Luna Varela do Carmo, Kelton Dantas Pereira, Marco Aurelio Goulart, Antonio G Laurinavicius, Jonathan Souza, Oswaldo Passarelli Junior, Luciana Armaganijan, Rodolfo Staico, Celso Amodeo, Alexandre Abizaid, Fernando Yue Cesena, Marcio G Sousa, Fernanda Consolim-Colombo
{"title":"顽固性高血压患者通过灌注导管射频消融进行肾脏去神经后的血压控制和临床疗效:随访长达 10 年的病例系列。","authors":"Luna Varela do Carmo, Kelton Dantas Pereira, Marco Aurelio Goulart, Antonio G Laurinavicius, Jonathan Souza, Oswaldo Passarelli Junior, Luciana Armaganijan, Rodolfo Staico, Celso Amodeo, Alexandre Abizaid, Fernando Yue Cesena, Marcio G Sousa, Fernanda Consolim-Colombo","doi":"10.1007/s40292-024-00685-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The long-term efficacy of renal denervation (RDN) has not been extensively documented.</p><p><strong>Aim: </strong>To describe the long-term follow-up of patients after RDN.</p><p><strong>Methods: </strong>We evaluated patients with resistant hypertension (RH) who underwent RDN with irrigated catheter from 2012 to 2014 at a single centre. Office blood pressure (BP) and 24-hour ambulatory BP were assessed. Clinical event (stroke, myocardial infarction, need for dialysis, or death from any cause), left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (uACR) were evaluated.</p><p><strong>Results: </strong>The analysis included 20 individuals (age 51 ± 10 years, 75% female, ambulatory systolic BP [SBP] 168 ± 22 mmHg, ambulatory diastolic BP [DBP] 101 ± 19 mmHg, taking 7 [IQR: 6-8] antihypertensive medications). The median follow-up period was 8.5 (IQR: 5.6-9.4) years. Mean (± SD) changes from baseline were: -47 ± 41 mmHg for office SBP, -25 ± 20 mmHg for office DBP, -29 ± 26 mmHg for ambulatory SBP, and -15 ± 16 mmHg for ambulatory DBP. The number of antihypertensive drugs markedly decreased one month after RDN and a gradual upward trend was observed over time. A clinical event occurred in 9 (45%) participants. LVMI decreased from 152 ± 37 to 120 ± 31 g/m<sup>2</sup> (p = 0.015), the eGFR declined from 88.9 ± 15.6 to 73.1 ± 24.2 mL/min/1.73 m<sup>2</sup> (p = 0.034), and the uACR did not significantly change from baseline to follow-up.</p><p><strong>Conclusions: </strong>In this observational study of patients with uncontrolled RH, RDN with an irrigated catheter was associated with a sustained BP reduction for up to a decade. However, a potential waning efficacy was suggested by the increasing use of antihypertensive medications over time.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":" ","pages":"687-694"},"PeriodicalIF":3.1000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Blood Pressure Control and Clinical Outcomes After Renal Denervation Through Irrigated Catheter Radiofrequency Ablation in Patients with Resistant Hypertension: A Case Series with Up to 10 Years of Follow-Up.\",\"authors\":\"Luna Varela do Carmo, Kelton Dantas Pereira, Marco Aurelio Goulart, Antonio G Laurinavicius, Jonathan Souza, Oswaldo Passarelli Junior, Luciana Armaganijan, Rodolfo Staico, Celso Amodeo, Alexandre Abizaid, Fernando Yue Cesena, Marcio G Sousa, Fernanda Consolim-Colombo\",\"doi\":\"10.1007/s40292-024-00685-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>The long-term efficacy of renal denervation (RDN) has not been extensively documented.</p><p><strong>Aim: </strong>To describe the long-term follow-up of patients after RDN.</p><p><strong>Methods: </strong>We evaluated patients with resistant hypertension (RH) who underwent RDN with irrigated catheter from 2012 to 2014 at a single centre. Office blood pressure (BP) and 24-hour ambulatory BP were assessed. Clinical event (stroke, myocardial infarction, need for dialysis, or death from any cause), left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (uACR) were evaluated.</p><p><strong>Results: </strong>The analysis included 20 individuals (age 51 ± 10 years, 75% female, ambulatory systolic BP [SBP] 168 ± 22 mmHg, ambulatory diastolic BP [DBP] 101 ± 19 mmHg, taking 7 [IQR: 6-8] antihypertensive medications). The median follow-up period was 8.5 (IQR: 5.6-9.4) years. Mean (± SD) changes from baseline were: -47 ± 41 mmHg for office SBP, -25 ± 20 mmHg for office DBP, -29 ± 26 mmHg for ambulatory SBP, and -15 ± 16 mmHg for ambulatory DBP. The number of antihypertensive drugs markedly decreased one month after RDN and a gradual upward trend was observed over time. A clinical event occurred in 9 (45%) participants. LVMI decreased from 152 ± 37 to 120 ± 31 g/m<sup>2</sup> (p = 0.015), the eGFR declined from 88.9 ± 15.6 to 73.1 ± 24.2 mL/min/1.73 m<sup>2</sup> (p = 0.034), and the uACR did not significantly change from baseline to follow-up.</p><p><strong>Conclusions: </strong>In this observational study of patients with uncontrolled RH, RDN with an irrigated catheter was associated with a sustained BP reduction for up to a decade. However, a potential waning efficacy was suggested by the increasing use of antihypertensive medications over time.</p>\",\"PeriodicalId\":12890,\"journal\":{\"name\":\"High Blood Pressure & Cardiovascular Prevention\",\"volume\":\" \",\"pages\":\"687-694\"},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"High Blood Pressure & Cardiovascular Prevention\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s40292-024-00685-7\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/11/18 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"High Blood Pressure & Cardiovascular Prevention","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s40292-024-00685-7","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/18 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
Blood Pressure Control and Clinical Outcomes After Renal Denervation Through Irrigated Catheter Radiofrequency Ablation in Patients with Resistant Hypertension: A Case Series with Up to 10 Years of Follow-Up.
Introduction: The long-term efficacy of renal denervation (RDN) has not been extensively documented.
Aim: To describe the long-term follow-up of patients after RDN.
Methods: We evaluated patients with resistant hypertension (RH) who underwent RDN with irrigated catheter from 2012 to 2014 at a single centre. Office blood pressure (BP) and 24-hour ambulatory BP were assessed. Clinical event (stroke, myocardial infarction, need for dialysis, or death from any cause), left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (uACR) were evaluated.
Results: The analysis included 20 individuals (age 51 ± 10 years, 75% female, ambulatory systolic BP [SBP] 168 ± 22 mmHg, ambulatory diastolic BP [DBP] 101 ± 19 mmHg, taking 7 [IQR: 6-8] antihypertensive medications). The median follow-up period was 8.5 (IQR: 5.6-9.4) years. Mean (± SD) changes from baseline were: -47 ± 41 mmHg for office SBP, -25 ± 20 mmHg for office DBP, -29 ± 26 mmHg for ambulatory SBP, and -15 ± 16 mmHg for ambulatory DBP. The number of antihypertensive drugs markedly decreased one month after RDN and a gradual upward trend was observed over time. A clinical event occurred in 9 (45%) participants. LVMI decreased from 152 ± 37 to 120 ± 31 g/m2 (p = 0.015), the eGFR declined from 88.9 ± 15.6 to 73.1 ± 24.2 mL/min/1.73 m2 (p = 0.034), and the uACR did not significantly change from baseline to follow-up.
Conclusions: In this observational study of patients with uncontrolled RH, RDN with an irrigated catheter was associated with a sustained BP reduction for up to a decade. However, a potential waning efficacy was suggested by the increasing use of antihypertensive medications over time.
期刊介绍:
High Blood Pressure & Cardiovascular Prevention promotes knowledge, update and discussion in the field of hypertension and cardiovascular disease prevention, by providing a regular programme of independent review articles covering key aspects of the management of hypertension and cardiovascular diseases. The journal includes: Invited ''State of the Art'' reviews. Expert commentaries on guidelines, major trials, technical advances.Presentation of new intervention trials design.''Pros and Cons'' or round tables on controversial issues.Statements on guidelines from hypertension and cardiovascular scientific societies.Socio-economic issues.Cost/benefit in prevention of cardiovascular diseases.Monitoring of healthcare systems.News and views from the Italian Society of Hypertension (including abstracts).All manuscripts are subject to peer review by international experts. Letters to the editor are welcomed and will be considered for publication.