compared the efficacy of renal denervation (RDN) versus spironolactone addition in patients with true resistant hypertension. We present the 24-month data. Methods: A total of 106 patients with true resistant hypertension were enrolled in this study: 52 patients were randomised to RDN and 54 patients to the spironolactone addition, with baseline systolic blood pressure of 159±17 and 155±17 mmHg and average number of drugs 5.1 and 5.4, respectively. Two-year data are available in 86 patients. Spironolactone addition, as crossover after one year, was performed in 23 patients after RDN, and spironolactone addition followed by RDN was performed in 5 patients. Results: Similar and comparable reduction of 24-hour systolic blood pressure after RDN or spironolactone addition after randomisation was observed, 9.1 mmHg (p=0.001) and 10.9 mmHg (p=0.001), respectively. Similar decrease of office blood pressure was observed, 17.7 mmHg (p<0.001) versus 14.1 mmHg (p<0.001), while the number of antihypertensive drugs did not differ significantly between groups. Crossover analysis showed non-significantly better efficacy of spironolactone addition in 24h systolic and office systolic blood pressure reduction than RDN (3.7 mmHg, p=0.27 and 4.6 mmHg in favour of spironolactone addition, p=0.28, respectively). Meanwhile, the number of antihypertensive drugs was significantly increased after spironolactone addition (+0.7, p=0.001).Changes of systolic blood pressure. Conclusions:In the settings of true resistant hypertension, spironolactone addition (if tolerated) seems to be of better efficacy than RDN in blood pressure reduction over a period of 24 months. However, by contrast to the 12-month results, blood pressure changes are not significantly greater. Introduction: Renal artery stenosis (RAS) is one of the leading causes of severe renal insufficiency, often providing a poor outcome if left untreated. A higher probability of better renal function improvement after revascularization in patients (pts) with severe renal impairment was suggested. Purpose: The present study aim to assess the renal outcome of three categories of patients with significant RAS (>70% unilateral, bilateral and RAS in a solitary kidney) 12 months after stent angioplasty and to identify predictors of predefined renal function improvement for the studied population. Methods: A total of 74 hypertensive pts diagnosed by renal angiography with significant RAS (>70%) were prospectively enrolled, subsequently resulting in 3 groups (34 pts -unilateral RAS, 28 pts -bilateral RAS, 12 pts -RAS in a solitary kidney). Clinical examination, cardiac and renal history, cardiovascular risk factors and comorbidities, laboratory findings ...