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

Objectives: Resistant hypertension (RHTN) is characterized by higher vascular damage by excess in arterial stiffness assessed by pulse wave velocity (PWV) and renal resistive index (RRI). RHTN is associated with increased renin-angiotensin-aldosterone system (RAAS) activity promoting vascular fibrosis. Aim of the study was to evaluate the link between vascular damage and plasma aldosterone concentration (PAC) in RHTN patients before and after renal denervation (RD). Methods: Consequent 25 patients (mean age 56 ± 10 years, 9 males) with confirmed true RHTN with standardized multidrug combination treatment underwent RD (Symplicity RDN System, Medtronic, USA). 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 (reference values 10–105 pg/ml) were determined by immunofluorescence method. Results: SBP and DBP dropped (−24.5/−13.2 mmHg, respectively; p < 0.05) a year after RDN. Arterial stiffness (PWV) improved 12 months after procedure (10.1 ± 1.8 to 9.3 ± 2.0 m/s, p < 0.05). RHTN patients characterized by rather high RRI at baseline and values remained 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). Delta PWV was associated both with decrease of PAC (r = 0.562, p = 0,04) and BP levels (r = 0.546, p = 0.03) with no association between RRI, PAC and BP. Conclusion: Effective treatment of RHTN improves vascular stiffness partly through decrease of BP and aldosterone levels. However no change in renal RRI detected without clear link to BP or RAAS activity.