Author + information
Resistant hypertension is defined as uncontrolled blood pressure despite the use of optimal doses of three antihypertensive agents, one of which is a diuretic. recently, catheter-based renal sympathetic denervation (RSD) has been shown to be safe and effective in patients with resistant hypertension. pathophysiology of kidney function, justify the use of renal sympathetic denervation in the treatment of hypertension. the aim of the present report is to briefly summarize and discuss the outcomes of 18 patients treated with RSD in the dominican republic.
Between august 2011 and may 2012, 18 patients screened for eligibility were referred to renal denervation. we used the Simplicity™ catheter and the EnligHTN™ balloon with low-power radiofrequency energy. post intervention analysis includes all patients remaining during follow-up at 6 months; only 15 were available at follow-up. we performed a paired samples t-test to compare means; two-tailed p values were statistically significant at <0.005 with 95% confidence intervals for mean bp differences.
Among these patients, 46.6% were female, 33.3% were diabetic, and 20% had coronary disease. baseline office blood pressure (BP) was 178.93 ± 18.38/97.27 ± 11.62 mmhg, despite a mean of 7±3.0 medications per patient. successful bilateral sympathetic denervation was performed in all patients. no procedural complications occurred.
At 6-months follow-up, the average office BP was 140.87 ± 18.24/ 84.33 ± 11.78 mmHg. Mean BP reduction at 6 months from baseline was 38.07 ± 21.38/12.93 ± 12.58 mmHg [P<0.0001 for Systolic Blood Pressure (SBP) and P=0.0014 for Diastolic Blood Pressure (DBP)], 95% confidence intervals of this difference was 26.23 to 29.91 mmHg for SBP reduction and from 5.96 to 19.90 mmHg for DBP reduction. There were no adverse events during follow-up (death, myocardial infarction, or stroke), and no deterioration in renal function was observed.
The findings indicate that renal denervation may be a non-pharmacological alternative for the treatment of patients with refractory hypertension in our population and may help stabilize their blood pressures and comorbidities. we have found no previous studies of this procedure with a heterogenic hispanic population. the long term effects of renal denervation should be confirmed in a large international randomized study.
- 2013 American College of Cardiology Foundation