Denervação simpática renal percutânea para tratamento da hipertensão arterial resistente

• Autor(a) principal: Moura Neto, Dario Gonçalves de
• Data de Publicação: 2015
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UFS
• Texto Completo: https://ri.ufs.br/handle/riufs/3252
• topic: Hipertensão arterial; Pressão arterial; Denervação; Hipertensão; Endotelina; Pressão aórtica; MAPA 24h; Hypertension; Endothelin; Denervation; Central pressure; 24-ABPM; CIENCIAS BIOLOGICAS::PARASITOLOGIA

The resistant hypertension is a disease difficult to diagnose and is associated with higher risk of cardiovascular events such as heart attack, stroke and sudden death. A considerable number of patients do not get effective control of the disease, despite the use of multiple drugs and high doses. Hyperactivation of the sympathetic nervous system is the pathophysiological basis for the ablation of afferent fibers, by applying radiofrequency energy in the renal arteries. This procedure, known as percutaneous sympathetic denervation has been shown to be a promising therapy and in recent years the results, with limited number of patients showed significant drop in blood pressure levels and cardiovascular risk. However, much of the reduction in risk can not be explained only by lowering blood pressure, emerging questions about treatment outcomes (use of multiple drugs / high doses) and assigning any failure of medication on independent effect vascular properties pressure. Vascular changes in micro and macrocirculation can not be fully observed by the peripheral measures, which required the understanding of endothelial dysfunction. The vascular endothelium is considered an active, dynamic tissue, so this dysfunction, in cases of high blood pressure, contributes to the development of atherosclerosis by promoting thrombosis, arterial stiffness and reduce tone and in the regulation of arterial flow. The identification of endothelin as a vasoconstrictor and the discovery of his release from the vascular endothelium suggested their involvement in the pathogenesis of hypertension and vascular disease, currently the most potent vasoconstrictor agent ever identified. We evaluated the reduction of blood pressure by sympathetic denervation in resistant hypertensive and one correlated their levels of endothelin of patients with cardiovascular disease. There were no complications, and at 18 months the average drop was 18 mmHg in systolic 24-ABPM and 19mmHg in central pressure. These two methods were shown to be equal in the assessment of therapeutic success. Higher levels of endothelin were present in cardiovascular disease may be a new marker of endothelial damage in heart disease.