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

• Published in: High blood pressure & cardiovascular prevention 2024-11, Vol.31 (6), p.687-694
• Main Authors: do Carmo, Luna Varela, Pereira, Kelton Dantas, Goulart, Marco Aurelio, Laurinavicius, Antonio G, Souza, Jonathan, Junior, Oswaldo Passarelli, Armaganijan, Luciana, Staico, Rodolfo, Amodeo, Celso, Abizaid, Alexandre, Cesena, Fernando Yue, Sousa, Marcio G, Consolim-Colombo, Fernanda
• Format: Article
• Language: English
• Subjects: Ablation; Antihypertensives; Blood pressure; Catheters; Creatinine; Denervation; Diuretics; Drugs; FDA approval; Hypertension; Patients; Standard deviation; Ultrasonic imaging; Veins & arteries
• ISSN: 1120-9879; 1179-1985
• DOI: 10.1007/s40292-024-00685-7

IntroductionThe long-term efficacy of renal denervation (RDN) has not been extensively documented.AimTo describe the long-term follow-up of patients after RDN.MethodsWe 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.ResultsThe 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.ConclusionsIn 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.