EVALUATING THE EFFECTIVENESS OF RADIOFREQUENCY RENAL DENERVATION IN HYPERTENSION USING CONTINUOUS CUFFLESS BLOOD PRESSURE MONITORING: A LANDMARK CASE STUDY

Objective: The efficacy of endovascular radiofrequency renal denervation (RDN) for treating and controlling hypertension has been disputed until recently. Current methods for assessing blood pressure (BP) following RDN use measurements from cuff-based devices, resulting in sparse, episodic, and possibly insufficient monitoring. This case study offers initial insights into one year of continual BP monitoring using a commercial cuffless device following RDN intervention, demonstrating the potential of cuffless devices in assessing the long-term effectiveness of RDN in patients.Design and method: A 62-year-old woman presented long-standing, untreated, stage 2-3 hypertension and multiple medication intolerances or inefficacies (e.g., nightmares with angiotensin receptor blockers, edema with calcium channel blockers, hypokalemia with thiazide diuretics). After excluding secondary hypertension, spironolactone and eplerenone were administered but caused arthralgia and muscle pain. Medical history included preeclampsia, one episode of multiple sclerosis, paroxysmal atrial fibrillation treated by ablation, and sleep apnea treated with continuous positive airway pressure. After 5 years of on-and-off treatment with candesartan 8 mg, the patient developed albuminuria and left ventricular hypertrophy. Endovascular radiofrequency RDN (Symplicity Spyral™, Medtronic) was performed under sedation: 19 lesions on the left and 16 on the right renal arteries. The patient wore a cuffless BP monitor (Aktiia SA, Switzerland) before and after the intervention. Systolic and diastolic BP (SBP, DBP) and heart rate (HR) were analyzed spanning 1 year before and after RDN. The patient stopped candesartan about one month after the RDN. Results: BPs were significantly reduced following RDN (SBP: 153.82±8.30 mmHg to 148.01±9.04 mmHg, difference: -5.81±0.17 mmHg, P<0.0001, Figures 1A-B; DBP: 100.80±6.60 mmHg to 96.30±6.47 mmHg, -4.50±0.13 mmHg, P<0.0001, Figures 1C-1D). No differences were found for HR (76.18±11.54 bpm to 76.40±12.05 bpm, 0.22±0.23 bpm, P=0.3217, Figures 1E-1F). Conclusions: This is the first example demonstrating how continual cuffless monitoring can support patients and providers in evaluating the effectiveness – or lack thereof – of RDN. In this case study, stopping the antihypertensive treatment seems to have influence the short-term response, which underscore the importance of adherence. Cuffless BP monitoring provided a level of granularity difficult to be achieved with traditional cuff-based modalities.