Adherence to Blood Pressure–Lowering Drugs and Resistant Hypertension: Should Trial of Direct Observation Therapy Be Part of Preassessment for Renal Denervation?

2013 ◽  
Vol 29 (12) ◽  
pp. 1741.e1-1741.e3 ◽  
Author(s):  
Marcel Ruzicka ◽  
Brendan McCormick ◽  
Frans H.H. Leenen ◽  
Michael Froeschl ◽  
Swapnil Hiremath
Keyword(s):  
Blood Pressure ◽  
Direct Observation ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Blood Pressure Lowering ◽  
Pressure Lowering

scholarly journals Role of the heart in blood pressure lowering during chronic baroreflex activation: insight from an in silico analysis

2018 ◽  
Vol 315 (5) ◽  
pp. H1368-H1382 ◽  
Author(s):  
John S. Clemmer ◽  
W. Andrew Pruett ◽  
Robert L. Hester ◽  
Radu Iliescu ◽  
Thomas E. Lohmeier
Keyword(s):  
Blood Pressure ◽  
Mathematical Model ◽  
Renal Denervation ◽  
Sympathetic Nerve Activity ◽  
Blood Pressure Lowering ◽  
Nerve Activity ◽  
Renal Sympathetic Nerve Activity ◽  
Pressure Lowering ◽  
Renal Sympathetic ◽  
Stimulation Of

Electrical stimulation of the baroreflex chronically suppresses sympathetic activity and arterial pressure and is currently being evaluated for the treatment of resistant hypertension. The antihypertensive effects of baroreflex activation are often attributed to renal sympathoinhibition. However, baroreflex activation also decreases heart rate, and robust blood pressure lowering occurs even after renal denervation. Because controlling renal sympathetic nerve activity (RSNA) and cardiac autonomic activity cannot be achieved experimentally, we used an established mathematical model of human physiology (HumMod) to provide mechanistic insights into their relative and combined contributions to the cardiovascular responses during baroreflex activation. Three-week responses to baroreflex activation closely mimicked experimental observations in dogs including decreases in blood pressure, heart rate, and plasma norepinephrine and increases in plasma atrial natriuretic peptide (ANP), providing validation of the model. Simulations showed that baroreflex-induced alterations in cardiac sympathetic and parasympathetic activity lead to a sustained depression of cardiac function and increased secretion of ANP. Increased ANP and suppression of RSNA both enhanced renal excretory function and accounted for most of the chronic blood pressure lowering during baroreflex activation. However, when suppression of RSNA was blocked, the blood pressure response to baroreflex activation was not appreciably impaired due to inordinate fluid accumulation and further increases in atrial pressure and ANP secretion. These simulations provide a mechanistic understanding of experimental and clinical observations showing that baroreflex activation effectively lowers blood pressure in subjects with previous renal denervation. NEW & NOTEWORTHY Both experimental and clinical studies have shown that the presence of renal nerves is not an obligate requirement for sustained reductions in blood pressure during chronic electrical stimulation of the carotid baroreflex. Simulations using HumMod, a mathematical model of integrative human physiology, indicated that both increased secretion of atrial natriuretic peptide and suppressed renal sympathetic nerve activity play key roles in mediating long-term reductions in blood pressure during chronic baroreflex activation.

Renal denervation enhances GABA-ergic input into the PVN leading to blood pressure lowering in chronic kidney disease

2017 ◽  
Vol 204 ◽  
pp. 88-97 ◽  
Author(s):  
Masaaki Nishihara ◽  
Ko Takesue ◽  
Yoshitaka Hirooka
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Denervation ◽  
Blood Pressure Lowering ◽  
Pressure Lowering

The blood pressure-lowering effect of renal denervation is inversely related to kidney function

2014 ◽  
Vol 32 (10) ◽  
pp. 2045-2053 ◽  
Author(s):  
Eva E. Vink ◽  
Willemien L. Verloop ◽  
Rianne B.C. Bost ◽  
Michiel Voskuil ◽  
Wilko Spiering ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Kidney Function ◽  
Renal Denervation ◽  
Blood Pressure Lowering ◽  
Blood Pressure Lowering Effect ◽  
Lowering Effect ◽  
Pressure Lowering

Lack of Blood Pressure-lowering Effect of Renal Denervation in a Drug-naïve Patient with Pronounced Arterial Stiffening

2014 ◽  
Vol 127 (9) ◽  
pp. e3-e4 ◽  
Author(s):  
Robert von Arx ◽  
Emrush Rexhaj ◽  
Yves Allemann ◽  
Aris Moschovitis ◽  
Stephan Windecker ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Denervation ◽  
Blood Pressure Lowering ◽  
Blood Pressure Lowering Effect ◽  
Naive Patient ◽  
Arterial Stiffening ◽  
Lowering Effect ◽  
Pressure Lowering ◽  
Drug Naïve ◽  
Drug Naive Patient

Quantifying the 3 Biases That Lead to Unintentional Overestimation of the Blood Pressure–Lowering Effect of Renal Denervation

2016 ◽  
Vol 9 (1) ◽  
pp. 14-22 ◽  
Author(s):  
James P. Howard ◽  
Matthew J. Shun-Shin ◽  
Adam Hartley ◽  
Deepak L. Bhatt ◽  
Henry Krum ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Denervation ◽  
Blood Pressure Lowering ◽  
Blood Pressure Lowering Effect ◽  
Lowering Effect ◽  
Pressure Lowering

scholarly journals Adherence to Antihypertensive Treatment and the Blood Pressure–Lowering Effects of Renal Denervation in the Renal Denervation for Hypertension (DENERHTN) Trial

Circulation ◽  
2016 ◽  
Vol 134 (12) ◽  
pp. 847-857 ◽  
Author(s):  
Michel Azizi ◽  
Helena Pereira ◽  
Idir Hamdidouche ◽  
Philippe Gosse ◽  
Matthieu Monge ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Treatment ◽  
Renal Denervation ◽  
Blood Pressure Lowering ◽  
Pressure Lowering
Sign in / Sign up

Export Citation Format

Share Document