Key result
Baseline DBP >90 mmHg in renal denervation is linked to increased internal CSF spaces at 12 months.
Why the study?
The relationship between baseline diastolic blood pressure and the cerebroprotective effect of renal denervation on brain MRI in patients with resistant hypertension needed to be evaluated.
Does baseline diastolic blood pressure >90 mm Hg limit the cerebroprotective effect of renal denervation as measured by brain MRI at 12 months in patients with resistant hypertension?
Observational (n=53)
Does baseline diastolic blood pressure >90 mm Hg limit the cerebroprotective effect of renal denervation as measured by brain MRI at 12 months in patients with resistant hypertension?
In patients with resistant hypertension undergoing renal denervation, baseline diastolic blood pressure >90 mm Hg predicts progressive enlargement of internal cerebrospinal fluid spaces on brain MRI at 1 year, suggesting a limited cerebroprotective benefit despite systolic blood pressure reduction.
High baseline DBP warrants neuroimaging caution post-denervation; leaves open diastolic contributions to brain structure changes.
Aim. To evaluate the relationship between the cerebroprotective effect of renal denervation (RDN) based on magnetic resonance imaging (MRI) data and diastolic blood pressure (DBP) in patients with resistant hypertension (RHT) over a one-year follow-up period. Material and methods . The study included 53 patients with RHT who underwent RDN. Inclusion criteria were true RHT in individuals of both sexes aged 40 to 80 years and signing of an informed consent form. There were following exclusion criteria: pseudoresistance; symptomatic hypertension; estimated glomerular filtration rate <30 ml/min/1,73 m2; pregnancy; history of anaphylaxis to radiographic contrast agents; severe concomitant diseases or conditions leading to a high risk of intervention. All study participants underwent a complete clinical and paraclinical examination, blood pressure (BP) measurement, and brain MRI. Statistical data processing was performed using the Statistica 10.0 software package. Results. Depending on the baseline DBP value, patients were divided into 2 groups. The first group consisted of 28 patients with DBP ≤90 mm Hg, and the second group consisted of 25 patients with DBP >90 mm Hg. Systolic blood pressure (SBP) was higher in the second group (p<0,05). MRI performed before RDN revealed no significant differences in the structural parameters of the lateral ventricles, the size of the subarachnoid spaces, or the cerebrospinal fluid (CSF)-containing structures. When examining patients 12 months after RDN, SBP decreased in both groups and did not differ significantly (145,7 and 147,9 mm Hg, p=0,62). MRI data 12 months after RDN revealed an increase in the internal CSF spaces in the group of patients with high DBP: length, transverse prepontine cistern diameter, transverse quadrigeminal cistern diameter, and length of the fourth ventricle (p<0,05). Conclusion. Long-term, persistent elevation of diastolic blood pressure in patients with RHT limits the cerebroprotective effects of renal denervation, despite a significant reduction in SBP, which may be due to irreversible cerebral vascular remodeling.
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Lichikaki et al. (2026) conducted an observational in Resistant hypertension (n=53). Baseline diastolic blood pressure >90 mm Hg in patients undergoing renal denervation vs. Baseline diastolic blood pressure ≤90 mm Hg in patients undergoing renal denervation was evaluated on Structural parameters of internal cerebrospinal fluid (CSF) spaces on brain MRI and systolic blood pressure at 12 months (p=<0.05). Baseline DBP >90 mm Hg in patients undergoing renal denervation was associated with increased internal CSF spaces on MRI at 12 months (p<0.05) despite similar SBP reductions (147.9 vs 145.7 mm Hg).
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