Katarzyna Kostka-Jeziorny

Effect of allopurinol on blood pressure and aortic compliance in hypertensive patients

Abstract Background. Arterial hypertension is commonly associated with hyperuricemia. Several studies have shown that allopurinol reduces arterial blood pressure in animal models and in adolescent patients with newly diagnosed hypertension. Moreover, allopurinol has shown beneficial effects on endothelial function and arterial wave reflection in contrast to uricosuric agents. Antihypertensive drugs produce different effects on serum uric acid levels. Objective. The aim of the study was to evaluate the influence of allopurinol on blood pressure and aortic compliance in patients with arterial hypertension depending on hypotensive therapy with angiotensin-converting enzyme inhibitor (ACE-I) or thiazide diuretic, hypotensive drugs with distinct effects on serum uric acid levels and conversely, a positive influence on pulse wave velocity (PWV) in the aorta. Material and Methods. Sixty-six patients aged 25–70 (mean age 46.17 ± 10.89) with mild and moderate arterial hypertension diagnosed on the basis of office blood pressure, were studied. They were randomized to antihypertensive therapy on either perindopril (n = 35) or hydrochlorothiazide (n = 31). After 8 weeks of antihypertensive therapy, 150 mg of allopurinol daily was added for the next 8 weeks. Measurement of the serum uric acid level, PWV and 24-h ambulatory blood pressure monitoring (ABPM) were performed at baseline, after 8 weeks antihypertensive therapy and again after the final 8 weeks with the additional allopurinol. Results. No significant changes in systolic (SBP) and diastolic blood pressure (DBP) or ABPM were observed after allopurinol treatment in either of the subgroups receiving ACE-I or thiazide-based antihypertensive therapy. The mean PWV decreased from 10.7 ± 1.4 m/s to 10.0 ± 1.2 m/s (p = 0.00008) in the ACE-I-based therapy subgroup and from 11.5 ±1.7 m/s to 10.4 ± 1.5 m/s (p = 0.00002) in the thiazide-based therapy subgroup after treatment with allopurinol. However, significant correlations were found between PWV changes and the basic PWV (r = −0.52; p < 0.001) or SBP changes (r = 0.29; p < 0.019) after allopurinol treatment. Conclusions. Allopurinol does not produce additional antihypertensive effects in patients with treated arterial hypertension. Allopurinol increases aortic compliance independently of ACE-I or thiazide-based, antihypertensive therapy. However, this effect is significantly dependent on the initial PWV in the aorta and on SBP changes during allopurinol therapy.

Transient renal artery stenosis during renal sympathetic denervation in a patient with resistant hypertension.

A 52-year-old female was admitted to the Department of Hypertension with resistant hypertension coexistent with type 2 diabetes mellitus, two episodes of transient ischaemic attack in the past, and obesity. The patient’s arterial hypertension was uncontrolled on 6 antihypertensive medications, which included a loop diuretic and an aldosterone antagonist. During the course of the patient’s previous hospitalisation, secondary hypertension was excluded. Angio-computed tomography (CT) results showed a bilateral double renal artery with a diameter of the main trunks of more than 4 mm (corresponding angiography, Fig. 1). A denervation procedure Simplicity cathether (Medtronic) was applied. In the main left renal artery, 6 ablations were performed, with a mean impedance change of 8.82 (D,%) and temperature of 52°C without any complications. During the first ablation of the main right renal artery, with an impedance change of 20 (D,%) and a temperature of 75.3°C, oedema of the arterial wall with a significant stenosis of 80% occurred (Fig. 2). A local administration of nitroglycerine and verapamil (injected via a catheter) was ineffective. Due to the above, no further ablations have been performed. A follow-up arteriography of the right renal artery was performed 24 h later, showing a minimal stenosis in the previously affected area (corresponding angiography, Fig. 3). No clinical complications have been observed during this adverse event based on blood pressure parameters and control laboratory tests including serum creatinine level. A follow-up angio-CT of the right renal artery is scheduled in 3 months. Based on published papers, there have been no case reports of acute transient renal artery stenosis during renal denervation procedures. One case of a single structural renal artery stenosis, which occurred in the form of a late complication (i.e. after 6 months), was reported by Kaltenbach et al. (J Am Coll Cardiol, 2012; 60: 2694–2695).

Effects of renal sympathetic denervation on blood pressure and glycaemic control in patients with true resistant hypertension: results of Polish Renal Denervation Registry (RDN-POL Registry)

BACKGROUND AND AIM The assessment of percutaneous renal sympathetic denervation (RDN) efficacy in patients with true-resistant hypertension (true-RH) in a newly established net of Polish centres (RDN-POL Registry). METHODS AND RESULTS Forty-four patients with true-RH (23 men, mean age 52.3 years) with daytime systolic blood pressure (SBP) in ambulatory blood pressure monitoring (ABPM) ≥ 135 mm Hg, on ≥ three antihypertensive agents, including diuretic, underwent RDN and completed 12-month follow-up. Mean reductions of office SBP/diastolic blood pressure were -23.8/-10.0, -12.5/-4.6, and -12.6/-6.1 mm Hg at 3, 6, and 12 months, respectively (all significant except diastolic at 6 months). Diabetes was the only predictor of office SBP reduction at 6 months (OR 9.6, 95% CI 1.4-66.5, p < 0.05). Mean 24-h SBP change was -8.3 mm Hg at 6 months and -4.6 mm Hg at 12 months. Increased 2 h-glucose in oral glucose tolerance test was the only predictor of 24-h SBP reduction at 6 months (OR 1.24 for 10 mg/dL glucose increase, 95% CI 1.04-1.48, p < 0.05). At 12 months, 24-h SBP change predictors were: baseline office SBP (OR 4.93 for 10 mm Hg SBP increment, 95% CI 1.01-24.1, p < 0.05) and 2 h-glucose (OR 1.47, 95% CI 1.08-2.00, p < 0.05). In ABPM responders, significant reduction of 2 h glucose was found as compared to the non-responders (-45.8 vs. -7.7 mg/dL, p < 0.005). CONCLUSIONS The RDN-POL Registry demonstrated moderate blood pressure decrease after RDN. The predictors of blood pressure reduction were diabetes, 2 h-glucose, and baseline office SBP. Analysis of ABPM responders indicates a probable positive impact of RDN on glycaemic control.

Denervation of the renal arteries - what next ?

Katarzyna Kostka-Jeziorny, MD, PhD, graduated in medicine from the Jagiellonian University Medical College in Krakow and currently works at the Department of Hypertension, Angiology, and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland. She became a specialist in internal medicine in 2011 and a specialist in hypertensiology in 2013. Assistant Professor, Head of Laboratory of Functional Diagnostics of Arteries in the Department of Hypertensiology, Angiology, and Internal Medicine, and Coordinator of the study “RDN-Pol Registry” in Poznan. Her scientific research interests include resistant hypertension, renal denervation, hyperuricaemia in hypertension, central blood pressure, and chronotherapy of hypertension. She is a member of European Society of Hypertension, European Society of Cardiology, American Society of Hypertension, and ‘Club 30’ of the Polish Cardiac Society. She is the co-author of 2015 Guidelines for the Management of Hypertension Recommendations of the Polish Society of Hypertension.

Leki złożone w terapii nadciśnienia tętniczego w Polsce. Stanowisko Ekspertów Polskiego Towarzystwa Nadciśnienia Tętniczego oraz Sekcji Farmakoterapii Sercowo-Naczyniowej Polskiego Towarzystwa Kardiologicznego

Nadciśnienie tetnicze jest podstawowym modyfikowalnym czynnikiem ryzyka chorob sercowo-naczyniowych: choroby niedokrwiennej serca, udaru mozgu, niewydolności serca i choroby niedokrwiennej tetnic konczyn dolnych, a takze najistotniejszą epidemiologicznie przyczyną zgonow na świecie. Jednocześnie czestośc wystepowania nadciśnienia tetniczego w Polsce stale rośnie — wedlug badania NATPOL z 2002 roku — dotyczyla 29% populacji doroslych Polakow [1], w powtornym badaniu NATPOL 2011 wzrosla do 32% [2], a w badaniu WOBASZ II w 2014 roku wynosila juz 43% [3].

Aortic coarctation disclosed in a middle-aged hypertensive patient by tardus parvus waveform in renal Doppler ultrasonography

Address for correspondence: Łukasz Stryczyński, MD, PhD, Department of Hypertension, Angiology, and Internal Medicine, Poznan University of Medical Sciences, ul. Długa 1/2, 61–848 Poznań, Poland, e-mail: l.stryczynski@gmail.com Conflict of interest: none declared Kardiologia Polska Copyright

Effect of unilateral catheter-based renal sympathetic denervation in a patient with resistant hypertension.

A 52-year-old woman was admitted to the Department of Hypertension with resistant hypertension coexistent with type 2 diabetes mellitus, two episodes of transient ischaemic attack in the past, and obesity. The patient’s arterial hypertension was uncontrolled on six antihypertensive medications. A denervation procedure Simplicity cathether (Medtronic) was applied. In the main left renal artery, six ablations were performed without any complications. During the first ablation of the main right renal artery, oedema of the arterial wall with a significant stenosis of 80% occurred. Due to the above, no further ablations were attempted. A follow-up arteriography of the right renal artery was performed 24 h later, showing a minimal stenosis in the previously affected area. On the qualification visit, the average office blood pressure (BP) was 203.33/107.66 mm Hg, and on ambulatory BP monitoring mean BP was 189/109 mm Hg in the day and 139/77 mm Hg in the night. In the central BP measurement (Sphygmocor, AtCor Medical), systolic BP was 172 mm Hg, diastolic BP — 98 mm Hg, augmentation index (AIx) — 40, AIx standarised to a heart rate of 75 bpm (AIx@HR75) — 40% (Fig. 1A). In the follow-up visits after six and 12 months, we observed significant falls in all measured parameters (Table 1, Fig. 1B). There was no modification of antihypertensive therapy in the follow up. There are just a few publications concerning unilateral renal denervation, and the presented results are contradictory. The measurement of central BP in hypertensive patients is of increasing interest because of both its predictive value for cardiovascular events and the differential effect of antihypertensive therapies compared to brachial BP. In our opinion, central BP should be considered as a valuable and objective marker of the effectiveness of invasive therapies. Our case shows that even unilateral renal ablation can be fully successful and decrease BP values to a remarkable extent in a 12 month observation.

2015 Guidelines for the Management of Hypertension. Part 8

Recommendations of the Polish Society of Hypertension Experts: Marcin Adamczak, Ludwina Szczepaniak-Chichel, Marzena Chrostowska, Danuta Czarnecka, Grzegorz Dzida, Krzysztof J. Filipiak, Jerzy Gąsowski, Jerzy Gluszek, Stefan Grajek, Tomasz Grodzicki, Kalina Kawecka-Jaszcz, Beata Wozakowska-Kaplon, Beata Begier-Krasinska, Jacek Manitius, Malgorzata Myśliwiec, Anna Niemirska, Aleksander Prejbisz, Danuta Pupek-Musialik, Grazyna Brzezinska-Rajszys, Katarzyna Stolarz-Skrzypek, Agnieszka Szadkowska, Tomasz Tomasik, Krystyna Widecka, Andrzej Wiecek, Adam Windak, Jacek Wolf, Tomasz Zdrojewski, Aleksandra Żurowska