Garmazi S. Role of the autonomic nervous system for differentiated selection of the patients for the treatment of resistant hypertension.

The thesis is devoted to actual scientific problem of increasing the effectiveness of the treatment of the patients with refractory hypertension by developing algorithm of the differentiated selection of patients with refractory hypertension dependently on the functional state of the autonomic nervous system. The retrospective analysis of clinical outcomes in patients with refractory arterial hypertension was conducted and RAH frequency was assessed as 10.9%. The peculiarities of clinical anatomy of sympathetic nerve ganglia renal arteries were analyzed. It was established that the main prognostic indicators of ANS function in patients with refractory hypertension, recommended for differentiated selection of patients are the level of autonomic maintenance (PPV = 0.88), the ratio LF/HF (PPV=0.89) and the number of episodes of uncontrolled hypertension at Holter blood pressure monitoring (PPV = 0,82). As additional criteria can be considered value for NE/E ratio equal to 5.0 and above, hypersympathicotonic signs (AR increased by sympathetic type). There was analyzed clinical outcomes in patients following a differentiated application of interventional treatment. It was shown that on average patients used 2.5 ± 0.3 medications, significantly less than the number applied for the intervention of drugs. After treatment of cases of relapses and complications were noted in the subgroup IA. With traditional approaches to the non-interventional treatment of RAH the number of episodes of uncontrolled blood pressure for 24 hours was 3.7 ± 0.4, while in the ID group - 2.5 ± 0.3, and the IA group - 1.9 ± 0.2. In these patients showed an increase in the subscale of the physical health of 46.2 ± 2.4 points to 87.5 ± 2.6 points (p = 0,007). The algorithm for selecting patients for the sympathetic denervation of the renal arteries into account the initial state of the autonomic nervous system and anatomical features of the renal arteries. Candidates for intervention is the intervention patients with hypertension duration of 5 years with confirmed hypersimpathicotonia (high reactivity to sympathetic type hypertensive index than 3.0, LF/HF ratio over 2.2) without evidence of renal artery stenosis.