The impact of renal denervation on diastolic function in patients with resistant hypertension and heart failure with preserved ejection fraction
A Moiseeva, A Caraus, M Abras, N CiobanuAbstract
Background
It is well established that sympathetic nervous system (SNS) hyperactivity is a crucial pathophysiological link in resistant hypertension and the progression of heart failure. Currently, the role of central and peripheral sympatholytic agents in modulating this activity is well documented. Simultaneously, an increasing number of clinical trials provide evidence of reduced SNS activity following renal denervation. While the impact of renal denervation on blood pressure levels is already well-studied, there is still limited evidence regarding its efficacy in the clinical course of heart failure.
Purpose
Comparable evaluation of effects of renal denervation versus sympathetic nervous system blockers on diastolic function in patients with resistant hypertension and heart failure with preserved ejection fraction.
Methods
The study enrolled 125 patients with resistant hypertension and HFpEF. All patients received a 4-week standardized outpatient treatment with Losartan 100 mg, Amlodipine 10 mg and Indapamide 1.5 mg to meet the diagnostic criteria for resistant hypertension. After confirming treatment resistance patients were randomly assigned to three research groups based on the treatment added to the previous regimen: Group I (50 patients) – selective I1-imidazoline receptor agonist Moxonidine, Group II (50 patients) – cardioselective beta-blocker Bisoprolol, and Group III (25 patients) – renal denervation (RDN). Patients were evaluated by echocardiography at baseline, 6, 12 and 24 months of follow-up. Renal denervation was performed in the main renal arteries and their branches.
Results
Improvement of all diastolic function parameters was noted beginning from the early evaluation stages in all three observation groups, with the maximal effect recorded toward the end of the study. Thus, the E/A ratio increased modestly without statistical significance between groups. At the same time, eₘ′ velocity rose significantly in all groups (p < 0.001), group III showing the greatest enhancement. E/eₘ′ ratio declined steadily (p < 0.001), reflecting reduced LV filling pressures, most pronounced in RDN group. LAVI decreased gradually, indicating improved atrial compliance, wheareas TR velocity fell slightly, suggesting lower pulmonary pressures, with no significant differences among groups (Table 1).
Conclusion
Long-term follow-up demonstrated progressive improvement in diastolic function across all treatment groups. While atrial remodeling and pulmonary pressure reduction were comparable, renal denervation group exhibited the most robust enhancement in myocardial relaxation and pressure unloading, highlighting its potential superiority in diastolic recovery.For image description, please refer to the figure legend and surrounding text.