SPC365

Reaming at resistant Hypertension: old weapons brought back.

Session: Sessão de Posters 07 - Hipertensão arterial
Speaker: Rui Carlos Gregório Antunes Coelho

Congress: CPC 2024
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.14 Risk Factors and Prevention - Other
Session Type: Cartazes
FP Number: ---
Authors: Rui Antunes Coelho; Ana Fátima Esteves; Catarina Sá; Ricardo Santos; Alexandre Calçada; Raquel Louzada; Joana Silva Ferreira; Jéni Quintal; Catarina Pohle; Sara Gonçalves; Filipe Seixo

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Background:</u></strong> High blood pressure (BP) is the most prevalent cardiovascular risk factor and remains the leading modifiable cause of death. In many patients, pharmacological therapy is insufficient to adequately control blood pressure. Multiple clinical trials have demonstrated the safety and efficacy of renal sympathetic denervation in reducing BP.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Purpose:</u></strong> The aim of this study is to present our center&rsquo;s initial experience with a radiofrequency renal denervation technique, describing the characteristics of the first patients submitted to this procedure, as well as to evaluate its safety and effectiveness in our population.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Methods:</u></strong> An observational study with all patients who were treated with renal denervation, between January and September 2023, was performed. For this procedure we selected patients with resistant Hypertension, defined as elevated BP values despite treatment with at least 3 different classes of anti-hypertensive medications (including one diuretic). Patients with secondary hypertension and with eGFR &lt;40 mL/min/1.73m<sup>2 </sup>were excluded. Baseline patient characteristics were evaluated as well as ABPM/AMPA values prior to the procedures and at least 3 months after. The Wilcoxon test was used to compare median blood pressure values before and after the procedure. A p-value &lt;0.05 was considered statistically significant.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Results:</u></strong> Nine patients underwent renal denervation, 7 (78%) male with a median age of 66 [50;70] years. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Three (33%) patients had grade 1 arterial hypertension, four (44%) had grade 2 and two (22%) had grade 3. Six patients (67%) had diabetes mellitus, seven (78%) had dyslipidemia, four (44%) were smokers and six (67%) had obstructive sleep apnea syndrome. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">All patients were taking renin-angiotensin-aldosterone system inhibitors, dihydropyridine calcium channel blockers and diuretics. Six patients (67%) were taking spironolactone and all but one were taking beta-blockers. Five patients (56%) were taking rilmenidine and one (11%) methyldopa. Patients were taking a mean of 5 (&plusmn; 1) pharmacological classes. After renal denervation, previously ongoing pharmacological therapy was maintained.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">There was no statistically significant difference in renal function before (GFR 90 [61;125] ml/min/m<sup>2</sup>) and after (GFR 96 [70;130] ml/min/m<sup>2</sup>) renal denervation (p = 0.770). There were no complications.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Comparing BP values prior and after the procedure, renal denervation was associated with a significant reduction in systolic (reduction of 18 [15;23] mmHg; p = 0.008), diastolic (9 [5;10] mmHg; p = 0.011) and mean BP (13 [9;15] mmHg, p = 0.008).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Conclusions:</u></strong> Renal denervation proved to be a safe and effective procedure in reducing blood pressure in this first group of patients with resistant hypertension who was submitted to procedure in our center. Further patients need to be included and a longer follow-up is needed to assess the benefit of this technique.</span></span></p>