Systemic Microvascular Function in Patients With Resistant Hypertension After Renal Sympathetic Denervation

Study Overview
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Brief Summary
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It has been proposed that the modulation of the activity of the sympathetic nervous system, through renal sympathetic denervation, besides reducing blood pressure, would promote an improvement in vascular reactivity and consequent improvement of macro and microcirculation. The present study aimed to investigate the influence of the renal sympathetic denervation on the skin microvascular function of patients presenting with resistant arterial hypertension.

Detailed Description
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Arterial hypertension is still a serious public health problem with considerable social and economic impact. Arterial hypertension is the result from a complex interaction between environmental and genetic factors that initiate and perpetuate elevated blood pressure. Studies show that about 10% of patients undergoing treatment have resistant hypertension, defined as high blood pressure refractory to at least three antihypertensive drugs. It is known that the sympathetic nervous system plays a fundamental role in the pathophysiology of hypertension, contributing to metabolic and vascular changes. The sympathetic nervous system has also a major role in the pathophysiology of arterial hypertension. Arterial hypertension has also been associated with functional microcirculatory alterations as well as systemic microvascular endothelial dysfunction in hypertensive patients, confirmed by different microcirculatory flowmetry techniques. In this context, it has been proposed that the modulation of the sympathetic nervous system through renal sympathetic denervation, besides reducing blood pressure, would promote an improvement in vascular reactivity and consequent improvement of macro and microcirculation. The present study aimed to investigate the influence of the renal sympathetic denervation on the skin microvascular function of patients with resistant hypertension.

Official Title
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Evaluation of Systemic Microvascular Density and Endothelial Function in Patients With Resistant Hypertension After Renal Sympathetic Denervation

Conditions
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Arterial Hypertension, Resistant Arterial Hypertension

Intervention / Treatment
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* Procedure: Renal sympathetic denervation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Resistant arterial hypertension under pharmacological treatment Exclusion Criteria: secondary arterial hypertension renal dysfunction severe kidney disease congestive heart failure

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Renal sympathetic denervation|Transcutaneous renal sympathetic denervation|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cutaneous microvascular reactivity | Evaluation of microvascular reactivity using laser speckle contrast imaging | Before and one, three, six and twelve months after intervention | 
| Cutaneous microvascular flow | Evaluation of the microvascular flow using laser speckle contrast imaging | Before and one, three, six and twelve months after intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cutaneous capillary density | Evaluation of cutaneous capillary density and reactivity using video-capillaroscopy | Before and one, three, six and twelve months after intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Arterial hypertension, Microcirculation, Sympathetic nervous system