Can catheter-based renal denervation reduce frequency of hospitalization in patients who have resistant hypertension and heart failure with reduced ejection fraction?

Hypertension is one of the most powerful and modifiable risk factors for the development, progression and even decompensation of heart failure. Uncontrolled hypertension increases to frequency of heart failure hospitalizations by increase sympathetic tone. Catheter-based renal denervation has been shown to reduce blood pressure in the treatment of multidrug-resistant hypertension. We report the improvement in clinical status after renal denervation in a 47-year-old male patient with a history of hypertension, chronic ischemic heart failure, and recurrent hospitalizations for acute hypertensive pulmonary edema despite optimal medical therapy.

The effect of interarm blood pressure difference on coronary collateral flow in patients with ST-segment elevation myocardial infarction who had undergone primary percutaneous coronary intervention.

OBJECTIVE: In patients with acute myocardial infarction, coronary collateral circulation (CCC) is associated with reduced infarct size, preserved cardiac function, and decreased mortality. An interarm blood pressure difference (IABPD) is shown to be independently associated with cardiovascular and all-cause of mortality. We aimed to determine the effect of IABPD on coronary collateral flow in patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary percutaneous coronary intervention (p-PCI). PATIENTS AND METHODS: We prospectively investigated 1,348 consecutive patients who were hospitalized for STEMI and underwent p-PCI. The Rentrop classification was used to assess CCC. According to this classification, we defined Rentrop 0 and 1 as poor CCC, and Rentrop 2 and 3 as good CCC. A 10 mm Hg difference is considered the upper limit of IABPD. RESULTS: Patients were divided into two groups according to the collateral circulation, 325 patients (24%) had good collateral, while 1,023 patients (76%) had poor collateral. IABPD was significantly higher in the poor collateral group (57 patients, 5.6%) than in the good collateral group (9 patients, 2.8%) (p=0.04). Pre-infarction angina and IABPD were identified as independent predictors of poor collateral (OR: 0.516, 95% CI 0.370-0.631, p=0.007; OR: 3.681, 95% CI: 1.773-7.461, p=0.01, respectively) in multivariate analysis. CONCLUSIONS: The IABPD was shown as an independent predictor of poor collateral circulation in patients with STEMI who underwent p-PC.

Successful treatment of multidrug-resistant hypertension with catheter-based renal denervation in a patient with a renal artery stent.

Renal artery stenting (RAS) and its effectiveness in the treatment of atherosclerotic renal artery disease are controversial.1 Catheter-based renal denervation (RDN) has been shown to reduce blood pressure in the treatment of multidrug-resistant hypertension.2 In this case, we presented the successful regulation of multidrug resistant hypertension after renal denervation in a patient with renal artery stent.