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Influence of Sympathetic Denervation of the Renal Artery on the Level of Arterial Blood Pressure, Cerebral Blood Flow and Cognitive Function In Patients With Resistant Arterial Hypertension

Efimova N. Yu., Lichikaki V. A., Lishmanov Yu. B.
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia

Keywords: brain perfusion; resistant arterial hypertension; cognitive function; renal sympathetic denervation; single photon emission computer tomography

DOI: 10.18087/cardio.2017.7.10003

Purpose. To study the effect of radiofrequency ablation of renal arteries on regional cerebral blood flow and cognitive function in patients with resistant arterial hypertension (AH). Material and methods. Transcatheter renal denervation (TRD) was performed in 17 patients with resistant AH. Examination before and after TRD included SPECT with mTc-HMPAO, 24-hours blood pressure (BP) monitoring, and comprehensive neuropsychological testing. Fifteen patients without angiographic signs of carotid atherosclerosis, coronary artery disease and AH, neurological and psychiatric disorders were investigated as control group. Results. Compared with control group patients with AH had decreases of regional cerebral blood flow (rCBF) in right (by 13.5%, p=0.00002) and left (by 15.5%, p=0.0006) inferior frontal lobes, in right temporal brain region (by 11.5%, p=0.008); in right and left occipital lobes (by 8.2%, p=0.04). In 6 months after TRD we observed significant improvement of cognitive function, parameters of 24-hour BP monitoring, and rCBF. We also noted definite close interdependence between changes of rCBF, indices of 24-hours BP monitoring, and dynamics of cognitive function. Improvement of long-term verbal memory correlated with increases of rCBF in left superior frontal and right occipital regions while dynamics of mentation and attention correlated positively with augmentation of rCBF in right posterior parietal region. Changes of perfusion in inferior parts of left frontal lobe and in right occipital region correlated with dynamics of index of diurnal diastolic hypertension time (R2=0.64, p=0.001, and R2=0.60, p=0.03, respectively). Conclusion. Our results suggest, that in patients with resistant AH positive effect of TRD on levels of 24-hour mean BP as well as on indices of BP load leads to in augmentation of rCBF and improvement of cognitive function.
  1. Amenta F., Di Tullio M.A., Tomassoni D. Arterial hypertension and brain damage – evidence from animal models (review). Clin Exp Hypertens 2003;25 (6): 359–380.
  2. Manolio T.A., Olson J., Longstreth W.T. Hypertension and cognitive function: Pathophysiologic effects of hypertension on the brain. Curr Hypertens Rep 2003;5:255–261.
  3. Vicario A., Martinez C.D. et al. Hypertension and cognitive decline: impact on executive function. J Clin Hypertens (Greenwich) 2005;7 (10):598–604.
  4. Shevchenko O. P., Prаskurnichy E. A., Yahno N. N., Parfenov V. A. Arterial hypertension and cerebral stroke. M.: Reafarm 2001. Russian (Шевченко О. П., Праскурничий Е. А., Яхно Н. Н., Парфенов В. А. Артериальная гипертония и церебральный инсульт. М.: Реафарм 2001).
  5. Collins R., Peto R., MacMahon S. et al. Blood pressure, stroke, and coronary heart disease. Part 2. Short-term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet 1990;335:827–839.
  6. Fabrigoule C., Rouch I., Taberly A. et al. Cognitive process in preclinical phase of dementia. Brain 199;121:135–141.
  7. Parati G., Esler M. The human sympathetic nervous system: Its relevance in hypertension and heart failure. Eur Heart J 2012;33:1058–1066.
  8. Krum H., Schlaich M., Whitbourn R. et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 2009;9671:1275–1281.
  9. Lassen N.A., Andersen A.R., Friberg L., Paulson O.B. The Retention of [99m-Tc]-d,l-HMPAO in the Human Brain after Intracarotid Bolus injection: A Kinetic Analysis. J Cerebral Blood Flow Metab 1988;8:13–22.
  10. Yonekura Y., Nishizawa S., Mukai T. SPECT with 99m-Tc-d,l-hexa-methyl propylene amine oxime (HM-PAO) compared with regional cerebral blood flow measured by PET. Effects of linearization. J Cerebral Blood Flow Metab 1988;8:82–89.
  11. Luria A. R. Higher cortical functions of man and their disturbances in local brain lesions. M.:1969; 504 p. Russian (Лурия А. Р. Высшие корковые функции человека и их нарушения при локальных поражениях мозга. М.:1969; 504 с.).
  12. Wechsler D. Wechsler Memory Scale-Revised. Manual. Psychological Corporation. New York. 1987. Wechsler D. Wechsler Memory Scale-Revised. Manual. Psychological Corporation. New York, 1987.
  13. Ghiadoni L., Panichi V., Versari D., et al. Markers of inflammation, endothelial function and blood pressure in untreated essential hypertensive patients. J Hypertens 2003;21:122.
  14. Zаlveyan N. A., Oshchepkova E. V., Bunyatyan M. S. et al. Circadian rhythm of blood pressure and the state of the target organs in patients with mild and moderate forms of hypertension. Ter arch 2001;2:33–38. Russian (Залвеян Н. А., Ощепкова Е. В., Бунатиян М. С. и др. Суточный ритм артериального давления и состояние органов-мишеней у больных с мягкой и умеренной формами гипертонической болезни. Тер арх 2001;2:33–38).
  15. Sander D., Klingelhofer J. Changes of circadian blood pressure patterns after hemodynamic and thromboembolic brain infarction. Stroke 1994;25:1730–1737.
  16. Efimova N. Y., Chernov V. I., Efimova I. Y. et al. Prevention of cerebral perfusion and neurocognitive dysfunction in patients with coronary artery disease undergoing coronary artery bypass grafting. Pathology circulation and cardiosurgery 2002;3:38–43. Russian (Ефимова Н. Ю., Чернов В. И., Ефимова И. Ю. и др. Профилактика нарушений мозговой перфузии и нейрокогнитивной дисфункции у больных ишемической болезнью сердца, перенесших аортокоронарное шунтирование. Патология кровообращения и кардиохирургия 2002;3:38–43).
  17. Chernov V. I., Efimova N. Y., Yefimovа I. Y. et al. Cerebral hemodynamics and cognitive function in the early and late periods after coronary bypass surgery. Angiology and Vascular Surgery 2004;10 (3):114–124. Russian (Чернов В. И., Ефимова Н. Ю., Ефимова И. Ю. и др. Состояние церебральной гемодинамики и когнитивной функции в ближайшие и отдаленные сроки после коронарного шунтирования. Ангиология и сосудистая хирургия 2004;10(3):114–124).
  18. Chernov V., Efimova N., Efimova I. et al. Short-term and long-term cognitive function and cerebral perfusion in off-pump and on-pump coronary artery bypass patients. Eur J Cardio-Thoracic Surgery 2006;29:74–81.
  19. Efimova N. Iu., Chernov V. I., Efimova I. Iu. et al. Cognitive dysfunction and brain perfusion in patients with arterial hypertension: possibilities of pharmacological therapy. Zh Nevrol Psikhiatr 2008;108 (11):10–15. Russian (Ефимова Н. Ю., Чернов В. И., Ефимова И. Ю. и др. Нейрокогнитивная дисфункция и состояние мозгового кровообращения у больных артериальной гипертонией, возможности медикаментозной коррекции. Журнал неврологии и психиатрии 2008;108 (11):10–15).
  20. Efimova I., Efimova N., Chernov V. et al. Ablation and Pacing: Improving Brain Perfusion and Cognitive Function in Patients with Atrial Fibrillation and Uncontrolled Ventricular Rates. PACE 2012;35:320–326.
  21. Kottke F.J., Kubicek W.G., Visscher M.B. The production of arterial hypertension by chronic renal artery-nerve stimulation. Am J Physiol 1945;145:38–47.
  22. Abramczyk P., Zwoliсska A., Oficjalski P. et al. Kidney denervation combined with elimination of adrenal-renal portal circulation prevents the development of hypertension in spontaneously hypertensive rats. Clin Exp Pharmacol Physiol 1999;26:32–34.
  23. Converse R.L. Jr, Jacobsen T.N., Toto R.D. et al. Sympathetic over activity in patients with chronic renal failure. N Engl J Med 1992;327:912–1918.
  24. Cohen S.L. Hypertension in renal transplant recipients: role of bilateral nephrectomy. Br Med J 1973;3:78–81.
  25. Smith H.W. Hypertension and urologic disease. Am J Med 1948;4:724–743.
  26. Afanasieva N. L., Pekarskiy S. E., Mordovin V. F. et al. The effects of transcatheter renal denervation on blood pressure and brain structural changes in resistant hypertension. Arterial hypertension 2013;19(3):257–262. Russian (Афанасьева Н. Л., Пекарский С. Е., Мордовин В. Ф. и др. Влияние транскатетерной денервации почечных артерий на уровень артериального давления и структурные изменения головного мозга у пациентов c резистентной артериальной гипертензией. Артериальная гипертензия 2013;19(3):257–262).
Efimova N. Yu., Lichikaki V. A., Lishmanov Yu. B. Influence of Sympathetic Denervation of the Renal Artery on the Level of Arterial Blood Pressure, Cerebral Blood Flow and Cognitive Function In Patients With Resistant Arterial Hypertension. Kardiologiia. 2017;57(7):27–34.

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