Cor Vasa 2019, 61(4):e378-e384 | DOI: 10.1016/j.crvasa.2018.09.007

(Prediction of long-term renal denervation efficacy)

Jan Kvasnička^a, Lukáš Lambert^b, Petr Waldauf^c, Tomáš Zelinka^a, Ondřej Petrák^a, Branislav Štrauch^a, Robert Holaj^a, Tomáš Indra^d, Zuzana Krátká^a, Judita Klímová^a, Jan Václavík^e, Eva Kociánová^e, Igor Nykl^f, Otakar Jiravský^f, Gabriela Rappová^f, Miloš Táborský^e, Marian Branny^f, Jiří Widimský Jr.^a, Ján Rosa^a

^a Centrum pro hypertenzi, III. interní klinika, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze, Praha

^b Radiodiagnostická klinika, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze, Praha

^c Klinika anesteziologie a resuscitace, 3. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha

^d Klinika nefrologie, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze, Praha

^e I. interní klinika - kardiologická, Lékařská fakulta Univerzity Palackého a Fakultní nemocnice Olomouc, Olomouc

^f Kardiocentrum, Nemocnice Podlesí, Třinec

Diversity of blood pressure response and great variability within studies emphasise the need to identify predictors of renal denervation efficacy. Previous studies identified various predictors within periods of 3-6 months. The goal of the current study is to examine the possible predictors of sustained decline of blood pressure (BP) after renal denervation in a long-term period of 2 years. Evaluated patients were either randomised in the original PRAGUE-15 study or were pilot patients, meeting the same inclusion criteria of true-resistant hypertension. Patients were considered as responsive when the decline of 24h systolic BP ≥ 10 mmHg was present 6, 12 and 24 months after the procedure. In addition, analysis for separate visits was performed. Denervation was performed using the unipolar Symplicity Renal Denervation System. Extensive assessment of computed tomography angiography by numerous measurements including morphology of the renal arteries was performed. A total of 48 patients were analysed, with 27 patients suitable for long-term prediction. Five of the 27 patients were identified as long-term responders with average 24h BP decline of 20/9 mmHg. Strongest predictors of BP decline were higher baseline 24h systolic blood pressure (p = 0.01) and higher diameter of the left renal artery (p = 0.04). Only a minority of denervated patients exhibited sustained BP decline. Higher baseline BP and higher renal artery diameter might be the strongest predictors. Our findings might theoretically support the actual hypothesis of the necessity to ablate the distal parts of the renal artery (these conditions might allow such ablation to be performed).

Keywords: Ambulatory blood pressure monitoring, Blood pressure, Renal denervation, Resistant hypertension

Published: August 11, 2019  Show citation