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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) 5610 51 BMI (kg/m2) 30.13.8 Waist (cm) 103.113.3 Smoking (%) 26 Creatinine (mg/dl) 10.5 Duration of hypertension (years) 14.77 HERHODOTOS REGISTRY Patients with resistant hypertension (n=320) Parameter Systolic office BP(mmHg) 15717 Diastolic office BP (mmHg) 8712 Office HR (bpm) 7019 24h Systolic BP (mmHg)* 14915 24h Diastolic BP (mmHg)* 859 Home systolic BP (mmHg) 14818 Home diastolic BP (mmHg) 8410 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) 5810 49 BMI (kg/m2) 33.15 Waist (cm) 104.111.3 Smoking (%) 30 Creatinine (mg/dl) 10.4 Duration of hypertension (years) 9.14 Greek RDN registry: Baseline BP RDN pts (n=68) Parameter Systolic office BP(mmHg) 17417 Diastolic office BP (mmHg) 9513 Office HR (bpm) 7019 24h Systolic BP (mmHg) 15817 24h Diastolic BP (mmHg) 9013 24h HR (bpm) 7019 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