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Meeting of the Balkan Excellent Centers
“The Greek experience of Renal Denervation in resistant
hypertension”
K. Dimitriadis, PhD, FESC
Consultant Cardiologist
First Cardiology Clinic,
University of Athens,
Hippokration Hospital
Abstract

The first renal denervation (RDN) procedures in Greece were performed in the First Cardiology
Clinic, University of Athens, Hippokration Hospital by Prof. Costas Tsioufis in patients with severe
drug-resistant hypertension.1 During the last 5 years numerous patients have undergone RDN in
this center which participates in international studies and registries and important experience has
been gathered regarding the safety and efficacy of this interventional therapy. In an attempt to
identify responders to RDN therapy in an animal setting, we have shown that RDN causes an
acute and chronic alteration in renal blood flow as well as resistive index,2 whereas stimulation of
the renal arteries did not lead to augmentation of blood pressure (BP) in swines in contrast to
previous reports.3 The Hippokration Hospital was also one of the few centers globally for the
EnligHTN I study the first-in-human study with the use of the multielectrode RDN catheter. From
this population important papers regarding the effect of RDN besides BP,4 on left ventricular
mass with up to 24 months follow-up have been published.5,6 In Greece, the Hellenic
Cardiological Society and the Working Group Hypertension and the Heart of the Society have
organized a national registry on patients with resistant hypertension under the name Herhodotos
with data on more than 300 cases providing a useful insight into the characteristics of potential
candidates for RDN. Additionally, the Greek RDN registry has taken place in 4 Greek hospital
centers including patients with drug resistant hypertension. In this “real-world’ multicenter
national registry, the efficacy of renal denervation in reducing BP as well as safety is proven
during a 12 months follow-up. Moreover, younger age and higher levels of baseline office systolic
BP are independently related to better BP response to RDN.
RDN in Greece
First Cases in Hippokration Hospital in 2011
 2 cases of patients with RHT

Renal Sympathetic Denervation
The Greek experience in the Hippocration Hospital
Clinical and pre-clinical
Global Simplicity Registry
EnligHTN I (FIM)
EnligHTN II
MS study
Greek RDN registry
Animal studies for indentification of reliable markers
of intra-procedural success
Tsioufis C, Papademetriou V, Dimitriadis K et al. Int J Cardiol 2012
Tsioufis C, et al. Int J Cardiol 2014
ENLIGHTN I study
6 months post RDN:
Worthley, Tsioufis, et al. Eur Heart J. 2013
12 months post RDN : Papademetriou, Tsioufis, et al. Hypertension 2014
24 months post RDN :
Tsioufis, Papademetriou, Dimitriadis K et al. Int J Cardiol 2015
Results: LV Mass Index
Tsioufis C, Papademertriou V, Dimitriadis K, et al. J Hypertens. 2015
LV hypertrophy status changes
•After RDN, the number of
patients with concentric LV
hypertrophy (decreased
from 16 patients (80%) at
baseline to 10 patients
(50%) at 12 months, and
to 7 patients (36.8%) at 24
months
8 CONFIDENTIAL-Do not distribute
Tsioufis C, Papademetriou V, Dimitriadis K, et al. J Hum Hypertens 2016
RDN in MS patiens
C.Tsioufis, K.Dimitriadis, A.Kasiakogias, et al. ESH 2016
The first Greek registry of patients
with Resistant Hypertension
Endorsed by the Hellenic Cardiac
Society and the WG of
Hypertension and the Heart
HERHODOTOS REGISTRY
Excellence centers
 Till today >300 pts registered

RHT pts
Parameter
Age (years)
Gender (males%)
(n=320)
5610
51
BMI (kg/m2)
30.13.8
Waist (cm)
103.113.3
Smoking (%)
26
Creatinine (mg/dl)
10.5
Duration of hypertension (years)
14.77
HERHODOTOS REGISTRY
Patients with resistant hypertension
(n=320)
Parameter
Systolic office BP(mmHg)
15717
Diastolic office BP (mmHg)
8712
Office HR (bpm)
7019
24h Systolic BP (mmHg)*
14915
24h Diastolic BP (mmHg)*
859
Home systolic BP (mmHg)
14818
Home diastolic BP (mmHg)
8410
HERHODOTOS REGISTRY
Patients with
Parameter
resistant hypertension
(n=320)
Number of drugs
4.4
ACE-i (%)
41
ARBs (%)
61
Renin-i (%)
9
CCBs (%)
70
Diuretics (%)
90
b-blockers(%)
64
Aldosterone antagonists (%)
19
α-blockers (%)
3
Centrally acting (%)
31
Greek RDN registry

4 centers in Greece
Athens-Hippokration Hospital
C. Tsioufis
 Heraklion Crete
M. Marketou
 Patras
P. Davlouros
 Τhessaloniki
A. Ziakas

Greek RDN registry: Baseline
characteristics
RDN pts
Parameter
Age (years)
Gender (males%)
(n=68)
5810
49
BMI (kg/m2)
33.15
Waist (cm)
104.111.3
Smoking (%)
30
Creatinine (mg/dl)
10.4
Duration of hypertension (years)
9.14
Greek RDN registry: Baseline BP
RDN pts
(n=68)
Parameter
Systolic office BP(mmHg)
17417
Diastolic office BP (mmHg)
9513
Office HR (bpm)
7019
24h Systolic BP (mmHg)
15817
24h Diastolic BP (mmHg)
9013
24h HR (bpm)
7019
Greek RDN registry: Baseline therapy
Patients with
Parameter
resistant hypertension
(n=68)
Number of drugs
4.1
RAAS blockade (%)
85
Renin-i (%)
3
CCBs (%)
78
Diuretics (%)
90
b-blockers(%)
68
Aldosterone antagonists (%)
32
α-blockers (%)
5
Centrally acting (%)
28
Office and ambulatory SBP after
RDN at 6 and 12 months
-30 mmHg
-29 mmHg
-13 mmHg
-12mmHg
Office and ambulatory DBP after
RDN at 6 and 12 months
-12mmHg
-11mmHg
-10mmHg
-9mmHg
BP response to RDN
85% (59 pts) with an at least 10 mmHg office
SBP reduction
 Patients that were RDN responders (85%,
n=58), compared to non-responders were
younger (57±9 vs 65±8 years, p<0.05), had
higher baseline office systolic BP (176±17 vs
160±11 mmHg, p<0.05) and 24h systolic BP
(159±13 vs 149±11 mmHg, p<0.05).

Correlation of office BP reduction at 12 months
with baseline office BP
r=0.402, p=0.008
Correlation of 24h SBP reduction at 12 months
with baseline 24h SBP
r=0.3673 p=0.027
ESH excellence centers
Collaborate
 Exchange experiences

In order to improve delivered therapies
in the field of RDN
Thank you