Meeting of the Balkan Excellent Centers The Greek
Meeting of the Balkan Excellent Centers “The Greek experience of Renal Denervation in resistant hypertension” K. Dimitriadis, Ph. D, FESC Consultant Cardiologist First Cardiology Clinic, University of Athens, Hippokration Hospital
Abstract n The first renal denervation (RDN) procedures in Greece were performed in the First Cardiology Clinic, University of Athens, Hippokration Hospital by Prof. Costas Tsioufis in patients with severe drug-resistant hypertension. 1 During the last 5 years numerous patients have undergone RDN in this center which participates in international studies and registries and important experience has been gathered regarding the safety and efficacy of this interventional therapy. In an attempt to identify responders to RDN therapy in an animal setting, we have shown that RDN causes an acute and chronic alteration in renal blood flow as well as resistive index, 2 whereas stimulation of the renal arteries did not lead to augmentation of blood pressure (BP) in swines in contrast to previous reports. 3 The Hippokration Hospital was also one of the few centers globally for the Enlig. HTN I study the first-in-human study with the use of the multielectrode RDN catheter. From this population important papers regarding the effect of RDN besides BP, 4 on left ventricular mass with up to 24 months follow-up have been published. 5, 6 In Greece, the Hellenic Cardiological Society and the Working Group Hypertension and the Heart of the Society have organized a national registry on patients with resistant hypertension under the name Herhodotos with data on more than 300 cases providing a useful insight into the characteristics of potential candidates for RDN. Additionally, the Greek RDN registry has taken place in 4 Greek hospital centers including patients with drug resistant hypertension. In this “real-world’ multicenter national registry, the efficacy of renal denervation in reducing BP as well as safety is proven during a 12 months follow-up. Moreover, younger age and higher levels of baseline office systolic BP are independently related to better BP response to RDN.
RDN in Greece First Cases in Hippokration Hospital in 2011 n 2 cases of patients with RHT n
Renal Sympathetic Denervation The Greek experience in the Hippocration Hospital Clinical and pre-clinical Global Simplicity Registry Enlig. HTN I (FIM) Enlig. HTN II MS study Greek RDN registry
Animal studies for indentification of reliable markers of intra-procedural success Tsioufis C, Papademetriou V, Dimitriadis K et al. Int J Cardiol 2012 Tsioufis C, et al. Int J Cardiol 2014
ENLIGHTN I study 6 months post RDN: Worthley, Tsioufis, et al. Eur Heart J. 2013 12 months post RDN : Papademetriou, Tsioufis, et al. Hypertension 2014 24 months post RDN : Tsioufis, Papademetriou, Dimitriadis K et al. Int J Cardiol 2015
Results: LV Mass Index Tsioufis C, Papademertriou V, Dimitriadis K, et al. J Hypertens. 2015
LV hypertrophy status changes • After RDN, the number of patients with concentric LV hypertrophy (decreased from 16 patients (80%) at baseline to 10 patients (50%) at 12 months, and to 7 patients (36. 8%) at 24 months 8 CONFIDENTIAL-Do not distribute Tsioufis C, Papademetriou V, Dimitriadis K, et al. J Hum Hypertens 2016
RDN in MS patiens C. Tsioufis, K. Dimitriadis, A. Kasiakogias, et al. ESH 2016
The first Greek registry of patients with Resistant Hypertension Endorsed by the Hellenic Cardiac Society and the WG of Hypertension and the Heart
HERHODOTOS REGISTRY Excellence centers n Till today >300 pts registered n RHT pts Parameter Age (years) Gender (males%) (n=320) 56 10 51 BMI (kg/m 2) 30. 1 3. 8 Waist (cm) 103. 1 13. 3 Smoking (%) 26 Creatinine (mg/dl) 1 0. 5 Duration of hypertension (years) 14. 7 7
HERHODOTOS REGISTRY Patients with resistant hypertension Parameter (n=320) Systolic office BP(mm. Hg) 157 17 Diastolic office BP (mm. Hg) 87 12 Office HR (bpm) 70 19 24 h Systolic BP (mm. Hg)* 149 15 24 h Diastolic BP (mm. Hg)* 85 9 Home systolic BP (mm. Hg) 148 18 Home diastolic BP (mm. Hg) 84 10
HERHODOTOS REGISTRY Patients with Parameter resistant hypertension (n=320) Number of drugs 4. 4 ACE-i (%) 41 ARBs (%) 61 Renin-i (%) 9 CCBs (%) 70 Diuretics (%) 90 b-blockers(%) 64 Aldosterone antagonists (%) 19 α-blockers (%) 3 Centrally acting (%) 31
Greek RDN registry n 4 centers in Greece Athens-Hippokration Hospital C. Tsioufis n Heraklion Crete M. Marketou n Patras P. Davlouros n Τhessaloniki A. Ziakas n
Greek RDN registry: Baseline characteristics RDN pts Parameter Age (years) Gender (males%) (n=68) 58 10 49 BMI (kg/m 2) 33. 1 5 Waist (cm) 104. 1 11. 3 Smoking (%) 30 Creatinine (mg/dl) 1 0. 4 Duration of hypertension (years) 9. 1 4
Greek RDN registry: Baseline BP RDN pts Parameter (n=68) Systolic office BP(mm. Hg) 174 17 Diastolic office BP (mm. Hg) 95 13 Office HR (bpm) 70 19 24 h Systolic BP (mm. Hg) 158 17 24 h Diastolic BP (mm. Hg) 90 13 24 h HR (bpm) 70 19
Greek RDN registry: Baseline therapy Patients with Parameter resistant hypertension (n=68) Number of drugs 4. 1 RAAS blockade (%) 85 Renin-i (%) 3 CCBs (%) 78 Diuretics (%) 90 b-blockers(%) 68 Aldosterone antagonists (%) 32 α-blockers (%) 5 Centrally acting (%) 28
Office and ambulatory SBP after RDN at 6 and 12 months -30 mm. Hg -29 mm. Hg -13 mm. Hg -12 mm. Hg
Office and ambulatory DBP after RDN at 6 and 12 months -12 mm. Hg -11 mm. Hg -10 mm. Hg -9 mm. Hg
BP response to RDN 85% (59 pts) with an at least 10 mm. Hg office SBP reduction n Patients that were RDN responders (85%, n=58), compared to non-responders were younger (57± 9 vs 65± 8 years, p<0. 05), had higher baseline office systolic BP (176± 17 vs 160± 11 mm. Hg, p<0. 05) and 24 h systolic BP (159± 13 vs 149± 11 mm. Hg, p<0. 05). n
Correlation of office BP reduction at 12 months with baseline office BP r=0. 402, p=0. 008
Correlation of 24 h SBP reduction at 12 months with baseline 24 h SBP r=0. 3673 p=0. 027
ESH excellence centers Collaborate n Exchange experiences n In order to improve delivered therapies in the field of RDN
Thank you
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