Denervação Renal com Cateter de Ablação por Radiofrequência de Ponta Irrigada em Hipertensos Resistentes

Background: The 3-year results of the Symplicity HTN-1 trial have shown the superiority of renal sympathetic denervation over drug treatment in patients with resistant hypertension. However, the efficacy of renal sympathetic denervation was not confirmed by Symplicity HTN-3, the first sham-controlled study. Our objective was to report the safety and efficacy of renal sympathetic denervation using the irrigated radiofrequency ablation catheter in patients with resistant hypertension. Methods: Twenty-one patients were submitted to the procedure since July 2012, nine of them had a follow-up ≥ 12 months and were included in this analysis. The primary endpoint was safety, evaluated by periprocedural adverse events, renal function and renal vascular abnormalities at 6 months. Secondary endpoints included changes in blood pressure obtained in office and in the number of anti-hypertensive drugs at 12 months. Results: Mean age was 48.8 ± 11.7 years. In the first case, there was a renal artery dissection caused by the vascular sheath. There were no cases of thrombosis, renal infarction or death. Serum creatinine levels did not increase during the follow-up period. At 6 months, one case of significant renal stenosis without clinical impact was diagnosed. The average reduction in office blood pressure was 41.1 ± 33.2/18.6 ± 15.2 mmHg (p = 0.04 for systolic blood pressure and p = 0.08 for diastolic blood pressure) and there was a mean reduction of 2.0 ± 2.3 in the number of anti-hypertensive drugs at 12 months (p = 0.03). Conclusions: Renal sympathetic denervation using the irrigated radiofrequency ablation catheter proved to be feasible, safe and effective.