Renal Sympathetic Plexus Denervation - Long-term Treatment Outcomes

Rezistentna hipertenzija nemogućnost je postizanja ciljnog tlaka usprkos primijeni minimalno 3 antihipertenzivna lijeka različitih razreda u maksimalnim dozama, od kojih jedan lijek mora biti diuretik. Prevalencija rezistentne hipertenzije kreće se između 10-30% te je povezna s povećnim rizikom od oštećenja kardiovaskularnog sustava i bubrežne funkcije. Terapija renalnom denervacijom indicirana je u pacijenata kod kojih je farmakološkom terapijom nemoguće kontrolirati krvni tlak. Dokazi upućuju na pozitivni utjecaj renalne denervacije na očekivano trajanje života te prevenciju kardiovaskularnih komplikacija u pacijenata s rezistentnom hipertenzijom. Renalna denervacija usto ima i pozitivni učinak na stanja poput kronične bubrežne bolesti, tip 2 diabetesa, OSA (Obstructive sleep apnea) sindroma, aritmije, hipertrofiju lijevog ventrikula te zatajenja srca. Studije su pokazale da renalna denervacija smanjuje masu lijevog ventrukula, poboljšava diastoličku funkciju te smanjuje atrijske i ventrikularne aritmije. RD također smanjuje vaskularni otpor i poboljšava centralnu hemodinamiku što bi moglo imati značajni prognostički utjecaj u pacijenata s rezistentnom hipertenzijom i visokim kardiovaskularnim rizikom. Primijećen je i pad albuminurije te prevalecije mikroalbuminurije i makroalbuminurije nakon RDN (renalna denervacija). Kronična aktivacija simpatičkog živčanog sustava povezana je i s komponentama metaboličkog sindroma, poput hiperinzulinemije, tip 2 diabetesa, i pretilosti. U pacijenata podvrgnutih renalnoj denervaciji zabilježen je pad glukoze u krvi na tašte, razine inzulina, i razine glukoze u krvi nakon dva sata tijekom oralnog testa tolerancije glukoze.
Resistant hypertension is failure to achieve goal blood pressure in spite of using a minimum of 3 antihypertensive drugs of different classes, one of which must be diuretic, at maximal tolerated doses. The prevalence of resistant hypertension ranges between 10-30% and is associated with higher risk of kidney and cardiovascular system damage. Treatment of resistant hypertension focuses on lifestyle modifications and pharmacological therapy. Device-based therapies are indicated in patients in whom pharmacological agents failed to control the blood pressure. Evidence suggests beneficial effects of renal sympathectomy on life expectancy and prevention of cardiovascular complications in patients with resistant hypertension. There are also reported effects of renal sypmathetic denervation in several conditions such as chronic kindey disease, type 2 diabetes mellitus, sleep apnea, arrhythmias, left ventricular hypertrophy, and heart failure. Studies showed that renal denervation reduces LV mass, improves diastolic function, and reduces the burden of atrial and ventricular arrhythmias. RDN also significantly improves arterial stiffness and central hemodynamics, which might have important prognostic implications in patients with resistant hypertension and high cardiovascular risk. Following RDN, the magnitude of albuminuria, as well as the prevalence of micro- and macroalbuminuria, decreased in treatment-resistant hypertensive patients. Chronic activation of the sympathetic nervous system has been associated with the components of metabolic syndrome, such as hyperinsulinemia, type 2 diabetes, and obesity. In patients who had renal denervation treatment, drops in fasting glucose, insulin level, and 2-hour glucose levels during an oral glucose tolerance test were observed.