1. 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
Για την διαχρονικά σταθερή στηριξή του

2. 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.

3. RDN in Greece First Cases in Hippokration Hospital in 2011
2 cases of patients with RHT

4. 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

5. Tsioufis C, et al. Int J Cardiol 2014
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

6. ENLIGHTN I study

7. Results: LV Mass Index
Tsioufis C, Papademertriou V, Dimitriadis K, et al. J Hypertens. 2015

8. 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

9. RDN in MS patiens
C.Tsioufis, K.Dimitriadis, A.Kasiakogias, et al. ESH 2016

10. The first Greek registry of patients with Resistant Hypertension
Endorsed by the Hellenic Cardiac Society and the WG of Hypertension and the Heart

11. HERHODOTOS REGISTRY Excellence centers
Till today >300 pts registered
Parameter
RHT pts
(n=320)
Age (years)
5610
Gender (males%) 51
BMI (kg/m2)
30.13.8
Waist (cm)
103.113.3
Smoking (%) 26
Creatinine (mg/dl)
10.5
Duration of hypertension (years)
14.77

12. Patients with resistant hypertension
HERHODOTOS REGISTRY
Parameter
Patients with resistant hypertension
(n=320)
Systolic office BP(mmHg)
15717
Diastolic office BP (mmHg)
8712
Office HR (bpm)
7019
24h Systolic BP (mmHg)*
14915
24h Diastolic BP (mmHg)*
859
Home systolic BP (mmHg)
14818
Home diastolic BP (mmHg)
8410

13. resistant hypertension
HERHODOTOS REGISTRY
Parameter
Patients with
resistant hypertension
(n=320)
Number of drugs
4.4
ACE-i (%) 41
ARBs (%) 61
Renin-i (%) 9
CCBs (%) 70
Diuretics (%) 90
b-blockers(%)
Aldosterone antagonists (%)
α-blockers (%)
Centrally acting (%) 64 19 3 31

14. Greek RDN registry 4 centers in Greece Athens-Hippokration Hospital
C. Tsioufis
Heraklion Crete
M. Marketou
Patras
P. Davlouros
Τhessaloniki
A. Ziakas

15. Greek RDN registry: Baseline characteristics
Parameter
RDN pts
(n=68)
Age (years)
5810
Gender (males%) 49
BMI (kg/m2)
33.15
Waist (cm)
104.111.3
Smoking (%) 30
Creatinine (mg/dl)
10.4
Duration of hypertension (years)
9.14

16. Greek RDN registry: Baseline BP
Parameter
RDN pts
(n=68)
Systolic office BP(mmHg)
17417
Diastolic office BP (mmHg)
9513
Office HR (bpm)
7019
24h Systolic BP (mmHg)
15817
24h Diastolic BP (mmHg)
9013
24h HR (bpm)

17. resistant hypertension
Greek RDN registry: Baseline therapy
Parameter
Patients with
resistant hypertension
(n=68)
Number of drugs
4.1
RAAS blockade (%) 85
Renin-i (%) 3
CCBs (%) 78
Diuretics (%) 90
b-blockers(%)
Aldosterone antagonists (%)
α-blockers (%)
Centrally acting (%) 68 32 5 28

18. Office and ambulatory SBP after RDN at 6 and 12 months
-30 mmHg
-29 mmHg
-13 mmHg
-12mmHg

19. Office and ambulatory DBP after RDN at 6 and 12 months
-12mmHg
-11mmHg
-10mmHg
-9mmHg

20. 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).

21. Correlation of office BP reduction at 12 months with baseline office BP
r=0.402, p=0.008

22. Correlation of 24h SBP reduction at 12 months with baseline 24h SBP
r= p=0.027

23. ESH excellence centers
Collaborate
Exchange experiences
In order to improve delivered therapies
in the field of RDN

24. Thank you