Manejo de la hipertensión resistente en una unidad multidisciplinaria de denervación renal: protocolo y resultados / Management of resistant hypertension in a multidisciplinary unit of renal denervation: protocol and results

RESUMEN

Introducción y objetivos. La hipertensión resistente es un problema clínico por la dificultad de su tratamiento y el aumento de morbimortalidad que conlleva. Se ha demostrado que la denervación renal por catéter mejora el control de estos pacientes. Se describen los resultados de la creación de una unidad multidisciplinaria para la implementación de la denervación renal en el tratamiento de la hipertensión resistente. Métodos. Un equipo compuesto por nefrólogos y cardiólogos diseñó un protocolo para la selección, la intervención y el seguimiento de los pacientes. Se incluyó a 197 pacientes con hipertensión esencial mal controlada pese a la toma de tres o más fármacos. A la técnica de ablación descrita, se añadió el soporte de un navegador basado en angiografía rotacional. Se comparó la presión arterial basal y tras el seguimiento utilizando el test de Wilcoxon para muestras apareadas. Resultados. Se excluyó a 108 (55%) pacientes con hipertensión seudorresistente. A los otros 89, se les administraron antialdosterónicos, a los que respondieron 60 pacientes (30%). Fueron candidatos a denervación los 29 (15%) pacientes restantes. Se realizó ablación a 11 pacientes, con una presión arterial de 164/99mmHg, en tratamiento con 4,4 fármacos. Tras un seguimiento de 72 días, las presiones arteriales sistólica y diastólica se redujeron en 25mmHg (p=0,02) y 10mmHg (p=0,06) respectivamente. En 10 pacientes (91%) se suspendió al menos un fármaco. Conclusiones. La denervación renal implementada mediante un programa multidisciplinario ofrece una mejora en la presión arterial similar a la de estudios previos, con mayor reducción de fármacos antihipertensivos (AU)

ABSTRACT

Introduction and objectives. Resistant hypertension is a clinical problem because of its difficult management and increased morbidity and mortality. Catheter-based renal denervation has been demonstrated to improve control in these patients. The results of establishing a multidisciplinary unit for the implementation of renal denervation in the management of resistant hypertension are described. Methods. A team of nephrologists and cardiologists created a protocol for patient selection, intervention, and follow-up. One hundred and ninety-seven patients with poorly controlled essential hypertension, despite taking 3 or more drugs, were included. The ablation technique previously described was supported by a navigator based on rotational angiography. Blood pressure at baseline and after follow-up was compared using the Wilcoxon test for paired samples. Results. One hundred and eight patients (55%) with pseudo-resistant hypertension were excluded. The other 89 were given antialdosteronic drugs, to which 60 patients (30%) responded. The remaining 29 patients (15%) were candidates for denervation. Eleven patients, with blood pressure 164/99mmHg and taking 4.4 antihypertensive drugs, were ablated. After 72 days of follow-up, systolic and diastolic blood pressure fell by 25 mmHg (P=.02) and 10 mmHg (P=.06), respectively. In 10 patients (91%) at least 1 drug was discontinued. Results. One hundred and eight patients (55%) with pseudo-resistant hypertension were excluded. The other 89 were given antialdosteronic drugs, to which 60 patients (30%) responded. The remaining 29 patients (15%) were candidates for denervation. Eleven patients, with blood pressure 164/99mmHg and taking 4.4 antihypertensive drugs, were ablated. After 72 days of follow-up, systolic and diastolic blood pressure fell by 25 mmHg (P=.02) and 10 mmHg (P=.06), respectively. In 10 patients (91%) at least 1 drug was discontinued. Conclusions. Renal denervation performed by a multidisciplinary team led to an improvement in blood pressure similar to previous studies, with a greater reduction of antihypertensive drugs. Conclusions. Renal denervation performed by a multidisciplinary team led to an improvement in blood pressure similar to previous studies, with a greater reduction of antihypertensive drugs (AU)