Features of brain magnetic resonance imaging (MRI) changes under the influence of renal denervation in patients with resistant hypertension

Abstract

Aim. To study brain magnetic resonance imaging (MRI) changes in patients with resistant hypertension (HTN) after renal denervation (RD) and its cerebral protection effectiveness.Material and methods. The study included 111 patients, of whom 50 were men (45%) and 61 were women (55%), who underwent RD. The mean number of antihypertensive drugs taken regularly was 4,1±1,1. All patients underwent brain MRI and 24-hour ambulatory blood pressure monitoring before and after renal denervation. The data were statistically processed using Statistica 10,0 software.Results. After RD, a pronounced antihypertensive effect was observed with a significant reduction in systolic and diastolic blood pressure by 10,3/5,5 and 13,1/7,3 mm Hg at 6 and 12 months, respectively. Office blood pressure, daytime, and nighttime blood pressure levels also decreased (p<0,001). According to MRI data after RD, a decrease in the relative number of patients with I and II degree cerebrospinal fluid circulation changes and an increase in the proportion of patients without detected pathology were noted, but no significant difference in the obtained results was found. A decrease in the linear dimensions of brain ventricles was observed, including a reduction in the size of the left posterior horn of the lateral ventricle (p=0,03) and the third ventricle diameter (p=0,02) at 6 months after RD. At 12 months, the sizes of the anterior horn (p=0,04) and left lateral ventricle body (p=0,017) decreased. A positive effect of RD on the linear dimensions of cerebrospinal fluid system was noted, manifested by a decrease in the mean size of frontal subarachnoid spaces (p=0,028). No significant changes in the frequency and degree of focal lesions and lacunar infarcts were observed after RD (p>0,05).Conclusion. RD contributes to a significant decrease in blood pressure levels and exerts a cerebral protective effect by reducing lateral brain ventricles, subarachnoid spaces, and absence of ischemia progression and intracranial hypertension after intervention.