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Angio-computed tomography reveals differences in the anatomy of renal arteries in resistant hypertension patients qualified for renal denervation versus pseudo-resistant hypertensive subjects
, 3, 4, 1
Affiliations- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Regional Specialist Hospital in Wroclław, Research and Development Center, Wroclaw, Poland
- 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland
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Abstract
Background: Renal denervation is a novel therapeutic option in resistant hypertension (RHT). The
anatomy of renal arteries and the presence of additional renal arteries are important determinants of
the effect of the procedure. The aim of this study was to assess the anatomy of renal arteries using angio-
-computed tomography in patients with RHT, who were qualified for renal denervation.
Methods: We analyzed angio-computed tomography scans of the renal arteries of 72 patients qualified
for renal denervation. We divided the study population into two groups: a resistant hypertension group
(RHT) and a pseudo-resistant hypertension group (NRHT). The biochemical and endocrine diagnostic
procedures were performed to rule out secondary hypertension. We analyzed the morphology, the diameters,
and the number of additional renal arteries.
Results: In both groups, we found additional renal arteries (ARN). ARN were more frequent in
RHT than in patients with non-resistant hypertension (48.4% vs. 24.3%; p < 0.05). They were
present more often on the left side (18 left side vs. 7 right side). The ARNs were longer than main
renal artery — left side 41.7 ± 12.1 mm vs. 51.1 ± 11.8 mm, right side 49.2 ± 14.5 mm vs. 60 ±
± 8.6 mm, respectively (p < 0.05). The diameters of ARN were similar in both groups. In the group of
patients with RHT the number of ARN was significantly higher (p < 0.04).
Conclusions: The ARNs occur more often in patients with RHT. It seems that there is no connection
between the resistance of hypertension and the diameters of renal arteries.
Abstract
Background: Renal denervation is a novel therapeutic option in resistant hypertension (RHT). The
anatomy of renal arteries and the presence of additional renal arteries are important determinants of
the effect of the procedure. The aim of this study was to assess the anatomy of renal arteries using angio-
-computed tomography in patients with RHT, who were qualified for renal denervation.
Methods: We analyzed angio-computed tomography scans of the renal arteries of 72 patients qualified
for renal denervation. We divided the study population into two groups: a resistant hypertension group
(RHT) and a pseudo-resistant hypertension group (NRHT). The biochemical and endocrine diagnostic
procedures were performed to rule out secondary hypertension. We analyzed the morphology, the diameters,
and the number of additional renal arteries.
Results: In both groups, we found additional renal arteries (ARN). ARN were more frequent in
RHT than in patients with non-resistant hypertension (48.4% vs. 24.3%; p < 0.05). They were
present more often on the left side (18 left side vs. 7 right side). The ARNs were longer than main
renal artery — left side 41.7 ± 12.1 mm vs. 51.1 ± 11.8 mm, right side 49.2 ± 14.5 mm vs. 60 ±
± 8.6 mm, respectively (p < 0.05). The diameters of ARN were similar in both groups. In the group of
patients with RHT the number of ARN was significantly higher (p < 0.04).
Conclusions: The ARNs occur more often in patients with RHT. It seems that there is no connection
between the resistance of hypertension and the diameters of renal arteries.
Keywords
renal denervation, renal artery anatomy, resistant hypertension
About this articleTitle
Angio-computed tomography reveals differences in the anatomy of renal arteries in resistant hypertension patients qualified for renal denervation versus pseudo-resistant hypertensive subjects
Journal
Issue
Article type
Original Article
Pages
379-384
Published online
2021-02-27
Page views
2404
Article views/downloads
569
DOI
Pubmed
Bibliographic record
Cardiol J 2023;30(3):379-384.
Keywords
renal denervation
renal artery anatomy
resistant hypertension
Authors
Tomasz Skowerski
Mariusz Skowerski
Andrzej Kułach
Tomasz Roleder
Andrzej Ochała
Zbigniew Gąsior
References (17)- Pimenta E, Calhoun DA. Resistant hypertension: incidence, prevalence, and prognosis. Circulation. 2012; 125(13): 1594–1596.
- Grassi G. Assessment of sympathetic cardiovascular drive in human hypertension: achievements and perspectives. Hypertension. 2009; 54(4): 690–697.
- Joffres M, Falaschetti E, Gillespie C, et al. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study. BMJ Open. 2013; 3(8): e003423.
- Daugherty SL, Powers JD, Magid DJ, et al. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation. 2012; 125(13): 1635–1642.
- Ewen S, Ukena C, Lüscher TF, et al. Anatomical and procedural determinants of catheter-based renal denervation. Cardiovasc Revasc Med. 2016; 17(7): 474–479.
- Hering D, Marusic P, Walton AS, et al. Renal artery anatomy affects the blood pressure response to renal denervation in patients with resistant hypertension. Int J Cardiol. 2016; 202: 388–393.
- Böhm M, Brilakis N, Mancia G, et al. TCT-762 Renal denervation treatment with the Symplicity Spyral multielectrode catheter: 6-month safety and blood pressure outcomes from the Global SYMPLICITY Registry. J Am Coll Cardiol. 2016; 68(18): B308.
- Mahfoud F, Bakris G, Bhatt DL, et al. Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry. Eur Heart J. 2017; 38(2): 93–100.
- Kandzari DE, Böhm M, Mahfoud F, et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet. 2018; 391(10137): 2346–2355.
- Townsend RR, Mahfoud F, Kandzari DE, et al. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet. 2017; 390(10108): 2160–2170.
- Mahfoud F, Tunev S, Ewen S, et al. Impact of lesion placement on efficacy and safety of catheter-based radiofrequency renal denervation. J Am Coll Cardiol. 2015; 66(16): 1766–1775.
- Skowerski M, Roleder T, Bańska-Kisiel K, et al. Long-term follow-up after radio-frequency catheter-based denervation in patients with resistant hypertension. Int J Cardiol. 2016; 215: 472–475.
- VonAchen P, Hamann J, Houghland T, et al. Accessory renal arteries: Prevalence in resistant hypertension and an important role in nonresponse to radiofrequency renal denervation. Cardiovasc Revasc Med. 2016; 17(7): 470–473.
- Lauder L, Ewen S, Tzafriri AR, et al. Renal artery anatomy in hypertensive patients study collaborators. Renal artery anatomy assessed by quantitative analysis of selective renal angiography in 1,000 patients with hypertension. EuroIntervention. 2018; 14(1): 121–128.
- Chan PL, Tan FH. Renin dependent hypertension caused by accessory renal arteries. Clin Hypertens. 2018; 24: 15.
- Pekarskiy SE, Baev AE, Mordovin VF, et al. Denervation of the distal renal arterial branches vs. conventional main renal artery treatment: a randomized controlled trial for treatment of resistant hypertension. J Hypertens. 2017; 35(2): 369–375.
- Beeftink MMA, Spiering W, De Jong MR, et al. Renal denervation beyond the bifurcation: The effect of distal ablation placement on safety and blood pressure. J Clin Hypertens (Greenwich). 2017; 19(4): 371–378.
