The impact of renal denervation treatment on left ventricular remodeling in patients with resistant hypertension

Abstract

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Agency for Research an Development OnBehalf HIPERDIAB Background Increased blood pressure is considered the major determinant for structural alterations of the left ventricle resulting in increased myocardial mass and pathological remodeling. Renal denervation is a novel treatment for hypertensive patients with promising results on blood pressure levels. Purpose Evaluation of impact of renal denervation treatment on indices of left ventricular remodeling in patients with resistant hypertension. Methods 75 patients with resistant hypertension after a 3-week standardized treatment with Losartan 100 mg, Amlodipine 10 mg and Indapamid 1,5 mg were randomly assigned into three equal groups, depending on medication supplemented to previously administered: IM group - Moxonidine, IIB group - Bisoprolol and IIID group – renal artery denervation (RDN). Patients were assessed by echocardiographic exam at baseline and 6 months follow-up. Renal denervation was performed with a Symplicity Spyral catheter. Results Increased at the baseline in all three groups (170,96 ± 11,69 g/m2 in IM versus 156,5 ± 11,08 g/m2 in IIB and 164,94 ± 9,61 g/m2 in IIID groups) left ventricular mass index at 6 months of evaluation noted a statistically authentic reduction in all three groups, the group of patients treated with Moxonidine and RDN having a comparable and superior effect to the group treated with Bisoprolol (159,02 ± 10,34 g/m2 versus 150,5 ± 10,51 g/m2 and 149,15 ± 9,31 g/m2 in IM, IIB and IIID groups, p > 0,05). Simultaniously with the regression of left ventricular myocardial hypertrophy all three treatment regimens induced the improvement of its geometry, renal denervation group demonstrated a superior effect in ameliorating of this parameter (Tab.). Conclusion The data obtained confirmed the benefit of RDN treatment in patients with resistant hypertension in inducing reverse-remodeling of the LV, the beneficial effect being superior to both pharmacotherapeutic regimens. Geometric pattern of the left ventricle Group IM Group IIB Group IIID χ2 p baseline Concentric remodeling 5 (20%) 5 (20%) 4 (16%) 0,71 > 0,05 Concentric hypertrophy 13 (52%) 15 (60%) 14 (56%) Excentric hypertrophy 7 (28%) 5 (20%) 7 (28%) Normal geometry - - - 6 months Concentric remodeling 3 (12%) 7 (28%) 7 (28%) 4,61 < 0,05 Concentric hypertrophy 13 (52%) 13 (52%) 10 (40%) Excentric hypertrophy 8 (32%) 5 (20%) 5 (20%) Normal geometry 1 (4%) - 3 (12%)

Renal denervation for uncontrolled hypertension: a systematic review and meta-analysis examining multiple subgroups

“…There were five RCTs that partially met the criteria for the ‘on-med’ group for the meta-analysis [ 39 , 41 , 50 , 52 , 53 ]. However, patients in these RCTs received different medication regimens in each arm.…”

“…Nine of the included RCTs were judged to have an overall low risk of methodological bias [15,16,[32][33][34][35][36][37][38], nine were judged to have 'some concerns' [39][40][41][42][43][44][45][46][47], and seven were judged to have a high risk of methodological bias according the Cochrane Risk of Bias tool [48][49][50][51][52][53][54]. A summary of the Risk of Bias Assessment is reported in Supplemental Digital Content 1 Appendix G, http://links.lww.com/HJH/C452.…”