Renal denervation in clinical practice: treating patients with high cardiovascular risk

Introduction: Arterial hypertension is the most common correctable risk factor for death worldwide. Achievement of therapeutic goal is hampered by multiple factors including non-adherence to drug therapy and individual physiological resistance. Objective: We aimed to determine the efficacy of renal denervation in lowering SBP and DBP at 1^st and 6^th month, in patients at high cardiovascular risk, in whom lowering BP would possibly also result in risk reduction and lower incidence of future cardiovascular events. Methods: The procedure was performed in 39 patients with resistant hypertension admitted to the University Hospital „Acibadem City Clinic – Cardiovascular Center“ (Sofia) for the period January 2017–June 2020. Access was via brachial artery and the Simplicity Spiral catheters were used, at an average of 19.5 ablation points per artery. The number of complications, as well as the mean systolic and diastolic BP values at 1^st and 6^th month were recorded. Baseline, risk profile and follow-up medical treatment of the study group was monitored. Results: In the study group, the predominant risk factors were dyslipidemia, age, diabetes mellitus, with 21 patients (53.84%) already having clinically significant atherosclerosis – a realized heart attack, stroke, peripheral or coronary revascularization. At follow-up, a significant reduction in both systolic and diastolic BP (blood pressure) values was observed. At the first month, the fall in SBP (systolic blood pressure) was –17.8 mm Hg, with a persistent reduction in the range of –14.5 mm Hg at 6^th month. In terms of DBP (diastolic BP), the mean reduction at the first month was –8.9 mm Hg and at the 6^th month it was –7.2 mm Hg. Regarding antihypertensive treatment, there was a mild reduction in the intake of antihypertensive drugs. Conclusion: Substantial proportion of people with hypertension have uncontrolled hypertension (both treatment resistant and due to non-adherence to treatment or due to additional pathophysiological mechanisms). Renal denervation has proven effective and safe in patients with uncontrolled hypertension and high cardiovascular risk profile