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Abstract: PO1811

Endovascular Renal Denervation Efficacy in a Five-Year Follow-Up

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Carvão, João, Servico de Saude da Regiao Autonoma da Madeira, Funchal, Ilha da Madeira, Portugal
  • Branco, Patricia Quadros, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
  • Mateus, Catarina, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
  • Gonçalves, Pedro, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
  • Almeida, Manuel De sousa, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
  • Gaspar, Maria augusta Cabrita silva, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
Background

Endovascular renal denervation (ERD) is a minimally invasive procedure that uses radiofrequency ablation to burn the nerves in the renal arteries. Renal sympathetic nerves can modulate sympathetic activity at the whole body level, playing an important role in essential hypertension. This study aim to evaluate ERD efficacy in the treatment of essential hypertension in a five-year follow-up.

Methods

We conducted a prospective study including 41 patients with essential hypertension. ERD was performed using Simplicity Probe or Spyral. Blood pressure (BP) was evaluated using 24hour ambulatory BP monitoring. Echocardiography was performed using HDI 5000. Clinical and biochemical variables were explored.

Results

A total of 41 patients were included. Overall, 53,7% (n=22) were females with a mean age of 63,6 ± 7,5 years, BMI 30,8 ± 5,2 Kg/m2, 17,1% (n=7) had an estimated glomerular filtration rate (eGFR) < 60ml/min/1,73m2 and 68,3% (n=28) diabetes. Proteinuria (>300mg/g) was found in 24,4% (n=10) of the patients.

A significant reduction in the number of antihypertensive drugs being taken was found after 5 years’ follow-up (p<0,001). Despite this reduction, a significant reduction in diastolic blood pressure (DBP) (p=0,001) was found, but not in systolic blood pressure (SBP) (p=0,08). Also left ventricle mass index (LVMI) reduced significantly (p<0,0001) and a reduction of acute elevation of left ventricle filling pressure (LVFP) was detected using E/e’ (p<0,0001).There was a worsening of eGFR (p<0,0001) as expected by the progressive worsening of kidney function.

We have found a non significant reduction in proteinuria (p=0,07). In the group with a reduction in proteinuria, it was not associated with BP and LVMI, when using multivariate analysis.

In a multivariate analysis, the reduction in the number of antihypertensive drugs, of the LVMI, SBP and DBP were not related with age, gender, body mass index and proteinuria.

Conclusion

In our population, we managed to reduce the number of anti-hypertensive drugs and still reduce patients DBP with RDN. Also RDN showed benefits in reducing LVMI and LVFP. Reduction of proteinuria, when present, was independent of BP anad LVMI. There was a worsening of kidney function as expected in a long term follow-up. RDN has been showed to be an effective mean of treating essential hypertension.