Renal denervation in patient with resistant hypertension: A case report

Resistant hypertension (RHT) is defined as blood pressure ≥140/90 mmHg despite treatment of ≥3 antihypertensive drugs in maximal tolerated doses. This condition affects 10-30 % patients with hypertension and is associated with significantly higher risk for cardiovascular and renal disease. Despite its multifactorial origin, focus has recently shifted to increased sympatic nerve system activity in RHT. Several studies of thoracolumbal sympathectomy done during 1950's, different animal models, and efficacy of drugs that act centrally on sympathic ganglions are proof that HTA can be regulated by blocking sympathic nerve system activity. Renal denervation (RND) is new, percutaneous, interventional procedure for ablation of afferent and efferent sympathic nerve fibers located in the adventitia of renal arteries. Recently published series have shown safety and efficacy of this procedure in lowering blood pressure. Incidence of early periprocedural complications is minimal. Also, morphology of renal arteries during long term follow up has not been influenced by this procedure. Efficacy of RND is emphasized by inducing lower BP values, by 30/15 mmHg in average. Most recent investigations imply that RND might have beneficial effect on functional capacity, reversal of left ventricular hypertrophy, reduction of insulin resistance and better diabetes control and lower influence of sleep apnea in patients with resistant hypertension.