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Long-term outcomes after renal denervation: a follow-up of 5 years
Session:
Sessão de Posters 07 - Hipertensão arterial
Speaker:
Maria Inês Gil Martins Roxo
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:
Maria Inês Roxo; Andreia Carnevale; Rita Calça; Ana Rita Martins; Pedro Gonçalves; Manuel Almeida; Augusta Gaspar; Patrícia Branco
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Background and Aims: Arterial hypertension (HTN) is a significant cause of cardiovascular morbimortality worldwide. Adequate blood pressure (BP) control constitutes a crucial tool to prevent its enduring end-organ damage and high burden of disease. Resistant HTN may be particularly challenging to address: in this field, denervation of the renal sympathetic nerves is developing as a promising despite controversial therapy. Our goal was to study long-term outcomes in a cohort of patients with resistant HTN submitted to renal denervation (RDN).</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Method: We conducted a retrospective, single-centre study amongst patients with resistant HTN who underwent RDN between July 2011 and July 2022. All patients routinely underwent blood and urine testing, 24-hour ambulatory BP monitoring (ABPM) and echocardiographic evaluation every 6 to 12 months after the procedure. We collected several demographic, clinical and laboratory variables, and analysed outcomes at 5 years of follow-up using SPSS software.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Results: 78 patients were submitted to RDN in our centre, 53% of which (n=41) were male. There were no complications related to the procedure. At 5 years of follow-up, there were different types of responders. In ABPM, 61% of the patients showed a decrease in mean systolic BP (SBP), with a median reduction of 16 mmHg (IQR 16.5). In 46% of patients, there was a reduction in albumin/creatinine ratio (ACR), with a median decrease of 17.63 mg/g (IQR 120.67). Before RDN, 30 patients (38.5%) had an ACR above 30 mg/g, while after 5 years the number of patients with ACR in this range was 21 (26.9%). In echocardiographic evaluation, 70% of the patients evidenced a decrease in left ventricular mass index (LVMI) with a median reduction of 20 g/m<sup>2</sup> (IQR 41). These results are summarised in Figure 1. In total, 70% of the patients were considered responders to RDN, either through a reduction in mean SBP, in LVMI, in ACR or simultaneously in all three variables. Additionally, the reduction in mean SBP in ABPM, LVMI and ACR proved to be independent variables, both in Spearman tests and binary logistic linear regression (nonsignificant p-values). 77% of the patients were prescribed less antihypertensive drugs after follow-up, with a median reduction of 2 drugs (IQR 2).</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Conclusion: Our study identified a significant percentage of responders to RDN, evidenced by an improvement in one or more variables associated with BP control and HTN-mediated end-organ damage, without any safety issues to report. It is also important to emphasize that the observed reduction in ACR and LVMI was independent of the reduction in SBP. This finding suggests that RDN might have a direct effect on albuminuria and left ventricular hypertrophy, instead of solely as an indirect result of the control of BP. Hence, while further studies are needed to support this evidence, the results nevertheless raise hope for the therapeutic potential of RDN in patients with resistant HTN.</span></span></p>
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