Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 11, November, p. 1525–1530

doi: 10.17219/acem/104550

Publication type: original article

Language: English

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Resistant hypertension: Renal denervation or pharmacovigilance? Insights from a renal denervation screening program

Marcin Ojrzanowski1,A,B,C,D,E,F, Jarosław D. Kasprzak1,A,C,E,F, Jan Zbigniew Peruga1,A,C,E, Małgorzata Kurpesa1,B,E, Łukasz Jankowski1,B,C,D, Sonu Sahni2,3,C,D,E, Michał Plewka1,A,B,C,D,E,F

1 Chair and Clinic of Cardiology, Medical University of Lodz, Poland

2 Department of Primary Care, Touro College of Osteopathic Medicine, New York, USA

3 Department of Internal Medicine, Brookdale University Hospital Medical Center, New York, USA

Abstract

Background. With emerging new therapeutic concepts including renal denervation (RDN), there is a renewed interest in resistant hypertension (ResH). Among patients suspected of having ResH, a definitive diagnosis needs to be established.
Objectives. This study presents observations from a standardized single-center screening program for RDN candidates, including medical therapy modification and reassessment.
Material and Methods. All patients referred to our center for RDN underwent a standardized screening protocol. Candidates were recruited from among patients receiving no less than 3 antihypertensive drugs, including diuretics with office blood pressure (BP) >140/90 mm Hg. The assessment included 2 measurements of BP and ambulatory BP monitoring (ABPM). If needed, pharmacotherapy was intensified and the diagnosis of ResH was reconfirmed after 6 weeks. If ResH was persistent, patients were hospitalized with repeated ABPM on day 4. Further, renal CT-angio was performed and a multidisciplinary team discussed the patients’ suitability for RDN.
Results. A total of 87 patients with a ResH diagnosis were referred for RDN. Mean office BP was 159/92 (±7.0/6.5) mm Hg and mean ABPM was 154/90 (±9.0/4.8) mm Hg. The initial medication included angiotensin convertase inhibitors (ACE-I, 78%), angiotensin receptor blockers (12%), β-blockers (85%), calcium channel blockers (36%), and diuretics (93%). During the 18 months of the RDN program, 5 patients underwent RDN and 2 further had ineligible renal anatomy. A new diagnosis of secondary hypertension was made in 21 patients. However, in 59 patients, BP control was achieved after optimization of medical therapy, with a mean ABPM of 124/74 mm Hg. The final treatment included ACE-I (100%), β-blockers (92%), indapamide (94%), amlodipine (72%), and spironolactone (61%). Medication in most of these patients (88%) included single-pill triple combination (52.5%) or double combination (35.6%).
Conclusion. Patients with elevated BP screened for RDN require a rigorous diagnostic workup. Up to 2/3 of patients can be managed with strict pharmacotherapy compliance and pharmaceutical intensification, including single-pill combinations and improved drug compliance. Hasty use of RDN may be a result of poor drug optimization and/or compliance. It does remain a viable treatment option in thoroughly vetted ResH patients.

Key words

compliance, arterial hypertension, resistant hypertension, renal artery denervation

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