Unilateral renal sympathetic denervation may reduce blood pressure in patients with refractory hypertension

Abstract

Resistant hypertension is defined as uncontrolled blood pressure (BP) in spite of concurrent use of ≥3 antihypertensive agents (BP ≥140/90 mmHg) of different classes or as controlled blood pressure with the use of ≥4 agents.1 Recently, the definition of refractory hypertension has been introduced, in order to describe patients with uncontrolled blood pressure in spite of concurrent use of ≥5 antihypertensive drugs, which is the extreme phenotype of antihypertensive treatment failure.2 Patients with resistant hypertension suffer prematurely from target organ dysfunction and from early occurrence of cardiovascular, cerebrovascular and renal complications, leading to increased mortality. 2,3 In the last years, catheter-based renal sympathetic denervation by radiofrequency has emerged as a new and effective method to treat resistant hypertension. After assessing that the renal arteries anatomy is favorable, usually by computed tomography or nuclear magnetic resonance angiography, renal denervation is performed bilaterally by introducing the treatment catheter into each renal artery and then delivering radiofrequency energy. Only few cases of unilateral renal denervation have been described until now, with conflicting results regarding the blood-pressure-lowering effect. [4][5][6] We here report a case of refractory hypertension successfully treated with renal denervation, performed unilaterally instead of bilaterally because of the patient's renal arteries' unfavorable anatomy. Case ReportA 52-year-old Caucasian woman with an approximately 12-year history of resistant essential hypertension was referred to us for percutaneous renal denervation. She was on a chronically low-sodium diet. Her body mass index was 28.5. She was not a smoker and denied the use of alcohol or drugs other than the antihypertensive agents. Her past medical history was otherwise unremarkable, except for a progressively severe and resistant hypertension. Secondary causes of hypertension had already been excluded elsewhere by proper evaluation. Despite opUnilateral renal sympathetic denervation may reduce blood pressure in patients with refractory hypertension ABSTRACTA 52-year-old Caucasian woman with essential resistant and refractory hypertension despite optimal medical therapy, including 6 different antihypertensive drugs was referred for the catheter-based renal denervation. Due to unfavourable anatomy because of non-critical fibromuscular dysplasia on the right renal artery, renal denervation of only the left renal artery was performed. Before and after the renal denervation, the patient's blood pressure was monitored by office measurements and ambulatory blood pressure measurements (ABPM). Before the procedure, the mean office blood pressure was 157/98 mmHg; at ABPM, the mean blood pressure values were 145/94 mmHg. At 6 months of follow-up, the mean office blood pressure was 134/90 mmHg and 121/76 mmHg at ABPM. In latest 12 months of follow-up, office and ABPM blood pressure were 125/80 and 127/80 mmHg respectively. This unique case sugg...