A drug-induced hypotensive challenge to verify catheter-based radiofrequency renal denervation in an obese hypertensive swine model

Abstract Objective Sham-controlled trials provided proof-of-principle for the blood pressure-lowering effect of catheter-based renal denervation (RDN). However, indicators for the immediate assessment of treatment success are lacking. This study sought to investigate the impact of RDN on renal renin arteriovenous difference (renal renin AV-Δ) following a hypotensive challenge (HC). Methods Twelve hypertensive Ossabaw swine underwent either combined surgical and chemical (n = 3) or catheter-based RDN (n = 9). A telemetry monitor was implanted to acquire hemodynamic data continuously. Before and after RDN, a sodium nitroprusside-induced HC was performed. Renal renin AV-Δ was calculated as the difference of plasma renin concentrations drawn from the renal artery and vein. Results In total, complete renal renin AV data were obtained in eight animals at baseline and six animals at baseline and 3 months of follow-up. Baseline renal renin AV-Δ correlated inversely with change in 24-h minimum systolic (− 0.764, p = 0.02), diastolic (r = − 0.679, p = 0.04), and mean (r = − 0.663, p = 0.05) blood pressure. In the animals with complete renin secretion data at baseline and follow-up, the HC increased renal renin AV-Δ at baseline, while this effect was attenuated following RDN (0.55 ± 0.34 pg/ml versus − 0.10 ± 0.16 pg/ml, p = 0.003). Renin urinary excretion remained unchanged throughout the study (baseline 0.286 ± 0.187 pg/ml versus termination 0.305 ± 0.072 pg/ml, p = 0.789). Conclusion Renin secretion induced by HC was attenuated following RDN and may serve as an indicator for patient selection and guide successful RDN procedures.

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Hypertension Secondary to Ingestion of Licorice Root Tea

Journal of Pharmacy Technology ◽

10.1177/875512251102700605 ◽

2011 ◽

Vol 27 (6) ◽

pp. 266-268 ◽

Cited By ~ 2

Author(s):

Tony Joseph Eid ◽

Amanda A Morris ◽

Sachin A Shah

Keyword(s):

Blood Pressure ◽

Dietary Supplements ◽

Blood Pressure Measurement ◽

Plasma Renin ◽

Licorice Root ◽

African American Female ◽

Lifestyle Modifications ◽

Plasma Aldosterone Concentration ◽

Serum Potassium Concentration ◽

The Impact

Objective: To report a case of hypertension secondary to ingestion of licorice root tea. Case Summary: A 46-year-old African American female with newly diagnosed stage 1 hypertension presented with a blood pressure measurement of 144/81 mm Hg and a reduced plasma potassium level of 3.2 mEq/L. The patient attempted lifestyle modifications prior to initiating an antihypertensive agent, but at a follow-up appointment, her blood pressure remained elevated. A current laboratory panel revealed a depressed morning plasma aldosterone concentration (PAC) of 5 ng/dL and low morning plasma renin activity (PRA) of 0.13 ng/mL/h. Later it was revealed that the patient regularly (1–2 cups/day) consumed “Yogi Calming” tea, a blend of herbs, including licorice root. The patient was advised to discontinue consumption of the herbal tea, and at a subsequent appointment, her blood pressure was 128/73 mm Hg and her laboratory panel had improved, including serum potassium concentration of 4.1 mEq/L, PAC of 6 ng/dL, and PRA of 0.19 ng/mL/h. Discussion: Excessive consumption of licorice has been well documented to cause pseudohyperaldosteronism, characterized by hypertension, hypokalemia, and suppressed plasma renin and aldosterone levels. Glycyrrhizin, the active ingredient in licorice, inhibits 11β-hydroxysteroid dehydrogenase type 2, an oxidase responsible for the conversion and inactivation of cortisol to cortisone. Chronic ingestion of licorice-containing foods has been demonstrated to cause pseudohyperaldosteronism. These include soft candies, lozenges, and dietary supplements, but licorice-containing teas have been infrequently described. Based on the Naranjo probability score, our patient's hypertension appears to have been a probable licorice-induced reaction secondary to a licorice-containing tea. Conclusions: Herbal and dietary supplements are frequently consumed by patients without full knowledge of the contents of the products or the impact on their health. In clinical practice, when hypertension is accompanied by hypokalemia and reduced PRA and PAC, licorice consumption should be investigated and causal hypertension ruled out.

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The relationship between diastolic blood pressure and the risk of cardiovascular events in patients with atrial fibrillation: the Fushimi AF registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.1168 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Ikeda ◽

M Iguchi ◽

H Ogawa ◽

Y Aono ◽

K Doi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Diastolic Blood Pressure ◽

Cardiovascular Events ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

The Impact

Abstract Background Hypertension is one of the major risk factors of cardiovascular events in patients with atrial fibrillation (AF). However, relationship between diastolic blood pressure (DBP) and cardiovascular events in AF patients remains unclear. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in Japan. Follow-up data were available in 4,466 patients, and 4,429 patients with available data of DBP were examined. We divided the patients into three groups; G1 (DBP<70 mmHg, n=1,946), G2 (70≤DBP<80, n=1,321) and G3 (80≤DBP, n=1,162), and compared the clinical background and outcomes between groups. Results The proportion of female was grater in G1 group, and the patients in G1 group were older and had higher prevalence of heart failure (HF), diabetes mellitus (DM), chronic kidney disease (CKD). Prescription of beta blockers was higher in G1 group, but that of renin-angiotensin system-inhibitors and calcium channel blocker was comparable. During the median follow-up of 1,589 days, in Kaplan-Meier analysis, the incidence rates of cardiovascular events (composite of cardiac death, ischemic stroke and systemic embolism, major bleeding and HF hospitalization during follow up) were higher in G1 group and G3 group than G2 group (Figure 1). When we divided the patients based on the systolic blood pressure (SBP) at baseline (≥130 mmHg or <130 mmHg), the incidence of rates of cardiovascular events were comparable among groups. Multivariate Cox proportional hazards regression analysis including female gender, age (≥75 years), higher SBP (≥130 mmHg), DM, pre-existing HF, CKD, low left ventricular ejection fraction (<40%) and DBP (G1, G2, G3) revealed that DBP was an independent determinant of cardiovascular events (G1 group vs. G2 group; hazard ratio (HR): 1.40, 95% confidence intervals (CI): 1.19–1.64, G3 group vs. G2 group; HR: 1.23, 95% CI: 1.01–1.49). When we examined the impact of DBP according to 10 mmHg increment, patients with very low DBP (<60 mmHg) (HR: 1.50,95% CI:1.24–1.80) and very high DBP (≥90 mmHg) (HR: 1.51,95% CI:1.15–1.98) had higher incidence of cardiovascular events than patients with DBP of 70–79 mmHg (Figure 2). However, when we examined the impact of SBP according to 20 mmHg increment, SBP at baseline was not associated with the incidence of cardiovascular events (Figure 3). Conclusion In Japanese patients with AF, DBP exhibited J curve association with higher incidence of cardiovascular events. Funding Acknowledgement Type of funding source: None

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Examining the effectiveness of telemonitoring with routinely acquired blood pressure data in primary care: challenges in the statistical analysis

BMC Medical Research Methodology ◽

10.1186/s12874-021-01219-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Richard A. Parker ◽

Paul Padfield ◽

Janet Hanley ◽

Hilary Pinnock ◽

John Kennedy ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Statistical Analysis ◽

Propensity Score ◽

Random Coefficient ◽

White Coat ◽

White Coat Effect ◽

Regression Adjustment ◽

The Impact

Abstract Background Scale-up BP was a quasi-experimental implementation study, following a successful randomised controlled trial of the roll-out of telemonitoring in primary care across Lothian, Scotland. Our primary objective was to assess the effect of telemonitoring on blood pressure (BP) control using routinely collected data. Telemonitored systolic and diastolic BP were compared with surgery BP measurements from patients not using telemonitoring (comparator patients). The statistical analysis and interpretation of findings was challenging due to the broad range of biases potentially influencing the results, including differences in the frequency of readings, ‘white coat effect’, end digit preference, and missing data. Methods Four different statistical methods were employed in order to minimise the impact of these biases on the comparison between telemonitoring and comparator groups. These methods were “standardisation with stratification”, “standardisation with matching”, “regression adjustment for propensity score” and “random coefficient modelling”. The first three methods standardised the groups so that all participants provided exactly two measurements at baseline and 6–12 months follow-up prior to analysis. The fourth analysis used linear mixed modelling based on all available data. Results The standardisation with stratification analysis showed a significantly lower systolic BP in telemonitoring patients at 6–12 months follow-up (-4.06, 95% CI -6.30 to -1.82, p < 0.001) for patients with systolic BP below 135 at baseline. For the standardisation with matching and regression adjustment for propensity score analyses, systolic BP was significantly lower overall (− 5.96, 95% CI -8.36 to − 3.55 , p < 0.001) and (− 3.73, 95% CI− 5.34 to − 2.13, p < 0.001) respectively, even after assuming that − 5 of the difference was due to ‘white coat effect’. For the random coefficient modelling, the improvement in systolic BP was estimated to be -3.37 (95% CI -5.41 to -1.33 , p < 0.001) after 1 year. Conclusions The four analyses provide additional evidence for the effectiveness of telemonitoring in controlling BP in routine primary care. The random coefficient analysis is particularly recommended due to its ability to utilise all available data. However, adjusting for the complex array of biases was difficult. Researchers should appreciate the potential for bias in implementation studies and seek to acquire a detailed understanding of the study context in order to design appropriate analytical approaches.

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Renal denervation alters cardiovascular and endocrine responses to hemorrhage in conscious newborn lambs

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1998.275.1.h285 ◽

1998 ◽

Vol 275 (1) ◽

pp. H285-H291 ◽

Cited By ~ 10

Author(s):

Francine G. Smith ◽

Isam Abu-Amarah

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Renal Denervation ◽

Plasma Renin ◽

Sympathetic Nerves ◽

Renal Nerves ◽

Elevated Plasma ◽

Baseline Levels ◽

Renal Sympathetic

To investigate the role of renal sympathetic nerves in modulating cardiovascular and endocrine responses to hemorrhage early in life, we carried out three experiments in conscious, chronically instrumented lambs with intact renal nerves (intact; n = 8) and with bilateral renal denervation (denervated; n = 5). Measurements were made 1 h before and 1 h after 0, 10, and 20% hemorrhage. Blood pressure decreased transiently after 20% hemorrhage in intact lambs and returned to control levels. In denervated lambs, however, blood pressure remained decreased after 60 min. After 20% hemorrhage, heart rate increased from 170 ± 16 to 207 ± 18 beats/min in intact lambs but not in denervated lambs, in which basal heart rates were already elevated to 202 ± 21 beats/min. Despite an elevated plasma renin activity (PRA) measured in denervated (12.0 ± 6.4 ng ANG I ⋅ ml−1 ⋅ h−1) compared with intact lambs (4.0 ± 1.1 ng ANG I ⋅ ml−1 ⋅ h−1), the increase in PRA in response to 20% hemorrhage was similar in both groups. Plasma levels of arginine vasopressin increased from 11 ± 8 to 197 ± 246 pg/ml after 20% hemorrhage in intact lambs but remained unaltered in denervated lambs from baseline levels of 15 ± 10 pg/ml. These observations provide evidence that in the newborn, renal sympathetic nerves modulate cardiovascular and endocrine responses to hemorrhage.

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Single Pill Indapamide and Perindopril Arginine Combination: Optimal Coupling of Vascular Protection and Hemodynamic Risk Factors Reduction in Patients with Essential Arterial Hypertension

Kardiologiia ◽

10.18087/cardio.2019.3.10236 ◽

2019 ◽

Vol 59 (3) ◽

pp. 18-26 ◽

Cited By ~ 1

Author(s):

E. V. Borisova ◽

A. I. Kochetkov ◽

O. D. Ostroumova

Keyword(s):

Blood Pressure ◽

Arterial Stiffness ◽

Arterial Hypertension ◽

Arterial Compliance ◽

Stage Ii ◽

Stiffness Index ◽

Single Pill ◽

Essential Arterial Hypertension ◽

The Impact

Objective: to investigate the impact of indapamide / perindopril single-pill combination (I / P SPC) on arterial stiffness parameters, blood pressure (BP) level and BP variability (BPV) in middle-aged patients with stage II grade 1–2 essential arterial hypertension (EAH). Materials and methods. We retrospectively formed a group of patients with stage II grade 1–2 EAH who had not previously received regular antihypertensive therapy (AHT) (n=52, mean age 52.9±6.0 years). All patients were treated with I / P SPC and all of them achieved target office BP level (less than 140 / 90 mm Hg). After 12 weeks of follow-up (from the time of reaching the target BP) assessment of AHT effectiveness (general clinical data, ambulatory blood pressure monitoring [ABPM], volume sphygmography, echocardiography), and vascular stiffness evaluation were performed.Results. At the end of follow-up office systolic BP (SBP), diastolic BP (DBP), pulse BP, day-time, night-time and 24‑hour SBP and DBP significantly (p<0.001 for all) decreased. According to the ABPM data day-time, nighttime, and 24‑hour systolic BPV significantly decreased (p=0.029, p=0.006 and p<0.001, respectively); day-time and 24‑hour diastolic BPV also significantly decreased (p=0.001 and p<0.001, respectively). Day-night standard deviation (SDdn) significantly decreased too (p=0.002 and p<0.001, respectively). Volumetric sphygmography showed significant decrease of right cardio-ankle vascular index (CAVI) (from 8.20±1.29 to 7.58±1.44, p=0.001) and of left CAVI (from 8.13±1.40 to 7.46±1.43, p<0.001), as well as reduction of the number o f patients with a right- and / or left-CAVI >9.0 (from 32.7 to 11.5 %, p=0.018). According to assessment of arterial stiffness using the Vasotens24 software package, the arterial stiffness index (ASI) significantly (p<0.001) decreased from 153.5±29.9 to 138.3±20.0 (by –9.2±13.1 %). Transthoracic echocardiography data demonstrated significant decrease (p<0.001) in effective arterial elastance (from 1.82±0.43 to 1.58±0.36 mm Hg; by –11.85±16.29 %) and significant (p<0.001) increase in the arterial compliance – from 1.27±0.34 to 1.54±0.38 mm Hg / ml (+26.95±38.06 %).Conclusion. In AHT naive patients 40–65 years old with stage II grade 1–2 EAH therapy with I / P SPC provided effective 24‑hour BP control, reduced BPV and improved arterial stiffness parameters.

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A Blood Pressure Lowering Effect Only through Complex Korean Medical Treatment, without Antihypertensive Drugs, for Patients with Stress Induced Hypertension - A Case Report

The Journal of Internal Korean Medicine ◽

10.22246/jikm.2021.42.5.808 ◽

2021 ◽

Vol 42 (5) ◽

pp. 808-819

Author(s):

Ji-hyun Lee ◽

Min-yeong Roh ◽

Seok-yeong Yoon ◽

Hyung-sun Jun ◽

Yang-hee Han ◽

...

Keyword(s):

Blood Pressure ◽

Medical Treatment ◽

Antihypertensive Drugs ◽

Blood Pressure Lowering Effect ◽

Hypertensive Patients ◽

Pittsburg Sleep Quality Index ◽

Induced Hypertension ◽

Pressure Lowering ◽

Pressure Symptom

Objectives: This study considered the effectiveness of integrative Korean medical treatment for stress-induced hypertensive patients without the use of conventional medication.Methods: A 62-year-old female with stress-induced hypertension (HTN) was hospitalized for 33 days. Her pattern identification was ascendant hyperactivity of liver yang (Ganyangsanghang)-type HTN. Herbal medicine and acupuncture were used for the treatment: Cheonggansoyo-san for 33 days and Chunwangbosim-dan for 15 days, together with acupuncture for 20 minutes twice a day. Blood pressure was checked daily during hospitalization with a digital sphygmomanometer in the brachial artery.Results: After 33 days of treatment, blood pressure decreased. The Handicap Inventory (DHI) scale and Pittsburg Sleep Quality Index (PSQI) scores both decreased. The patient also reported fewer complaints. A five-month follow-up after discharge, with no further treatment, confirmed stable blood pressure. Symptom improvements continued with no significant side effects.Conclusions: This study indicates that Korean medical treatment is effective for stress-induced hypertensive patients.

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Control of salt and volume retention cannot be ruled out as a mechanism underlying the blood pressure-lowering effect of renal denervation

Hypertension Research ◽

10.1038/hr.2013.82 ◽

2013 ◽

Vol 36 (11) ◽

pp. 1006-1007 ◽

Cited By ~ 3

Author(s):

Yutang Wang ◽

Kate M Denton ◽

Jonathan Golledge

Keyword(s):

Blood Pressure ◽

Renal Denervation ◽

Blood Pressure Lowering ◽

Blood Pressure Lowering Effect ◽

Lowering Effect ◽

Pressure Lowering ◽

Volume Retention

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Effects of Indomethacin Alone and during Diuretic or β-Adrenoreceptor-Blockade Therapy on Blood Pressure and the Renin System in Essential Hypertension

Clinical Science ◽

10.1042/cs055203s ◽

1978 ◽

Vol 55 (s4) ◽

pp. 203s-205s ◽

Cited By ~ 12

Author(s):

J. A. Lopez-Ovejero ◽

M. A. Weber ◽

J. I. M. Drayer ◽

J. E. Sealey ◽

J. H. Laragh

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Water Retention ◽

Antihypertensive Effect ◽

Renin Secretion ◽

Blood Pressure Lowering ◽

Blood Pressure Lowering Effect ◽

Uncomplicated Hypertension ◽

Pressure Lowering ◽

Propranolol Therapy

1. Indomethacin was administered alone or in addition to either diuretic or propranolol therapy to three groups of patients with essential hypertension on a free sodium diet. 2. Indomethacin administration reduced renin secretion by about 30% in untreated uncomplicated hypertensive patients and by about 75% in those whose renin secretion had either been stimulated or suppressed by maintained diuretic or β-adrenoreceptor-blockade therapy. 3. Indomethacin administration produced no net effect on blood pressure in untreated patients with uncomplicated hypertension but it blunted or reversed the antihypertensive effect of either diuretic or propranolol therapy. 4. Salt and water retention may be an important factor in the blood pressure-raising effect of indomethacin during diuretic or propranolol therapy: In addition, prostaglandin synthesis may be important in counteracting increased α-adrenergic tone, which may limit the blood pressure-lowering effect of β-adrenoreceptor-blockade. 5. Because of these interactions and their pressor potential indomethacin should be used with caution when combined with either diuretics or β-adrenoreceptor blockers.

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Relevance of Targeting the Distal Renal Artery and Branches with Radiofrequency Renal Denervation Approaches—A Secondary Analysis from a Hypertensive CKD Patient Cohort

Journal of Clinical Medicine ◽

10.3390/jcm8050581 ◽

2019 ◽

Vol 8 (5) ◽

pp. 581 ◽

Cited By ~ 3

Author(s):

KIUCHI ◽

SCHLAICH ◽

CHEN ◽

VILLACORTA ◽

HO ◽

...

Keyword(s):

Blood Pressure ◽

Renal Artery ◽

Renal Denervation ◽

Secondary Analysis ◽

Distal Segment ◽

Renal Arteries ◽

Lowering Effect ◽

Post Hoc

We searched for an association between changes in blood pressure (BP) at 12 and 24 months after renal denervation (RDN) and the different patterns of ablation spots placement along the renal artery vasculature. We performed a post-hoc analysis of a 24‐month follow‐up evaluation of 30 patients who underwent RDN between 2011 and 2012 using our previous database. Patients who had (i) resistant hypertension, as meticulously described previously, and (ii) Chronic kidney disease (CKD) stages 2, 3 and 4. Correlations were assessed using the Pearson or Spearman correlation tests as appropriate. The mean change in systolic ambulatory BP monitoring (ABPM) compared to baseline was –19.4 ± 12.7 mmHg at the 12th (p < 0.0001) and –21.3 ± 14.1 mmHg at the 24th month (p < 0.0001). There was no correlation between the ABPM Systolic Blood Pressure (SBP)-lowering effect and the total number of ablated spots in renal arteries (17.7 ± 6.0) either at 12 (r = –0.3, p = 0.1542) or at 24 months (r = –0.2, p = 0.4009). However, correlations between systolic BP-lowering effect and the number of ablation spots performed in the distal segment and branches were significant at the 12 (r = –0.7, p < 0.0001) and 24 months (r = –0.8, p < 0.0001) follow-up. Our findings indicate a substantial correlation between the numbers of ablated sites in the distal segment and branches of renal arteries and the systolic BP-lowering effect in the long-term.

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