SUPER RESPOSTA À TERAPIA DE DENERVAÇÃO RENAL EM PACIENTE COM HIPERTENSÃO ARTERIAL REFRATÁRIA E DISFUNÇÃO SISTÓLICA GRAVE: UM RELATO DE CASO COM RESPOSTA COMPLETA

Refractory systemic arterial hypertension represents a clinical challenge due to the limited effective therapeutic options for patients who do not respond to multiple combined drug classes. Renal denervation has been investigated as an innovative approach for these cases, demonstrating efficacy in reducing blood pressure. However, some patients present exceptionally pronounced responses to the procedure, being called “super-responders”. This study aims to analyze a clinical case of severe refractory hypertension with differentiated response to renal denervation, highlighting factors that may influence the success of the procedure. The report concerns a 29-year-old woman who presented progressive dyspnea, syncope episodes and extremely high blood pressure levels, even with the use of ten antihypertensive drugs at maximum doses. Examinations showed severe left ventricular hypertrophy and severe systolic dysfunction (LVEF: 20%), leading to the indication of renal denervation by radiofrequency ablation. The procedure was successful, but resulted in a significant decrease in blood pressure, requiring adjustment of the therapeutic plan. During follow-up, the patient demonstrated an exceptional response to treatment, dispensing with most antihypertensive drugs and presenting sustained blood pressure control (<120/80 mmHg). In addition, a surprising recovery of cardiac function was observed, with normalization of the ejection fraction. The results obtained contribute to the improvement of patient selection criteria and the optimization of the therapeutic approach to this condition. This case highlights the efficacy of renal denervation in super-responders and reinforces the need for clearer criteria for selecting these individuals. This case report adds evidence to the growing body of literature on the potential of renal denervation in the treatment of refractory hypertension and reinforces the interest in understanding the mechanisms underlying the super-response, for better selection of these individuals, helping to define the role of renal denervation in the broader spectrum of management of hypertension and heart failure.