MRI in the assessment of cerebral injury and cerebroprotective effects of renal denervation in resistant hypertension

The purpose of this single-centre, prospective, comparative study was to evaluate the pattern and severity of the brain structural changes in patients with resistant hypertension based on MRI assessments and their changes one year after renal denervation.

Material and Methods. The study comprised 53 patients with resistant hypertension (RH), aged 52.1 ± 9.1 years, who underwent renal denervation (RDN) following the Good Clinical Practice guidelines. Patients underwent office blood pressure measurements, 24-hour blood pressure monitoring (BPM), and brain MRI scanning. Using brain MRI, the cerebrospinal fluid (CSF) system measurements, the presence and severity of periventricular white matter lesion and focal changes in the brain white matter were evaluated.

Results. Initially, patients with RH had a high incidence of the structural brain alterations: 43 (81%) patients with fine focal brain lesions, 43 (81%) patients with enlarged CSF spaces, and 48 (90%) patients with periventricular white matter lesions. After renal denervation, a significant hypotensive effect was noted. According to brain MRI, the number of patients without enlarged CSF spaces did not change significantly: 15 (25%) patients initially, and 12 (20%) patients a year later (χ² = 0.63, р = 0.43 и χ² = 0.72, р = 0.40). The incidence of periventricular white matter lesion did not significantly change one year after RDN; however, the incidence of fine focal brain lesions significantly decreased in 21 patients (81% to 60%, p = 0.02).

Conclusion. Thus, it has been revealed that patients with resistant hypertension are characterised by a high incidence of structural brain alterations based on MRI assessments. Bilateral renal denervation is followed by a significant decrease in the incidence of fine focal brain lesions, without a significant change in the cerebrospinal fluid volume one year after the procedure.

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