Renal Artery Denervation for Resistant Hypertension in Two Siblings: A Case Study

Introduction This case report highlights the challenges of controlling resistant hypertension in two siblings who were diagnosed with resistant to medical treatment arterial hypertension (AH) and had renal denervation (RDN) procedures, resulting in different outcomes. Case Presentation A 63-year-old male with hypertension, heart failure with preserved ejection fraction, obesity, pacemaker due symptomatic bradycardia and dyslipidemia presented with uncontrollable blood-pressure (BP). Despite antihypertensive combination therapy with five medications, adequate BP control could not be achieved. A 61-yearold male, sibling of previous patient, similarly presented with resistant AH. Both patients presented with the average systolic BP above 180 mmHg. There is a positive family history of AH. Possible secondary causes of AH, such as renal artery stenosis and primary hyperaldosteronism, were excluded. After evaluating the renal artery anatomies via CT angiography, and ensuring suitability, RDN procedures were performed. A RDN procedure was performed for a 63-year-old patient. The number of ablation sites depended on the artery length. Post-procedure angiography confirmed the absence of complications in both renal arteries. At three-month follow-up, the patient maintained his antihypertensive therapy and had an average BP of 160/87 mmHg. A 61-year-old patient experienced a similar procedure, but the intervention was terminated due to bradycardia and asystole during ablation of both renal arteries. A repeat RDN, genetic examination for family sinus node weakness syndrome and alternative interventional strategy is under consideration. Discussion The priority for controlling AH primarily remains antihypertensive combination therapy and lifestyle corrections. A proportion of patients may not achieve target BP even with combined antihypertensive medications. Recent trials have demonstrated a BP-lowering efficacy in patients with resistant hypertension [1]. As medical interventions, medications, are inherently subject to inter-individual variability in response, further studies are needed to evaluate the therapeutic success, long-term effects, and indications for RDN [2,3]. Conclusions This case report highlights approaches in controlling AH, including procedures not routinely performed.