Interventional recanalisation of long segment aortic atresia

2020 ◽  
Vol 30 (9) ◽  
pp. 1337-1338
Author(s):  
Michael Huntgeburth ◽  
Wael Ahmad ◽  
Jan Brunkwall ◽  
Narayanswami Sreeram
Keyword(s):  
Blood Pressure ◽  
Young Adult ◽  
Arterial Hypertension ◽  
Stent Implantation ◽  
Aortic Atresia ◽  
Wire Crossing ◽  
Resistant Arterial Hypertension ◽  
Therapy Resistant Arterial Hypertension

AbstractWe report the case of a long-segment aortic atresia as the cause for therapy resistant arterial hypertension in a young adult. Recanalization was achieved interventionally by wire-crossing and stent implantation with subsequent normalization of blood pressure.

scholarly journals Baroreflex activation therapy for resistant hypertension: results from mid-term prospective ambulatory blood pressure registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Sindt ◽  
T Madej ◽  
S Grimm ◽  
M Knaut
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Pressure Drop ◽  
Arterial Hypertension ◽  
Antihypertensive Drugs ◽  
Drug Resistant ◽  
Baroreflex Activation Therapy ◽  
Activation Therapy ◽  
Resistant Arterial Hypertension

Abstract Objectives First generation baroreflex activation therapy (BAT) devices showed clinical efficacy in patients with drug-resistant arterial hypertension (AHT), but the safety profile was insufficient. Data regarding efficacy of second-generation devices were generated mostly from office blood pressure (BP) measurements or short-term 24-hour ambulatory blood pressure measurements (ABPM). We present a mid-term prospective registry to evaluate the efficacy and safety of recent BAT devices. Purpose The purpose of our study was to find a method that helps patients with drug-resistant arterial hypertension to control their blood pressure. Further we sought to reduce the overall amount of antihypertensive drugs to lessen side effects, as well as the effects of polypharmacy. Methods All patients receiving Barostim neo between November 2013 and June 2019 for resistant AHT were prospectively included into this observational study. ABPM was performed at baseline, in 3-month intervals in the first year after BAT implantation and in 6-month intervals afterwards for up to 42 months. Patients were assigned into two groups of responders and non-responders. Non-responders had a mean blood pressure drop (BPD) below 5mmHg. Responders in turn were categorized into 3 sub-groups (low-BPD between 5–9 mmHg, medium-BPD between 10–19 mmHg and high-BPD ≥20 mmHg). The primary efficacy end-points were changes in systolic and diastolic BP and number of antihypertensive medications. The primary safety end point was BAT-related major adverse events (MAE). Results 64 patients (mean age 63 years, 67% males) were included. Only patients who completed a 24-hour ABPM during a follow up were counted in the statistical analysis. We had an overall responder rate of 67.8%. Out of those 15.4% had low-BPD, 38.4% medium-BPD and 46.2% had a high-BPD. Systolic BP decreased over the 3.5-years period from 168±17 mmHg to 149±19 mmHg (n=19, mean change −18.8 mmHg; 95% confidence interval [CI]: −29.32 to −8.36; p<0.0007). Diastolic BP decreased from 97±16 to 85±12 mmHg (n=19, mean change −11.7 mmHg; 95% CI: −19.2 to −4.2; p<0.0021). The mean number of antihypertensive drugs was reduced from 6.9±1.3 to 5.2±1.5 (n=19, mean change −1.7; 95% CI: −0.8 to −0.27; p<0.0009). The time course of primary end-points is shown in Fig.1. Freedom from BAT-related MAE was 93.5%. 4 perioperative complications (1 pocket bleeding, 1 pocket infection, 1 N. hypoglossus palsy, 1 hoarseness) resolved without residual side effects. There were five non BAT related deaths (7,8%) in the follow up period. Conclusion Systolic and diastolic ABP, as well as number and dosage of antihypertensive drugs decreased significantly during 3.5-years follow-up after Barostim neo implantation in 64 consecutive patients (of whom 62 completed at least one follow-up). No MAE associated with BAT were observed after the perioperative period. However, further controlled trials are needed to confirm the long-term efficacy of BAT. Figure 1. Mean blood pressure drop Funding Acknowledgement Type of funding source: None

scholarly journals Effects of Renal Denervation on Ambulatory Blood Pressure Measurements in Patients With Resistant Arterial Hypertension

2014 ◽  
Vol 37 (5) ◽  
pp. 307-311 ◽  
Author(s):  
Thomas Lambert ◽  
Hermann Blessberger ◽  
Verena Gammer ◽  
Alexander Nahler ◽  
Michael Grund ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Ambulatory Blood Pressure ◽  
Renal Denervation ◽  
Pressure Measurements ◽  
Resistant Arterial Hypertension ◽  
Ambulatory Blood Pressure Measurements

scholarly journals Magnetic resonance imaging of the aortic wall as a risk index for acute ischemic stroke in patients with resistant arterial hypertension

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N Ryumshina ◽  
A E Sukhareva ◽  
O V Mochula ◽  
T A Shelkovnikova ◽  
A S Maksimova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Arterial Hypertension ◽  
Acute Ischemic Stroke ◽  
Contrast Enhancement ◽  
Renal Denervation ◽  
Aortic Wall ◽  
Control Group ◽  
Contrast Enhanced ◽  
Resistant Arterial Hypertension

Abstract Aim To value the possible relationship between the intensity of neoangiogenesis in the aortic wall in patients with resistant arterial hypertension and the subsequent development of ischemic cerebral disorders in them over a three-year follow-up. Materials and methods This study comprised 36 patients with resistant hypertension, in whom the renal denervation was carried out. MRI of the brain and also with contrast enhancement of the aorta and kidneys were examined. MRI studies included T2 and T1 spin-echo MRI, and also coronal slices, with suppression of the signal from adipose tissue (TR=150 ms, TE = 4 ms), before and in 12–15 minutes after contrast-enhanced. The diameter and thickness of the wall of the descending aorta were measured. Index of the enhancement of the aortic wall was calculated as the ratio of intensities of the wall after, and before contrast-enhanced. 9 according to MRI data - developed an acute ischemic stroke during this period, and 27 had no cerebral circulation disorders. The control group consisted of individuals without hypertension (n=12). Results After renal denervation, the systolic blood pressure significantly decreased in all patients for more than 15 mm Hg. In groups of patients with ischemic stroke, and without it, the diameter of the aortic lumen at the level above the renal arteries was 22,1±2,4 mm and 22,8±2,7 mm, respectively; the aortic wall thickness was 3,9±0,7 mm and 3,7±0,8 mm. In control subjects without hypertension, the wall thickness was less than 2,7 mm (on average 2,2±0,4 mm), with an aortic diameter of 21,3±0,9. As to the index of enhancement (as a marker of neoangiogenesis intensity) in the control group, in everybody, the IE was <1,12. In patients with stroke within 3 years after renal denervation, IE = 2,12±0,31, and in patients without stroke IE = 1,66±0,19. The value of IE = 1,82 was the best for separating groups with and without stroke in the three years endpoint, as from the ROC analysis. Conclusion Contrast enhancement of the aortic wall in MRI is associated with the risk of brain ischemic stroke in patients with resistant arterial hypertension, even when blood pressure control is achieved by renal denervation. This makes it possible to predict the risk of stroke in these patients more reliably and encourages the inclusion of agents that reduce the activity of inflammation and pathological neoangiogenesis in the aortic wall, to the spectrum of antihypertensive therapy. FUNDunding Acknowledgement Type of funding sources: None. Brain MRI T2WI MRI of the kidneys and aorta, T1WI

scholarly journals Radiofrequency denervation of the renal arteries in patients with resistant arterial hypertension: 3 years of observation experience

2019 ◽  
Vol 16 (4) ◽  
pp. 65-69
Author(s):  
Nina Yu Savelyeva ◽  
Anna Yu Zherzhova ◽  
Ekaterina V Mikova ◽  
Liudmila I Gapon ◽  
Grigorii V Kolunin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Antihypertensive Drugs ◽  
Blood Pressure Monitoring ◽  
Secondary Hypertension ◽  
Renal Arteries ◽  
Radiofrequency Denervation ◽  
Intact Kidney ◽  
Resistant Arterial Hypertension

Objective. To evaluate the efficiency of radiofrequency denervation of the renal arteries in patients with resi-stant arterial hypertension during a three-year follow-up. Materials and methods. The study involved 40 patients with resistant arterial hypertension aged 27 to 70 years (mean age 54.91±9.77 years) while receiving three or more antihypertensive drugs (including diuretic) in optimal doses. The conditions for inclusion in the study were considered resistant arterial hypertension with blood pressure (BP)>160/100 mm Hg, intact kidney function - glomerular filtration rate (MDRD)>45 ml/min - and the absence of secondary hypertension. All patients had sympatic radiofrequency denervation of renal arteries; its efficiency later was estimated according to the clinical measurement and ambulatory blood pressure monitoring (ABPM). Results. The level of office BP reliably differed initially and after 3 years: DSBP -34.48±6.44 mm Hg (p=0.001), DDBP - 22.29 mm Hg (p=0.001). According to ABPM results, reliable dynamics of systolic blood pressure was not observed. The data of DBP at night were significantly lower after 36 months; DDBP was -5.37±9.77 mm Hg. Conclusions. A marked decrease in the data of office SBP and DBP was observed, which proves the long-term efficiency of radiofrequency denervation of the renal arteries in patients with resistant hypertension. Accor-ding to ABPM results after 36 months, a significant decrease was registered among the DBP indicators at night and daytime.

Abstract P255: Resistance Hypertension And Achievement Of Target Blood Pressure Level By Continuous Positive Airway Pressure Long Therapy In Patients With Obstructive Sleep Apnea

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Oksana Rekovets ◽  
Yuriy Sirenko ◽  
Nina Krushynska ◽  
Olena Torbas ◽  
Svitlana Kushnir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Arterial Hypertension ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Obstructive Sleep ◽  
Resistant Arterial Hypertension

The aim was to assess the arterial stiffness changes in patients with resistant arterial hypertension (AH) and obstructive sleep apnea (OSA) and possibilities of its correction by continuous positive airway pressure (CPAP)-therapy. Design: In 10 month follow-up study were included 46 patients with RAH, who were divided into groups: 1-st - patients with RAH and moderate to severe OSA on CPAP (n=21); 2-nd - patients with RAH and moderate to severe OSA without CPAP (n=25). They underwent somnography by dual-channel portable monitor device, office and ambulatory blood pressure monitoring, echocardiography and applanation tonometry. All patients received similar antihypertensive therapy according to 2013 ESH Guidelines for the management of arterial hypertension. Results: Patients with RAH and OSA (mean apnea-hypopnea index (AHI) 36.5±2.7 event h-1) in comparison with patients with RAH without OSA (mean AHI 3.4±0.2 event h-1) had significantly higher body mass index (34.2±0.7 vs 31.6±0.7 kg m-2, P<0.05), uric acid level (6.7±0.1 vs 5.6±0.4 mg dl-1, P<0,05)). Patients with RAH and OSA in comparison with patients with RAH without OSA had higher carotid-femoral pulse wave velocity (PWVcf) (12.1±0.5 vs 10.2 m s-1, P<0,05) and central systolic blood pressure (CSBP) (143.8±2.7 vs 136.2±3.4 mm Hg, P<0,05). During 10 months follow-up in patients with RAH and moderate and sever OSA on CPAP-therapy there were significantly decrease of PWVcf (from 12.1±0.5 to 10.5±0.5 m s-1, P<0,05), decrease office systolic blood pressure (from 147.8±3.7 to 136.7±2.8 mm Hg; P<0,05) and diastolic blood pressure (from 96.8±3.5 to 87.0±3.3 mm Hg; P<0,05) with achievement of target levels in 67,2% patients. Central systolic BP decreased (from 143.8±2.7 to 137.7±2.8 mm Hg; P<0,05). Conclusion: The combination of therapy continuous positive airway pressure with antihypertensive treatment in patients with resistant arterial hypertension and moderate to severe obstructive sleep apnea improved achievement of target blood pressure, decreased arterial stiffness and decreased central blood pressure.

scholarly journals Renal denervation with a resistant arterial hypertension: the results of a five-year follow-up

2018 ◽  
Vol 90 (9) ◽  
pp. 88-91 ◽  
Author(s):  
P V Glybochko ◽  
A A Svetankova ◽  
A V Rodionov ◽  
A S Maltseva ◽  
V A Sulimov ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Arterial Hypertension ◽  
Kidney Function ◽  
Renal Denervation ◽  
Quality Of Life Indicators ◽  
Before And After ◽  
Resistant Arterial Hypertension

Aim. To evaluate the 5-year results of renal denervation (RDN) in patients with resistant arterial hypertension (AH). Materials and methods. The study included 14 patients to whom, during the 2011-2013 period RDN has been completed. Before and after the intervention, office blood pressure, quality of life indicators according to the EQ-5D questionnaire, mass index bodies, indicators of kidney function were duly assessed. Results. Five years after RDN, office BP decreased from 165/110 to 139/95 mm Hg. Art. (p

scholarly journals Correlation arterial stiffness and central blood pressure with obstructive sleep apnea in patients with resistant arterial hypertension

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
O Rekovets ◽  
Y Sirenko ◽  
N Krushynska ◽  
O Torbas ◽  
S Kushnir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Aortic Stiffness ◽  
Pulse Wave ◽  
Central Blood Pressure ◽  
Nocturnal Hypoxemia ◽  
Obstructive Sleep ◽  
Resistant Arterial Hypertension

Abstract   The aim assess correlation the arterial stiffness in patients with resistant arterial hypertension (AH) and obstructive sleep apnea (OSA) Design 185 patients with AH were enrolled into the study. They were divided on 2 groups: OSA group – 148 patients were found to have OSA, indicated by at mean AHI of 38.1±2.5 h–1, and control group – 37 patients without OSA, mean AHI 3.02±0.25 h–1 (P&lt;0.001). Patients of both groups were comparable on age, growth, total cholesterol level and office systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results Patients with RAH and OSA (mean apnea-hypopnea index (AHI) 36.5±2.7 event/h) in comparison with patients with RAH without OSA (mean AHI 3.4±0.2 event/h) had significantly higher body mass index (34.2±0.7 vs 31.6±0.7 kg/m2, P&lt;0.05), uric acid level (6.7±0.1 vs 5.6±0.4 mg/dl, P&lt;0,05), higher carotid-femoral pulse wave velocity (PWVcf) (12.1±0.5 vs 10.2 m/s, P&lt;0,05) and central systolic blood pressure (CSBP) (143.8±2.7 vs 136.2±3.4 mm Hg, P&lt;0,05). Patients of both groups had comparable office blood pressure (SBP 145.6±1.67 vs 138.4±3.66 mm Hg, P=0.057 and DBP 93.6+±1.18 vs 89.1±2.11 mm Hg, P=0.073), but significantly higher 24-h systolic and diastolic blood pressure. We suggest that in the study some patients with OSA had masked arterial hypertension. Daytime sleepiness in OSA patients was associated with structural remodeling of the left ventricle myocardium and more expressed arterial stiffness: ESS score was independently correlated with snoring duration (β=−0.008; P=0.021), interventricular septum thickness (β=0.023; P=0.026), LVMI (β=−0.037; P=0.039) and indexes of central pulse wave: ejection duration (ED) (β=−0.020; P&lt;0.001) and subendocardial viability ratio (SEVR) (β=−0.224; P=0.012). Nocturnal hypoxemia in OSA patients was associated with increased aortic stiffness and higher central blood pressure: desaturation index was independently correlated with Aix (β=4.167; P=0.009), Aix75 (β=−3.929; P=0.006) and central DBP (β=0.151; P=0.004). Conclusion In patients with RH and OSA nocturnal hypoxemia correlation with increased aortic stiffness and higher central blood pressure. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Resistant arterial hypertension: problems and opportunities for personalised drug therapy

2020 ◽  
Vol 27 (5) ◽  
pp. 60-73
Author(s):  
A. V. Fendrikova ◽  
V. V. Skibitskiy ◽  
E. S. Garkusha ◽  
A. I. Chesnikova ◽  
M. Е. Statsenko
Keyword(s):  
Blood Pressure ◽  
Drug Therapy ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Salt Sensitivity ◽  
Target Blood Pressure ◽  
Antihypertensive Drug Therapy ◽  
Controlled Study ◽  
Salt Loading ◽  
Resistant Arterial Hypertension

Background. Effective drug therapy for resistant arterial hypertension is among major problems in modern medicine. The actual prevalence of resistant arterial hypertension is unknown, and its pathogenetic mechanisms are actively investigated. Among its important components is salt-sensitivity of the patient. At the same time, effi cacy of combined antihypertensive therapy in relation to salt-sensitivity of patients with resistant arterial hypertension is not fully understood.Objectives. Effi cacy assessment of personalised drug therapy in salt-sensitive and salt-resistant patients with resistant arterial hypertension.Мethods. We conducted a non-randomised controlled study with the observation time of 48 weeks. All patients had ambulatory blood pressure monitoring (ABPM) in the onset and past 48 weeks of treatment. Prior to therapy, the patient’s salt-sensitivity was determined with ABPM in salt loading (V.I. Kharchenko’s test). Two cohorts were formed with respect to the test results to include salt-sensitive (n = 67) and salt-resistant (n = 54) patients. Both cohorts received a combined therapy: enalapril 10 mg twice a day, amlodipine 10 mg/day, hydrochlorothiazide 12.5 mg/day, aliskiren 150 mg/day. If a target blood pressure was not observed in 3 weeks, aliskiren was elevated to 300 mg/day. Therapeutic effi cacy was assessed with ABPM after 48 weeks. Non-parametric statistical analysis was performed using Statistica 6.10 (StatSoftInc, USA).Results. The study included 121 patients with resistant arterial hypertension, median age 63 [58;67]. With background therapy, the target blood pressure was observed in 29 (43.4%) patients in cohort 1 and in 38 (70.4%) — in cohort 2 (intergroup p < 0.05). Statistically signifi cant lower ABPM values were registered in both cohorts after 48 weeks. Daily blood pressure normalised with therapy in 62.1% of patients in cohort 1 and in 68.4% — in cohort 2. The salt-resistant cohort exhibited a more pronounced reduction in ABPM values compared to salt-sensitive patients.Conclusion. Salt-sensitivity is a factor for personalising antihypertensive drug therapy in patients with resistant arterial hypertension due to specifi city of mechanisms for maintaining high blood pressure. Combined antihypertensive therapy with aliskiren is statistically more effective in salt-resistant than in salt-sensitive patients.

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