RENAL SYMPATHETIC DENERVATION AS TREATMENT FOR REFRACTORY HYPERTENSION: CASE REPORT. (June 2022)

• Record Type: Journal Article
• Authors: Paffer, Matheus Toscano; Paffer, Pedro Toscano; Procópio, Arthur; Ribeiro, Fernando; Montenegro, Gabriela; Montenegro, Patrícia
• Is Part Of: Journal of hypertension. Volume 40(2022)Supplement 1
• Page Start: e233
• Page End: e234
• Publication Date: 2022-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000837868.89921.23
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Among hypertensive patients, a portion is considered refractory hypertension, where the pressure remains uncontrolled with the use of five or more antihypertensive drugs. For such patients with refractory hypertension, a new hemodynamic procedure has been gaining ground in recent years, being performed in selected cases, the renal sympathetic denervation. We present the case of Mr. GAS, 55 years old. Design and method: GAS, male, 55 years old, BMI of 33.95, hypertensive for a long, was refractory to drug treatment, using 7 antihypertensive drugs. At the admission, laboratory tests, he presented potassium of 4, sodium of 141, blood urea nitrogen of 31 and creatinine of 1.4. The admission BP was 130x80 mmHg. On September 25, 2021, the procedure was performed through percutaneous access in the right femoral artery, up to the renal arteries, with the Simplicity catheter. Thirty-one ablations were performed in the right kidney and 28 ablations in the left kidney. Soon after the procedure, the patient had a blood pressure of 116x69mmHg and at discharge it was 120x80mmHg. The patient was discharged with 3 antihypertensive drugs and maintains follow-up with maintenance of the discharge prescription so far. Results: Hypertension refractory to drug treatment showed the need for an alternative treatment leading to the development of radiofrequency renal denervation. The procedure consists of applying radiofrequency in the lumen of the renal arteries, leading to thermal rupture of the postganglionic sympathetic nerves that innervate the kidneys. Its goal is to reduce the renal efferent activity, with an increase in blood flow in the kidneys, decreasing the activation of the renin-angiotensin-aldosterone system and water retention. Conclusions: In the present report, the patient on admission was not out of control, but also had a high antihypertensive load, in order to maintain pressure control. Renal sympathetic denervation can provide a better quality of life to the patient, since in some cases, it can reduce the amount of medication and also the chance of future problems, such as target organ damage, heart attack and stroke. Proving to be a good option, in selected cases in patients with refractory hypertension.