The aim of this study was evaluate stateArterial Reactivity (reserve and autoregulation) of brain (ARB) in patients with resistant hypertension after renal sympathetic denervation (RSD).Design and Method:
All participants of research have given the informed agreement. We used ultasonography of transcranial Doppler‘s method in the middle cerebral arteries (MCA) from temporal window. We studied the changes of flow Velocity mean (Vm) starting, during hypercapnia (HC) or hyperoxia (HO) (inhalation 2 min 4% mixture of carbonic gas (MCG) with air or 100% oxygen) and FmV in period of recovery (rec) (air-inhalation 2min) of 72 patients with resistant hypertension (BP > 160/100 mmHg despite three or more antihypertensive drugs), age 52,9 ± 8.8years, initially (i) and 24weeks after (a) RSD. We used Indexes of FVm: IFVm = (Vm0-Vm)/Vm0*100, Index of Recovery IR = Vm0/Vmrec, Speed Modification FVm – SM FVm = (Vm-Vm0)/120, coefficient - Normalized to Blood Pressure Answer NBPA = (Vm-Vm0)/(Vm0*(BP–BP0)) and ather. Vm0, BP0 are starting and Vm, BP are the parameters at period of inhalation, Vmrec is Vm after 120s - time of inhalation. RSD was done bilaterally using transfemoral access (8 ablation points, temperature control mode, target t = 600 C, power limit = 8watt, duration = 2min). The patients were instructed to maintain pharmacotherapy unchanged during the study.Results:
Patients had: initial 3types of ARB HO: normal 8.7%, abnormal reduced 23.6%, abnormal opposite 67.3%, after RSD - 42.6%, 33.3%, 20.4% and 2 types of ARB HC: normal 30.8%, abnormal reduced 69.2%, after RSD - 35.4%, 64.6% respectively. Parameters of ARB HO were i/a RSD: IFVm 5.2+-1.6/12.6+-2.4 p = 0.00, SM FVm 0.98+-0.26/-5.3+-1.4 p = 0.00, NBPA -0.48+-0.14/0.56+-0.09 p = 0.03. Parameters of ARB HC were i/a RSD: IFVm 24.7+-8.2/31.5+-12.8, p = 0.49 IR 1.51+-0.05/1.01 ± 0.02, NBPA 3.3+-0.2/8.4+-2.1.Conclusions:
Arterial Reactivity of brain was significant impaired for patients with resistant hypertension initial: normal, abnormal reduced, abnormal opposite types of reaction and these reaction changed and intensity and speed of the ARB improved after renal denervation.