Secondary rise in blood pressure after renal denervation

摘要

In July, 2011, a 58-year-old man with type II diabetes and hypertension resistant to treatment was referred to our hospital for renal denervation. He had had hypertension for 30 years and his antihypertensive medication dose had been increased over several years. In 2001, he had a minor stroke, and in 2009, a carotid artery stent was implanted. On examination, his blood pressure was 170/90 mm Hg despite treatment with seven anti-hypertensive drugs (appendix). Resistant hypertension was confirmed by 24 h ambulatory blood pressure measurement. He also had sleep apnoea which was treated with continuous positive airway pressure therapy. Aldosteronism, phaeochromocytoma, and renal artery stenosis were ruled out. Renal resistive indices (RI) on both sides were similar. Normal renal function with microalbuminuria was present. Magnetic resonance angiography (appendix) done before renal denervation showed early ramification but no relevant stenosis on either side.