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VASCULAR STIFFNESS IN TRUE RESISTANT HYPERTENSIVE PATIENTS AFTER RENAL DENERVATION: DOES PLASMA ALDOSTERONE MATTER?

Objective: Patients with resistant hypertension (RHTN) are characterized by higher incidence and severity of vascular damage resulting in excess stiffness assessed by pulse wave velocity (PWV) and renal resistive index (RRI). RHTN is also associated with increased renin-angiotensin-aldosterone system (RAAS) activity promoting vascular and kidney fibrosis. Aim of the study was to investigate the link between vascular damage and plasma aldosterone concentration (PAC) in severe hypertensive patients before and after renal denervation (RD). Design and method: 25 patients (mean age 56 ± 10 years, 9 males) with confirmed true RHTN with standardized multidrug combination treatment underwent renal denervation (Symplicity RDN System, Medtronic, USA) between January 2012 and October 2015. Markers of vascular damage, office blood pressure (BP) and PAC were evaluated before and twelve months after procedure. RRI was noninvasively assessed by ultrasonography (Vivid 7 Dimension, GE, USA), PWV was calculated by applanation tonometry (SphygmoCor XCEL, AtCor Medical, Australia). Aldosterone plasma concentration (normal limits 10–105 pg/ml) were determined by immunofluorescence method. Results: There was a significant decrease of office systolic and diastolic BP (−24.5/−13.2 mmHg, respectively, P < 0.05) levels a year after RDN. Arterial stiffness measured by PWV improved significantly 12 months after procedure (10.1 ± 1.8 to 9.3 ± 2.0 m/s, P < 0.05). Patients with RHTN were characterized by rather high RRI at baseline and values remained mostly unchanged during follow-up (0.7 ± 0.08 and 0.71 ± 0.08 respectively; P = 0.87). PAC slightly but significantly decreased a year after procedure (−13.6 ± 6 pg/ml, P = 0.008). Changes in PWV were associated both with decrease of PAC (r = 0.562, P = 0.04) and office BP levels (r = 0.546, P = 0.03). There was lack of association between RRI changes, office BP and PAC changes. Conclusions: Effective treatment of resistant hypertension improves vascular stiffness partly through decrease of blood pressure and aldosterone levels. However renal RRI remains mostly unchanged without clear link to BP level and RAAS activity.