Systemic Microvascular Function in Patients With Resistant Hypertension After Renal Sympathetic Denervation

Overview

It has been proposed that the modulation of the activity of the sympathetic nervous system, through renal sympathetic denervation, besides reducing blood pressure, would promote an improvement in vascular reactivity and consequent improvement of macro and microcirculation. The present study aimed to investigate the influence of the renal sympathetic denervation on the skin microvascular function of patients presenting with resistant arterial hypertension.

Full Title of Study: “Evaluation of Systemic Microvascular Density and Endothelial Function in Patients With Resistant Hypertension After Renal Sympathetic Denervation”

Study Type

  • Study Type: Observational [Patient Registry]
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: January 6, 2020

Detailed Description

Arterial hypertension is still a serious public health problem with considerable social and economic impact. Arterial hypertension is the result from a complex interaction between environmental and genetic factors that initiate and perpetuate elevated blood pressure. Studies show that about 10% of patients undergoing treatment have resistant hypertension, defined as high blood pressure refractory to at least three antihypertensive drugs. It is known that the sympathetic nervous system plays a fundamental role in the pathophysiology of hypertension, contributing to metabolic and vascular changes. The sympathetic nervous system has also a major role in the pathophysiology of arterial hypertension. Arterial hypertension has also been associated with functional microcirculatory alterations as well as systemic microvascular endothelial dysfunction in hypertensive patients, confirmed by different microcirculatory flowmetry techniques. In this context, it has been proposed that the modulation of the sympathetic nervous system through renal sympathetic denervation, besides reducing blood pressure, would promote an improvement in vascular reactivity and consequent improvement of macro and microcirculation. The present study aimed to investigate the influence of the renal sympathetic denervation on the skin microvascular function of patients with resistant hypertension.

Interventions

  • Procedure: Renal sympathetic denervation
    • Transcutaneous renal sympathetic denervation

Clinical Trial Outcome Measures

Primary Measures

  • Cutaneous microvascular reactivity
    • Time Frame: Before and one, three, six and twelve months after intervention
    • Evaluation of microvascular reactivity using laser speckle contrast imaging
  • Cutaneous microvascular flow
    • Time Frame: Before and one, three, six and twelve months after intervention
    • Evaluation of the microvascular flow using laser speckle contrast imaging

Secondary Measures

  • Cutaneous capillary density
    • Time Frame: Before and one, three, six and twelve months after intervention
    • Evaluation of cutaneous capillary density and reactivity using video-capillaroscopy

Participating in This Clinical Trial

Inclusion Criteria

  • Resistant arterial hypertension under pharmacological treatment Exclusion Criteria:

  • secondary arterial hypertension – renal dysfunction – severe kidney disease – congestive heart failure

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 80 Years

Investigator Details

  • Lead Sponsor
    • National Institute of Cardiology, Laranjeiras, Brazil
  • Provider of Information About this Clinical Study
    • Principal Investigator: Eduardo Tibirica, MD, PhD, MD, PhD – National Institute of Cardiology, Laranjeiras, Brazil
  • Overall Official(s)
    • EDUARDO V TIBIRICA, MD, PhD, Principal Investigator, National Innstitute of Cardiology

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