Objective: A comparison influence of renal denervation versus pharmacological treatment with sympathetic nervous system blockers on blood pressure in patients with resistant hypertension.
Methods: 125 patients with resistant hypertension wi-thout comorbidities after a 3-week standardized treat-ment with Losartan 100 mg, Amlodipine 10 mg and Indapamid 1,5 mg and confirmation of their resistance were randomly assigned into three groups, depending on medication supplemented to previously adminis-tered: IM group – selective I1-imidazoline agonist Moxonidine, IIB group – cardioselective beta-blocker Bisoprolol and IIID group – renal artery denervation (RDN). Patients were assessed by ambulatory blood pressure monitoring at baseline, 3, 6 and 12 month follow-up. The compliance to drug treatment was confirmed by 8-item Morisky Medication Adherence Scale. Renal denervation was performed with a Symplicity Spyral catheter.
Results: Statistically significant dynamics of SBP m/24 h was recorded starting with 3 months of evaluation in all three groups, the group of patients undergoing RDN demonstrating a net superior effect compared with pharmacological treatment: –6.48 ± 0.81 mmHg in I M group versus –6.2 ± 0.88 mmHg in II B group and –23.28 ± 1.9 mmHg in III D group, p< 0.001. The beneficial effect was maintained until the end of the study, when in observational group supplemented with Moxonidine SBP m/24 h were 159.6 ± 1.72 mmHg with a total reduction of –19.9 ± 0.7 mmHg from baseline, in Bisoprolol group –164.08 ± 1.93 mmHg with a reduc-tion of – 13.88 ± 1.13 mmHg and 141.76 ± 0.77 mmHg in RDN group with a total reduction of –35.16 ± 2.23 mmHg, p< 0.001. DBP m/24 h similar to SBP m/24 h noted a significantly reduction at 3 month follow-up: –4.8 ± 0.96 mmHg in IM group versus –3.64 ± 0.47 mmHg in IIB group and –12.08 ± 0.63 mmHg in IIID group, p< 0.001. The maximum reduction in DBP m/24 h were registered at 12 month follow-up, a comparative analyses of dynamics between groups showing a presence of statistical difference due to superiority of renal denervation treatment in amelioration of this parameter: – 13.68 ± 0.83 mmHg in IM group versus –10.72 ± 0.64 mmHg in IIB group and – 20.2 ± 1.28 mmHg in IIID group, p< 0.001.
Conclusions: Application of all three treatment regimens has been shown to be effective in reducing SBP and DBP values m/24 hours in patients with resistant hypertension, with a superior but comparable effect of Moxonidine to Bisoprolol and the absolute superiority of renal denervation treatment versus both pharmaco-logical treatment regimens.