Significant reduction in systolic blood pressure following renal artery stenting in patients with uncontrolled hypertension: Results from the HERCULES trial

Abstract Background Atherosclerotic renal artery stenosis is a risk factor for cardiovascular death. Observational studies support the benefit of renal revascularization on outcomes in selected patients with high-risk clinical manifestations. In this context, we evaluated the factors associated with long-term mortality after renal artery stenting in patients with severe renal artery stenosis, impaired kidney function and/or uncontrolled hypertension. Methods The medical records of patients undergoing renal artery stenting between 2004 and 2014 were extracted. Blood pressure and creatinine were recorded at baseline, 24 hours post-stenting and in the one month to one year interval that followed revascularization. Long-term follow-up was performed in March 2020. Results The cohort consisted of 65 patients. Median follow-up was 120 months. In the first year after stenting, less patients had chronic kidney disease (CKD) class 3b – 5 as compared to baseline (35.3 vs. 56.9%, p=0.01). The number of patients with controlled blood pressure after revascularization increased with 69.2% (p<0.001). Long-term all-cause mortality reached 44.6%. Age (OR 1.1; 95%CI 1.0–1.2; p=0.01), male gender (OR 7.9; 95%CI 1.9 – 43.5; p=0.008), post-stenting CKD class 3b-5 (OR 5.8; 95%CI 1.5–27.9; p=0.01), and post-revascularization uncontrolled hypertension (OR 8.9; 95%CI 1.7–63.5; p=0.01) were associated with long-term mortality independent of diabetes mellitus and coronary artery disease. Conclusion Improved CKD class and blood pressure were recorded in the first year after renal artery stenting in patients with severe renal artery stenosis and high-risk clinical manifestations. The lack of improvement in kidney function and blood pressure was independently associated with long-term mortality.

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P3570Bilateral renal artery stenting is effective method for the treatment of uncontrolled hypertension and renal function

European Heart Journal ◽

10.1093/eurheartj/ehz745.0432 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Uzokov ◽

A L Alyavi ◽

B A Alyavi ◽

S A Iskhakov ◽

D D Payziev

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Serum Creatinine ◽

Renal Artery ◽

Uncontrolled Hypertension ◽

Renal Artery Stenting ◽

Group I ◽

Group Ii ◽

Bilateral Stenting

Abstract Background Renal artery (RA) stenosis is one of the main causes of severe uncontrolled primary hypertension among population. Aim of the study was to investigate effectiveness of stent replacement in renal arteries and influence it on renal function in uncontrolled hypertensive patients (UHP) with pharmacotherapies. Methods 86 consecutive UHP with renal etiology confirmed by angiography were enrolled in this study. Mean age of the patients was 43.2±12.5 years (aged 31–59 years, male=46%). Blood pressure, serum creatinine, microalbuminuria were assessed at baseline and after the intervention and during the follow-up for statistics. Mean follow-up was 2.0±1.0 years. Results Total of 128 hemodynamically significant renal artery stenosis were treated by implanting stents in all 86 patients. Among them in 42 patients were performed bilateral stenting (Group I) and 44 patients unilateral stenting (Group II). Systolic and diastolic blood pressure (SBP, DBP) decreased in both groups during the follow-up, however it was noted that only SBP were decreased significantly in Group I (unilateral stenting) whilst reduction in DBP not significantly when compared to Group II. Mean reduction in SBP was from 165.0±20.5 mmHg to 130.4±14.0 mmHg in Group I vs. from 158.0±22.0 to 135.0±15.0 mmHg in Group II (P=0.003 when compared two groups) and in DBP was from 95.0±11.2 mmHg to 83.4±8.0 mmHg in Group I vs. from 93.0±10.0 to 82.0±7.5 mmHg in Group II (P>0.05 when compared two groups). Serum creatinine levels were reduced from 123.0±49.0 μmol/l to 85.4±30.6 μmol/l in Group I vs 116.8±51.2 μmol/l to 86.9±35.5 μmol/l (P<0.05 when compared two groups). Significantly reduction in MAU were noted in both groups (P<0.05) but when compared two groups there were no significant changes in reduction. Conclusion Renal artery stenting is effective method for the treatment of UHP and may improve outcomes of the patients. Bilateral stenting seems to be more effective in blood pressure and serum creatinine control in UHP.

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Impact of a Pill Box Clinic to Improve Systolic Blood Pressure in Veterans with Uncontrolled Hypertension Taking 3 or More Antihypertensive Medications

Journal of Managed Care Pharmacy ◽

10.18553/jmcp.2014.20.9.905 ◽

2014 ◽

Vol 20 (9) ◽

pp. 905-911 ◽

Cited By ~ 3

Author(s):

Angela K. Porter ◽

Shawn Riser Taylor ◽

Abigail H. Yabut ◽

Antoine Al-Achi

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Uncontrolled Hypertension ◽

Antihypertensive Medications

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Abstract 091: Improved Blood Pressure Control and High Adherence to a Novel Management Model of Hypertension Care in a West African Population

Hypertension ◽

10.1161/hyp.70.suppl_1.091 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Isaac Owusu ◽

Fred Adomako-Boateng ◽

Fred Kueffer ◽

Molly Guy ◽

Chemuttaai Lang’at ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Pressure Control ◽

Management Plan ◽

West African ◽

Sub Saharan Africa ◽

Management Model ◽

Uncontrolled Hypertension ◽

Hypertension Management ◽

Software Application

Background: Logistic and socioeconomic barriers limit effective blood pressure (BP) control in many parts of Sub-Saharan Africa, including the Republic of Ghana. We tested a novel hypertension management model of care designed for resource-limited settings. Methods and Results: The “Akoma Pa” model was developed using human-centered design methodology involving patients, physicians, and nurses. The model consisted of a mobile tablet, BP machine and a novel software application in a unique platform to allow for longitudinal patient management. Patients were provided with a tailored hypertension management plan based on their enrollment comorbidities and risk factors. A cohort of 150 hypertensive patients (57±8 years; 73% female) accessed regular blood pressure assessments at a local pharmacy and received real-time automated feedback based on their individualized plan. On the mobile application, clinicians were able to view patient data, provide patients with feedback via SMS on their condition, and write electronic prescriptions which could be accessed by participating pharmacies. Average baseline BP was 135±18/84±10 mmHg in the overall cohort and 153±13/90±11 mmHg in the subgroup with uncontrolled hypertension (n=58). After 6 months of voluntary weekly monitoring, systolic blood pressure decreased significantly (p<0.01) in the overall cohort (-4.7±18.7 mmHg) and in the uncontrolled subgroup (-15.2±17.6mmHg). Systolic blood pressure remained constant in the sub group with controlled pressure at baseline. The proportion of the population with uncontrolled hypertension decreased from 39% to 27% (p=0.01). Patient compliance with weekly BP assessments was 61% and 2,855 BP assessments were conducted. During 33 of the 2,855 BP assessments (1% of pharmacy visits), the software application directly referred patients to a health facility (33 visits in 25 patients). Improvement in overall health awareness was reported in 82% of the participants and 95% of participants indicated a desire to continue using this model in the future. Conclusions: Compliance and satisfaction with this multifaceted hypertension care model were high and led to significant and sustained decreases in blood pressure in this West African hypertensive population.

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Extended Renal Artery Denervation Is Associated with Artery Wall Lesions and Acute Systemic and Pulmonary Hemodynamic Changes: A Sham-Controlled Experimental Study

Cardiovascular Therapeutics ◽

10.1155/2020/8859663 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Aleksandr D. Vakhrushev ◽

Heber Ivan Condori Leandro ◽

Natalia S. Goncharova ◽

Lev E. Korobchenko ◽

Lubov B. Mitrofanova ◽

...

Keyword(s):

Blood Pressure ◽

Renal Artery ◽

Systolic Blood Pressure ◽

Renal Arteries ◽

Artery Wall ◽

Pulmonary Hemodynamics ◽

Pulmonary Hemodynamic ◽

Renal Artery Denervation ◽

The Impact ◽

Wall Lesions

Objectives. We sought to assess acute changes in systemic and pulmonary hemodynamics and microscopic artery lesions following extended renal artery denervation (RDN). Background. RDN has been proposed to reduce sympathetic nervous system hyperactivation. Although the effects of RDN on systemic circulation and overall sympathetic activity have been studied, data on the impact of RDN on pulmonary hemodynamics is lacking. Methods. The study comprised 13 normotensive Landrace pigs. After randomization, 7 animals were allocated to the group of bilateral RDN and 6 animals to the group of a sham procedure (SHAM). Hemodynamic measures, cannulation, and balloon-based occlusion of the renal arteries were performed in both groups. In the RDN group, radiofrequency ablation was performed in all available arteries and their segments. An autopsy study of the renal arteries was carried out in both groups. Results. The analysis was performed on 12 pigs (6 in either group) since pulmonary thromboembolism occurred in one case. A statistically significant drop in the mean diastolic pulmonary artery pressure (PAP) was detected in the RDN group when compared with the SHAM group (change by 13.0 ± 4.4 and 10.0 ± 3.0 mmHg , correspondingly; P = 0.04 ). In 5 out of 6 pigs in the RDN group, a significant decrease in systemic systolic blood pressure was found, when compared with baseline ( 98.8 ± 17.8 vs. 90.2 ± 12.6 mmHg , P = 0.04 ), and a lower mean pulmonary vascular resistance (PVR) ( 291.0 ± 77.4 vs. 228.5 ± 63.8 dyn ∗ sec ∗ c m − 5 , P = 0.03 ) after ablation was found. Artery dissections were found in both groups, with prevalence in animals after RDN. Conclusions. Extensive RDN leads to a rapid and significant decrease in PAP. In the majority of cases, RDN is associated with an acute lowering of systolic blood pressure and PVR. Extended RDN is associated with artery wall lesions and thrombus formation underdiagnosed by angiography.

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