Key result
Renal denervation reduced average 24-hour systolic blood pressure by a median of 15 mmHg and decreased TNF-α levels at 1 year in patients with resistant hypertension and coronary heart disease, though the antihypertensive effect was less pronounced in those with severe coronary atherosclerosis.
Why the study?
Changes in blood pressure and proinflammatory markers following renal denervation had not been investigated in patients with resistant hypertension and coronary heart disease.
Does renal denervation reduce blood pressure and proinflammatory markers in patients with resistant hypertension and coronary heart disease?
Cohort (n=35)
No
Does renal denervation reduce blood pressure and proinflammatory markers in patients with resistant hypertension and coronary heart disease?
Effect estimate: median reduction of 15 mmHg
Absolute Event Rate: 144% vs 154%
p-value: p=0.01
Renal denervation significantly reduces blood pressure and TNF-α in patients with resistant hypertension and coronary heart disease, though the antihypertensive effect is blunted in those with severe coronary atherosclerosis requiring revascularization.
Supports renal denervation exploration in resistant hypertension with CHD; hypothesis-generating and should not yet change practice.
Introduction. Patients with resistant hypertension (RH) associated with coronary heart disease (CHD) and, in particular, with an unfavorable course of coronary atherosclerosis have the highest risk of cardiovascular complications. Tumor necrosis factor-alpha (TNF-α) and high-sensitivity C-reactive protein (hs-CRP) were shown to play a role of independent predictors for the development of such complications. However, the changes in these markers and blood pressure (BP) due to renal denervation (RDN) have not been a subject of investigation in this patient group yet. Objectives . To study changes in BP and proinflammatory markers in patients with RH and CHD after RDN and to compare the indicators depending on the severity of coronary atherosclerosis. Material and Methods . The study analyzed case histories of 35 patients with RH and CHD who underwent a full clinical, instrumental, and laboratory examination before and one year after RDN. Results . We observed a reduction of average 24-hour blood pressure by 15 (0–21) / 7(–3–14) mmHg ( p < 0.05), a decrease in TNF-α from 7.8 (6.3; 9.6) to 7.3 (6.8; 8.6) pg/mL ( p = 0.044), and a downward trend of hs-CRP values from 2.4 (1.4; 6.0) to 1.8 (1.3; 3.6) mg/L ( p = 0.186). Group of patients with unfavorable course of coronary atherosclerosis had higher levels of TNF-α initially ( р = 0.040) and a year after RDN ( р = 0.038), but no significant changes in BP were observed. Conclusions . Obtained data suggested that the antihypertensive effect of RDN was less pronounced in patients with an unfavorable course of coronary atherosclerosis.
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Zyubanova et al. (2020) conducted a cohort in Resistant hypertension and coronary heart disease (n=35). Renal denervation vs. Baseline was evaluated on Average 24-hour systolic blood pressure (median reduction of 15 mmHg, p=0.01). Renal denervation reduced average 24-hour systolic blood pressure by a median of 15 mmHg and decreased TNF-α levels at 1 year in patients with resistant hypertension and coronary heart disease, though the antihypertensive effect was less pronounced in those with severe coronary atherosclerosis.
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