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to define and develop a procedure that can select patients with resistant hypertension (RH) for a renal sympathetic denervation (RSD) procedure, by being orienting to the specific initial values of β-adrenoreactivity (β-AR) and systolic blood pressure (SBP).The analysis included 23 RH patients receiving the maximally tolerable doses of 4 antihypertensive drugs. The investigations involving BP control and a Russian spectrophotometric procedure for determining β-AR in terms of the change in the osmoresistance of erythrocyte membranes (EM) were performed at baseline and 4 and 24 weeks. RSD was carried out using endovascular radiofrequency ablation of the renal arteries. The therapy was not changed during the observation.If SBP was170 mm Hg and β-AR of EM40 conditional units (CUs) at baseline, ΔSBP was 17.68±3.24 mm Hg and the efficiency of RSD was 100%. When SBP was170 mm Hg and β-AR of EM40 CUs at baseline, ΔSBP was 0.97±4.21 mm Hg (p0.05) and the efficiency of RSD was low.The overall estimate of baseline SBP and β-AR of EM in patients with RH could determine the expediency of the RSD procedure in order to lower BP. The proposed procedure can optimize the selection of patients and enhance the efficiency of RSD in the treatment of RH.Цель исследования. Разработать способ, позволяющий проводить отбор пациентов с резистентной артериальной гипертонией (РАГ) для процедуры симпатической денервации почек (СДП), ориентируясь на конкретные исходные показатели β-адренореактивности (β-АР) и систолического артериального давления (САД). Материалы и методы. В анализ включили 23 пациентов с РАГ, получавших максимально переносимые дозы 4 антигипертензивных препаратов. Исследования, включая контроль АД и отечественный спектрофотометрический метод определения β-АР по изменению осморезистентности эритроцитарных мембран (ЭМ), проведены исходно, через 4 и 24 нед. СДП осуществляли путем эндоваскулярной радиочастотной абляции почечных артерий (ПА). Терапия в процессе наблюдения не менялась. Результаты. В случае, если исходно САД170 мм рт.ст. и β-АР ЭМ40 усл. ед., то ΔСАД составило –17,68±3,24 мм рт.ст., а эффективность СДП 100%, при исходном САД170 мм рт.ст. и β-АР ЭМ40 усл. ед. ΔСАД составило 0,97±4,21 (p0,05) и эффективность СДП была низкой. Заключение. Суммарная оценка исходных САД и β-АР ЭМ у больных РАГ позволила определить целесообразность проведения процедуры СДП с целью снижения АД. Предлагаемый способ дает возможность оптимизировать подбор пациентов и повысить эффективность применения СДП при лечении РАГ.

Effective treatment of uncontrolled hypertension using catheter-based percutaneous renal denervation may depend strongly on the anatomic strategy applied when delivering therapy. We hypothesized that concentering renal denervation treatment in the distal region of the artery would improve clinical response.We conducted a single-center, double-blind, randomized, controlled, and parallel group study (ClinicalTrials.gov NCT02667912). Fifty-one treatment-resistant hypertensive patients meeting guideline indications were randomized either to 'conventional' treatment restricted to the main renal artery (n = 26) or to 'distal' treatment applied mainly in the distal branches beyond the main bifurcation (n = 25). Computer-based treatment assignment was performed in the catheterization laboratory at the time of the procedure by the interventional radiologist and remained unknown to patients, investigators, and other outcomes assessors for the entire study period. Six months after randomization, the distal therapy group (n = 24) had a significantly greater decrease in the primary outcome, 24-h mean ambulatory SBP, as compared with the conventionally treated group (n = 21): -22.6 ± 20.0 vs -9.4 ± 18.7 mmHg; P less than 0.05. No major safety issues were observed in either group.Percutaneous renal denervation treatment was significantly less effective at lowering 24-h blood pressure in treatment-resistant hypertensive patients when therapy was applied conventionally in the trunk of renal artery as compared with when applied to distal segmental branches. This observation is in accordance with previous surgical and anatomical findings showing that most renal nerve fibers are distant from the lumen proximally and become available for endovascular treatment mainly in the distal portion of the vessel.

Background Software programs sold with ambulatory blood pressure monitoring (ABPM) devices are designed to use some set 'typical' night-time (e.g. 2300-0700) to estimate daytime/night-time blood pressure (BP) with limited accuracy. Alternative use of individual periods of sleep/wakefulness from patient diaries is time consuming and subjective. We developed a simple mathematical algorithm for the detection of the 'night-time' as a period of low values in diurnal profiles of heart rate (HR) allowing accurate automatic analysis of daytime/night-time blood pressure. To test this technique we designed a software application allowing automatic analysis of ABPM data based on the different night-time definitions, including the developed algorithm and compared reproducibility of the degree of BP dipping produced by the different methods across two days of 48-h ABPM. Methods A 48-h ABPM study was performed in 33 patients with uncomplicated stage II hypertension. Means and standard deviations (SD) of the differences in the degree of BP dipping between two 24-h periods of 48-h ABPM were obtained separately for three methods of night-time definition: automatic detection from individual HR profiles, fixed 2300-0700 h interval and sleep time from patient diaries. Results Reproducibility of the BP dip estimation across 2 days of BP monitoring was significantly better for night-time detected from individual HR profiles than for the fixed 2300-0700 h interval or sleep time from diary. The SD of the differences was 6.7/8.2 compared with 13.5/18.3 and 13.0/14.8 respectively (systolic BP/diastolic BP, mmHg). Conclusions Implementation of the developed method of night-time definition may significantly improve automatic analysis of ABPM data.

Objective:The aim of the study is to evaluate the glycemic control dynamics depending on degree of blood pressure (BP) reduction after 6 months of transcatheter renal denervation (TRD) of patients with true resistant hypertension (RH) and type 2 diabetes mellitus (T2DM).Design and method:Thirty two

Objective: We wished to assess the relationship between the plasma concentrations of matrix metalloproteinases (MMP) and their tissue inhibitors with intrarenal vascular resistance level, renal function and development of microalbuminuria in patients with resistant hypertension (RH) and type 2 diabetes mellitus (DM). Design and Method: A total of 18 patients with RH and type 2 DM were included in the study (mean aged 58.6 ± 7.5 years, 6 male, office blood pressure (BP) 174.4 ± 20.2/94.1 ± 15.2 mmHg, basal glycaemia 8.8 ± 2.3 mmol/L, HbA1c 6.8 ± 0.7%, an estimated glomerular filtration rate (eGFR) 74.2 ± 27.9 mL/min/1.73m 2), which submitted to office BP measurements, renal Doppler ultrasound and laboratory tests to assess microalbuminuria (defined as 30–300 mg/24 h), eGFR (MDRD formula), HbA1c and basal glycaemia levels, plasma concentrations of MMP-9, MMP-2, tissue inhibitor of MMP type 1 (TIMP-1). Results: Decreased MMP-9 concentration was linearly associated with increased resistive index (RI) in renal arteries (in the main renal arteries: R = −0.60, p = 0.009 (right), R = 0.−60, p = 0.008 (left); in segmental arteries: R = −0.49, P = 0.038 (right) and R = −0.59, P = 0.012 (left)), while growth of TIMP-1/MMP-9 ratio was positively correlated with RI at segmental arteries (R = 0.51, R = 0.028- on the right, R = 0.46, P = 0.04- on the left). Additionally, decreased MMP-9 concentration was linearly associated with decreased eGFR (R = 0.53, P = 0.029). No correlation was observed between MMP-2, MMP-9, TIMP-1, TIMP-1/MMP-9, TIMP-1/MMP-2 ratios and microalbuminuria, however, microalbuminuric patients had a higher TIMP-1/MMP-2 ratio than normoalbuminuric patients (2.97(2.15–3.80) and 1.58(1.39–1.99)ng/mL, accordingly, P = 0.026). Besides, microalbuminuric patients had a higher TIMP-1/MMP-2 ratio than normoalbuminuric patients [2.97 (2.15–3.80) and 1.58 (1.39–1.99), accordingly, P = 0.026)]. Conclusions: In patients with RH and type 2 DM the decreased MMP-9 activity and increased TIMP-1/MMP-9 ratio are associated with growth of intrarenal vascular resistance and decline of renal filtration function. Furthermore, increased TIMP-1/MMP-2 ratio in these patients was due primarily to increase in basal glycaemia level and linked to development of microalbuminuria.