Efficacy and safety of renal denervation in comorbid patients with resistant hypertension: results of a two-year follow-up

Aim. To study the clinical efficacy of renal denervation (RDN) in patients with resistant hypertension (RH), type 2 diabetes (T2D) and coronary artery disease (CAD) after endovascular revascularization. Material and methods. The prospective, non-randomized, controlled, single-center study included 75 patients with true RH, T2D and CAD after complete endovascular revascularization. The participants were distributed in a 1:1,5 ratio into the RDN group and the control group. RDN was performed through femoral vascular access with a Spyral catheter (Medtronic, USA). The follow-up period was 24 months. The primary endpoint was the change in mean 24-hour arterial pressure (BP). The secondary endpoint was the assessment of the incidence of adverse cardiovascular and cerebral events. Changes in paraclinical parameters and drug therapy were also assessed. Results. In the RDN group, mean 24-hour systolic BP decreased from 158 [144;167] to 147 [137;156] mm Hg (p<0,05) and diastolic BP from 97 [82;112] to 89 [75;101] mm Hg (p<0,05); glycated hemoglobin — from 7,6 [6,9;8,4] to 6,6 [6,2;7,2]% (p<0,05). In the RDN group, a decrease in the number of antihypertensive drugs taken was noted due to diuretic therapy discontinuation (p<0,05). The rate of major adverse cardiovascular events was 26,7% in the RDN group and 24,4% in the control group. The mean average value of late lumen loss of the stented segment according to quantitative coronary angiographic analysis (qualitative comparative analysis, QCA) was 24,7% in the RDN group and 28,1% in the control group. The incidence of de novo stenosis was 23,3% in the RDN group and 22,2% in the control group. There were no differences between the groups. The glomerular filtration rate in both groups did not change significantly and remained stable. Conclusion. The study results confirm the favorable pleiotropic effects and safety of RDN in polymorbid patients with a combination of RH, T2D and CAD with the total sympathetic nervous system involvement, which offers opportunities for a wider study and implementation of this interventional procedure in clinical practice.