Regression of left ventricular hypertrophy in patients with resistant hypertension after renal denervation: the role of hemodynamic and antifibrotic effects

Abstract

Aim. To study the features of regression of left ventricular hypertrophy and magnetic resonance changes of cardiac fibrosis in patients with resistant hypertension (RH) 1 year after renal denervation (RDN) in relation to changes in blood pressure (BP), the level of high-sensitivity C-reactive protein (hsCRP), matrix metalloproteinases 2, 9 (MMP-2, MMP-9), tissue inhibitor of metalloproteinase type 1 (TIMP-1).Material and methods. The study included 42 patients with true RH. The mean age of the patients was 59 (51; 62) years, while half were men. All patients took 3 or more antihypertensive drugs. At baseline and after 12 months, creatinine, hsCRP, MMP-2, MMP-9, TIMP-1 were determined, as well as 24-hour blood pressure monitoring, assessment of left ventricular mass (LVM) and contrast agent accumulation according to cardiac MRI. RDN was performed using Symplicity Fleх (n=18) and Symplicity Spyral (n=24) catheters in accordance with the manufacturer's instructions.Results. A year after RDN, a significant antihypertensive effect and a decrease in heart rate were noted. Sixteen patients (38,1%) reached the target office BP level. After 1 year, a significant decrease in the levels of hsCRP from 2,05 (1,04; 3,28) to 1,64 (0,96; 2,25) mg/l (p=0,045) and MMP-2 from 278,2 (240,9; 353,4) to 265,2 (221,2; 293,2) ng/ml (p=0,018) was detected. There was a trend towards an increase in TIMP-1 and a decrease in MMP-9. According to MRI 1 year after RDN, there was a tendency to increase the contrast agent volume, and there was a pronounced LVM decrease from 228 (180; 295,2) to 204 (169,8; 277) g (p=0,029). Correlation analysis revealed a direct connection between a decrease in LVM and a decrease in SBP and DBP levels, MMP-2 and MMP-9 levels. There was a relationship between a decrease in the contrast agent volume and an increase in TIMP-1 level (r=-0,64; p=0,04).Conclusion. A year after RDN, patients with RH show regression of left ventricular hypertrophy with a pronounced antihypertensive effect and a decrease in collagen production, which could also be significant for suppressing the myocardial fibrosis.