THE EFFECT OF RENAL DENERVATION ON THE CIRCADIAN BLOOD PRESSURE PATTERN IN PATIENTS WITH RESISTANT HYPERTENSION.

OBJECTIVE: Loss of the normal circadian rhythm of blood pressure is associated with adverse cardiovascular outcomes, the activity of the sympathetic nervous system in this context having an important pathophysiological mechanism. So, the objective of the study was to evaluate the impact of sympathetic renal denervation on circadian blood pressure pattern in patients with resistant hypertension.

DESIGN AND METHOD: The study included 75 patients with resistant hypertension, without comorbidities and mean age of 49.59 ± 0.52 years. After a 3 week standardized treatment with Losartan, Amlodipine and Indapamide patients were randomly assigned into three equal groups, depending on medication supplemented to the previously administered: I M group (n = 25) - Moxonidine, II B group (n = 25) - Bisoprolol and III D group (n = 25) - renal artery denervation. AMBP was done at baseline and 6 months follow-up. Renal denervation was performed using Medtronic Spyral catheters.

RESULTS: At baseline, most patients presented a non-dipper pathological profile for both systolic and diastolic blood pressure (Table 1).At 6 months of evaluation, the improvement of the diurnal profile was recorded in all three observational groups, renal denervation demonstrating a net superior effect compared to the SNS-blockers. In this way, towards the end of the study the dipper profile for SBP was recorded in 5 (20%), 4 (16%) and 10 (40%) patients, non-dipper - in 19 (76%), 21 (84%) and 15 (60%) patients from I M, II B and III D groups, respectively; night-picker pattern was noted in 1 (4%) patient from I M group, over-dipper profile not being registered (p > 0.05, x2 = 6.28). Circadian DBP pattern noted the disappearance of pathological profiles night-picker and over-dipper, non-dipper being registered in 19 (76%), 18 (72%) and 16 (64%) patients, the physiological dipper profile was recovered by 6 (24%), 7 (28%) and 9 (36%) patients from I M, II B and III D groups, respectively (p > 0.05, x2 = 0.90).

CONCLUSIONS: Renal denervation has shown efficacy in improving the circadian diurnal profile, thus reducing the risk of cardiovascular events in patients with resistant hypertension.