LAUSR

Objective: Renal sympathetic denervation (RD) is the most promising invasive options to treat resistant hypertension (HTN). In Russian practice radiofrequency (RF) is the only feasible option. Emergence of the new RF RD multielectrode catheter systems in Russian HTN Excellence Centers provide a way to test this method. The aim of the study was to investigate the baseline characteristics of patients with resistant HTN undergoing RF RD and to determine immediate postprocedural clinical effects. Design and method: During 2018–2019, two series of RF RD procedures were performed in patients with truly resistant HTN using balloon-type (bipolar ablation) or spiral-type (unipolar ablation) multielectorde catheters. A comparative analysis of two groups of patients was carried out according to the type of catheter used. Dynamics of office systolic blood pressure (SBP) were assessed as delta between the two timepoints: at screening and at hospital discharge. The safety assessment of RF RD was performed. We applied multiple linear regression method to determine the factors associated with the delta of office SBP after RF RD. Results: A total of 48 patients taking 4 (4;6) antihypertensive drugs were included. Radiofrequency RD was performed with a balloon-type catheter in 27 patients (mean age 56 ± 12 y.o.; 12 males) and with a spiral-type catheter in 21 patients (50 ± 14 y.o.; 8 males). The duration of RF RD was significantly longer in the spiral catheter group (110 vs 60 min, p < 0.001), but twice as much RF ablations (24 vs 12, p = 0.002). None had acute kidney injury after RD (delta creatinine -0.6 micromol/L; 95% CI [-3.97; 2.78]). At discharge there was a pronounced decrease in office SBP (adjusted for baseline covariates) of -26 mm Hg (95% CI [-29; -23]). The main factors associated with the delta of office SBP were: smoking status (beta = -7.95; positive if “yes’’), baseline office SBP (beta = -0.48; positive), and blood glucose (beta = 5.28; negative). Conclusions: Radiofrequency renal denervation using multielectode catheters is characterized by pronounced and favorable short-term hemodynamic effects. We have found new potential predictors of these effects. Further research will focus on testing initial hypotheses in the long term run.