| Abstract | UVOD: Rezistentna hipertenzija definirana je nemogućnošću uspostavljanja ciljnih vrijednosti arterijskog tlaka unatoč terapiji barem trima antihipertenzivnim lijekovima različitih skupina (od kojih je jedan diuretik) u kombinacijama i najvišim tolerabilnim dozama. Osim farmakološkog liječenja bolesnike s refraktornom rezistentnom hipertenzijom,p otvrđenom suradljivosti te prethodno isključenim sekundarnim uzrocima arterijske hipertenzije podvrgava se postupku denervacije renalnog pleksusa. Prema smjernicama ESH 2018 mjerenje krutosti žila se direktno povezuje s kardiovaskularnim rizikom. ----- CILJEVI RADA: Cilj ovog istraživanja bio je prikazati vrijednosti mjerenja krutosti krvnih žila kao metodu praćenja ishoda renalne denervacije u bolesnika s refraktornom rezistentnom hipertenzijom. ----- ISPITANICI I METODE: Ovo istraživanje uključivalo je 10 bolesnika s refraktornom rezistentnom hipertenzijom koji su bili praćeni nakon zahvata renalne denervacije. Prva skupina je višemjesečno praćena (do 12 mjeseci), dok je druga skupina višegodišnje praćena (do 4 godine). Bolesnicima je krutost žila mjerena uređajem „Agedio B900“ koji radi na principu oscilometrije. ----- REZULTATI: U prvoj skupini (6 bolesnika) prosječna dob bila je 58,33 godina. Prosječna vrijednost krutosti žila mjerena brzinom pulsnog vala prije renalne denervacije iznosila je 9,80 m/s te pokazuje pad u narednim mjerenjima kako slijedi: 8,85 m/s (1 mj., p=0,04), 8,70 m/s (6 mj., p=0,03) te 8,53 m/s (12 mj., p=0,02). Drugu skupinu činile su 4 bolesnice prosječne dobi 61,75 godina. Prosječna vrijednost brzine pulsnog vala 2 godine nakon renalne denervacije iznosila je 9,92 m/s te dalje kako slijedi: nakon 3 godine 9,87 m/s (p=0,97) te nakon 4 godine 9,32 m/s (p=0,54). ----- ZAKLJUČAK: Renalna denervacija kao dodatna metoda kontrole arterijskog tlaka ima dugoročne pozitivne učinke povrh sniženja arterijskog tlaka u smislu sniženja krutosti žila kroz više godina. Krutost žila mjerena brzinom pulsnog vala dokazan je marker povišenog kardiovaskularnog rizika i moguć je marker praćenja ishoda denervacije renalnog pleksusa. |
| Abstract (english) | INTRODUCTION: Resistant hypertension is defined by blood pressure that remains above goal in spite of concurrent use of three antihypertensive agents of different classes (one of the three should be a diuretic) in correct combination and at maximally tolerated doses. Other than pharmacological treatment, patients with reftractory resistant hypertension whose compliance has been confirmed are suitable for the treatment of renal denervation, when potential causes of secondary hypertension have been excluded. According to ESC/ESH 2018 Guidelines measurement of vascular stiffness is directly linked to cardovascular risk. ----- AIM: The aim of this study was to demonstrate the measurement values of vascular stiffness as a method for monitoring the outcome of renal denervation in patients with refractory resistant hypertension. ----- PATIENTS AND METHODS: This study included 10 patients with refractory resistant hypertension who were observed after the procedure of renal denervation. The first group was assessed for up to 12 months after the procedure while the second group was assessed for up to 4 years. Vascular stiffnes was measured for all patients with device “Agedio B900“ which operates on the principle of oscillometry. ----- RESULTS: Average age of the first group (6 patients) was 58.33 years. Average group vascular stiffness measured as pulse wave velocity before renal denervation was 9.80 m/s and after 1, 6 and 12 months the results were respectively: 8.85 m/s (1 mj., p=0.04), 8.70 m/s (6 mj., p=0.03) and 8.53 m/s (12 mj., p=0.02). Average age of the second group (4 patients) was 61.75 years. Average group pulse wave velocity 2 years after renal denervation was 9.92 m/s and after 3 and 4 years the results were respectively: 9.87 m/s (p=0.97) and 9.32 m/s (p=0.54). ----- CONCLUSION: Renal denervation as an additional method for blood pressure control has long-term positive effects in lowering arterial blood pressure and decreasing vascular stiffness. Vascular stiffness measured as pulse wave velocity is established as a risk factor for cardiovascular morbidity and is a possible method for measuring the outcome of renal denervation. |
