Reaming at resistant hypertension: old weapons brought back

Background High blood pressure (BP) is the most prevalent cardiovascular risk factor and remains the leading modifiable cause of death. In many patients, pharmacological therapy is insufficient to adequately control blood pressure. Multiple clinical trials have demonstrated the safety and efficacy of renal sympathetic denervation in reducing BP. Purpose The aim of this study is to present our center’s initial experience with a radiofrequency renal denervation technique, describing the characteristics of the first patients submitted to this procedure, as well as to evaluate its safety and effectiveness in our population. Methods An observational study with all patients who were treated with renal denervation, between January and September 2023, was performed. For this procedure we selected patients with resistant Hypertension, defined as elevated BP values despite treatment with at least 3 different classes of anti-hypertensive medications (including one diuretic). Patients with secondary hypertension and with eGFR <40 mL/min/1.73m2 were excluded. Baseline patient characteristics were evaluated as well as ABPM/AMPA values prior to the procedures and at least 3 months after. The Wilcoxon test was used to compare median blood pressure values before and after the procedure. A p-value <0.05 was considered statistically significant. Results Nine patients underwent renal denervation, 7 (78%) male with a median age of 66 [50;70] years. Three (33%) patients had grade 1 arterial hypertension, four (44%) had grade 2 and two (22%) had grade 3. Six patients (67%) had diabetes mellitus, seven (78%) had dyslipidemia, four (44%) were smokers and six (67%) had obstructive sleep apnea syndrome. All patients were taking renin-angiotensin-aldosterone system inhibitors, dihydropyridine calcium channel blockers and diuretics. Six patients (67%) were taking spironolactone and all but one were taking beta-blockers. Five patients (56%) were taking rilmenidine and one (11%) methyldopa. Patients were taking a mean of 5 (± 1) pharmacological classes. After renal denervation, previously ongoing pharmacological therapy was maintained. There was no statistically significant difference in renal function before (GFR 90 [61;125] ml/min/m2) and after (GFR 96 [70;130] ml/min/m2) renal denervation (p = 0.770). There were no complications. Comparing BP values prior and after the procedure, renal denervation was associated with a significant reduction in systolic (reduction of 18 [15;23] mmHg; p = 0.008), diastolic (9 [5;10] mmHg; p = 0.011) and mean BP (13 [9;15] mmHg, p = 0.008). Conclusions Renal denervation proved to be a safe and effective procedure in reducing blood pressure in this first group of patients with resistant hypertension who was submitted to procedure in our center. Further patients need to be included and a longer follow-up is needed to assess the benefit of this technique.