Breaking resistance: impact of renal denervation on blood pressure control and heart failure development

Background Treatment-resistant hypertension remains a significant clinical challenge and a major risk factor leading to adverse cardiovascular events. Importantly, it leads to cardiovascular remodeling, causing organ damage, such as left ventricular hypertrophy (LVH) and diastolic dysfunction. Among the patients with heart failure, increasing levels of NT-proBNP are associated with worsening of the disease. Renal artery denervation (RDN) has emerged as a novel therapeutic approach for hypertension patients by targeting the sympathetic nervous system to achieve better blood pressure (BP) control. Additionally, some studies suggested RDN might have a positive impact on cardiac remodeling assessed by echocardiogram, especially on diastolic dysfunction. Purpose Our study aims to evaluate the RDN impact on blood pressure and heart failure progression in resistant hypertension patients. Methods Our study included patients who failed to reach optimal BP control, defined by ESC guidelines as <140/90 mmHg, despite optimal medical treatment for more than 1 year. All patients received at least 4 different classes of anti-hypertensive drugs, including beta-blockers. Patients were assigned for renal artery denervation after secondary causes of hypertension were ruled out. The procedure was done using a Symplicity Spiral Catheter. BP results were obtained using office measurements and 24-hour BP monitoring at baseline, 3 months, and 1 year after the denervation procedure. All patients had NT-proBNP analysis at baseline and 1 year after the procedure, and patients who voluntarily agreed had a preformed echocardiography. Results 40 patients were enrolled in the study. The mean patient age was 58 years, and 55% (N-22) were females. At the baseline, patients received 5.8 different medications for BP control, and mean BP was 167/89 ± 18.75/13.45 mmHg, with 73 ± 10.7 PBM. After 3 months mean systolic BP was 156 ± 21.5 mmHg (p = 0.030) and 89 ± 15.22 mmHg for diastolic (p=0.701). During 1-year follow-up, mean results for systolic blood pressure were 151 ± 9.9 mmHg (p = 0.008) with diastolic blood pressure 88 ± 11.1 mmHg (p=0.67). The mean NT-proBNP at index was 314.3± 301.9 pg/mL and 167.30± 184.1 pg/mL after RDN (p=0.026). In the echocardiogram group (N-17), left ventricular mass showed a positive reduction: from 132.4 ± 23.65 g/m2 to 122.5 ± 20.78 g/m2 (p = 0.026). Among the diastolic dysfunction parameters, deceleration time improved from 236.5 ± 44.70 ms to 213.6 ± 44.70 ms (p = 0.013), E/E’ changed from 14.18± 3.66 to 12.67± 2.43 (p = 0.065), E/A relation changed from 1.1± 0.28 to 1.13± 0.26 (p = 0.664), Edelta 6.52± 1.42 cm/s to 6.69± 1.85 cm/s (p = 0.720). Conclusion Renal artery denervation showed statistically significant systolic BP reduction after 3 months and 1 year, and additionally, a reduction in NT-proBNP levels in 1 year follow-up. After 3 months, positive changes were observed in myocardial function assessed by echocardiography.