Caso Clínico: Denervación renal en paciente con hipertensión arterial de muy difícil control.

Presentación del caso:

Paciente de 56 años de edad, remitida a consulta de Riesgo Vascular por crisis hipertensivas.

A. Personales:
Hipertensión arterial diagnosticada hace 5-6 años.
Miolipomas adrenales en seguimiento por Endocrinología, no funcionantes.
Apnea del sueño en tratamiento con CPAP. No suele utilizarla.
Hábitos tóxicos: Fumadora activa desde los 13 años de 1-2 paquete al día. No alcohol. No otras sustancias.

Tratamiento: losartan 100 mg (1-0-0), aldactone 100 mg (1-0-0), labetalol 100mg (1-0-0), nifedipino 30 mg (1-0-1), doxazosina 4 mg(0-01).

No alergias medicamentosas.


Dr. Fernando Jaén Águila. Unidad Riesgo Vascular Servicio Medicina Interna - Hospital Universitario Virgen de las Nieves. Granada

Caso Clínico:

Procedimiento realizado en la Unidad de Hemodinámica del Hospital Universitario Virgen de las Nieves de Granada por los Doctores Eduardo Molina Navarro y Joaquin Sánchez Gila y el equipo de Enfermería de la Unidad. También participa el Dr. Andrés Estivill servicio de UVI.

Bibliografía

1. Krum H, Schlaich M, Whitbourn R, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-concept cohort study. Lancet 2009;373:1275-1281
2. Esler MD, Krum H, Sobotka PA, et al. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet. 2010;376(9756):1903-9
3. Bhatt DL, Kandzari DE, O’Neill WW, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med 2014;370:1393-1401.
4. Kandzari DE, Böhm M, Mahfoud F, et al. SPYRAL HTN-ON MED trial. Effects of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet 2018;391:2346-2355
5. Böhm M, Kario K, Kandzari DE, et al. Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial. Lancet 2020;395:1444-1451
6. Azizi M, Schmieder RE, Mahfoud F, et al. Six-month results of treatment-blinded medication titration for hypertension control following randomization to endovascular ultrasound renal denervation or a sham procedure in the RADIANCE-HTN SOLO Trial. Circulation 2019.
7. Williams B, Mancia G, Spiering W, et al. 2018 Practice Guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension. Eur Heart J 2018;39:3021-3104
8. Daemen J, Mahfoud F, Kuck KH, et al. Safety and efficacy of endovascular ultrasound renal denervation in resistant hypertension: 12-month results from the ACHIEVE study. J Hypertens 2019;37:1906-1912
9. Papademetriou V, Tsioufis CP, Sinhal A, et al. Catheter-based renal denervation for resistant hypertension: 12-month of the EnligHTN I first-in-human study using a multielectrode ablation system. Hypertension 2014; 64:565-572
10. Kandzari DE, Bhatt DL, Brar S, et al. Predictors of blood pressure response in the Symplicity HTN-3 trial. Eur Heart J 2015;36:219-227
11. Mathiassen ON, Vase H, Bech JN, et al. Renal denervation in treatment-resistant essential hypertension. A randomized, SHAM-controlled, double-blinded 24-h blood pressure-based trial. J Hypertens 2016; 34:8:1639-1647
12. Stavropoulos K, Patoulias D, Imprialos K, Doumas M, Katsimardou A, Dimitriadis K, et al. Efficacy and safety of renal denervation for the management of arterial hypertension: A systematic review and meta-analysis of randomized, sham-controlled, catheter-based trials. J Clin Hypertens 2020;22:572-584
13. Mahfoud F, Böhm M, Schmieder R, et al. Effects of renal denervation on kidney function and long-term outcomes: 3-year follow-up from the Global SYMPLICITY Registry. Eur Heart J 2019;40:3474–3482
14. Rodriguez-Leor O, Segura J, García-Donaire JA, et al. Renal denervation for the treatment of resistant hypertension in Spain. The Flex-Spyral Registry. Rev Esp Cardiol 2020;73:615-622
15. Völz S, Spaak J, Elf J, et al. Renal sympathetic denervation in Sweden: a report from the Sweden registry for renal denervation. J Hypertens 2018;36:151-8
16.Rodríguez-Leor O, Jaén-Águila f, Segura j. Renal denervation for the management of hypertension. Joint position statement from the SEH-LELHA and the ACI-SEC. REC Interv Cardiol. 2022.

Lo siento, debes estar conectado para publicar un comentario.