Keywords
Riñón
Simpatectomía
Catéter
Ablación Hypertension
Kidney
Sympathectomy
Catheters
Ablation
How to Cite
Abstract
Background: systemic arterial hypertension affects over 1.2million people worldwide and represents one of the most important risk factor to acute myocardial infarct and stroke. Only 35% of hypertensive patients have controlled blood pressure levels. Percutaneous renal denervation (PRD) has shown to significantly decrease blood pressure levels in patients with resistant systemic hypertension. The aim of this study was to determine the reduction of blood pressure in Venezuelan patients with resistant hypertension undergoing PRD. Methods: prospective, single arm, observational, multicenter study including consecutive patients undergoing RSD. The primary endpoint was to assess systolic blood pressure levels at the 30-day followup. The secondary endpoint was to determine the presence of procedure-related adverse events. Results: the first 24 patients undergoing PRD were included. The average blood pressure prior the procedure was 171.6/93.2 ± 15.5/ 11.3 mmHg, with the use of 4.1 ± 1.5 antihypertensive drugs per patient. Success rate was 96%, and 11.1 ± 1.9 ablations were performed per patient. A systolic blood pressure decrease of 29 ± 21 mmHg (P = 0.009) was observed 30 days after the procedure. There were no procedure-related complications. Conclusions: the present study showed that the use of guided percutaneous renal denervation Symplicity ® catheter as a therapeutic strategy in patients with resistant hypertension resulted in the significant decrease in systolic blood pressure values at 30-day follow-up.
References
Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, et al. Heart disease and stroke statistics-2009 update: a report from the American heart association statistics committee and stroke statistics subcommittee. Circulation 2009; 119(3): 480-6. https://doi.org/10.1161/CIRCULATIONAHA.108.191259
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365(9455): 217-23. https://doi.org/10.1016/S0140-6736(05)17741-1
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Prospective Studies Collaboration. Lancet. 2002;360(9349):1903-13. https://doi.org/10.1016/S0140-6736(02)11911-8
Vasan RS, Larson MG, Leip EP, Evans JC, O'Donnell CJ, Kannel WB, Levy D. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001;345(18):1291-7. https://doi.org/10.1056/NEJMoa003417
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension 2003; 42(6): 1206-52. https://doi.org/10.1161/01.HYP.0000107251.49515.c2
Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008; 117(25): e510-26. https://doi.org/10.1161/CIRCULATIONAHA.108.189141
DiBona GF. Sympathetic nervous system and the kidney in hypertension. Curr Opin Nephrol Hypertens 2002; 11(2): 197-200. https://doi.org/10.1097/00041552-200203000-00011
DiBona GF, Kopp UC. Neural control of renal function. Physiol Rev 1997; 77(1): 75-197. https://doi.org/10.1152/physrev.1997.77.1.75
Esler M, Jennings G, Korner P, Willett I, Dudley F, Hasking G, et al. Assessment of human sympathetic nervous system activity from measurements of norepinephrine turnover. Hypertension 1988; 11(1): 3-20. https://doi.org/10.1161/01.HYP.11.1.3
Morrissey DM, Brookes VS, Cooke WT. Sympathectomy in the treatment of hypertension; review of 122 cases. Lancet 1953; 1(6757): 403-08. https://doi.org/10.1016/S0140-6736(53)91589-X
Smithwick RH, Thompson JE. Splanchnicectomy for essential hypertension; results in 1,266 cases. J Am Med Assoc 1953; 152(16): 1501-04. https://doi.org/10.1001/jama.1953.03690160001001
Evelyn KA, Singh MM, Chapman WP, Perera GA, Thaler H. Effect of thoracolumbar sympathectomy on the clinical course of primary (essential) hypertension. A ten-year study of 100 sympathectomized patients compared with individually matched, symptomatically treated control subjects. Am J Med 1960; 28: 188-221. https://doi.org/10.1016/0002-9343(60)90184-4
Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 2009; 373(9671): 1275-81. https://doi.org/10.1016/S0140-6736(09)60566-3
Esler MD, Krum H, Schlaich M, Schmieder RE, Böhm M, Sobotka PA for the SYMPLICITY HTN-2 Investigators. Renal sympathetic denervation in patients with treatmentresistant hypertension (The SYMPLICITY HTN-2 trial): a randomised controlled trial. Lancet 2010; 376(9756):1903-9. https://doi.org/10.1016/S0140-6736(10)62039-9
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41. https://doi.org/10.1159/000180580
Casal H, Collet C, Burger B; Beer N, Bellera V, Leon C, et al. Renal Sympathetic Denervation for Resistant Hypertension in the Real World Clinical Practice: Preliminary Results of the Symplicity Venezuela Registry. J Am Coll Cardiol. 2013;61(10 Suppl):E2055. https://doi.org/10.1016/S0735-1097(13)62055-0
Brandt MC, Mahfoud F, Reda S, Schirmer SH, Erdmann E, Böhm M, et al. Renal Sympathetic Denervation Reduces Left Ventricular Hypertrophy and Improves Cardiac Function in Patients With Resistant Hypertension. J Am Coll Cardiol. 2012;59(10):901-909. https://doi.org/10.1016/j.jacc.2011.11.034
Mahfoud F, Schlaich M, Kindermann I, Ukena C, Cremers B, Brandt MC, et al. Effect of Renal Sympathetic Denervation on Glucose Metabolism in Patients With Resistant Hypertension: A Pilot Study. Circulation.2011;123(18):1940-6. https://doi.org/10.1161/CIRCULATIONAHA.110.991869
Franklin SS, Gustin W, Wong ND, Larson MG, Weber MA, Kannel WB, et al. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation. 1997;96(1):308 -315." https://doi.org/10.1161/01.CIR.96.1.308