Substantial blood pressure reduction with renal denervation in a drug-naïve patient intolerant to antihypertensive pharmacotherapy: a case report

When introduced clinically 6 years ago, renal denervation was thought to be the solution for all patients whose blood pressure could not be controlled by medication. The initial two studies, SYMPLICITY HTN-1 and HTN-2, demonstrated great magnitudes of blood pressure reduction within 6 mo of the procedure and were based on a number of assumptions that may not have been true, including strict adherence to medication and absence of white-coat hypertension. The SYMPLICITY HTN-3 trial controlled for all possible factors believed to influence the outcome, including the addition of a sham arm, and ultimately proved the demise of the initial overly optimistic expectations. This trial yielded a much lower blood pressure reduction compared with the previous SYMPLICITY trials. Since its publication in 2014, there have been many analyses to try and understand what accounted for the differences. Of all the variables examined that could influence blood pressure outcomes, the extent of the denervation procedure was determined to be inadequate. Beyond this, the physiological mechanisms that account for the heterogeneous fall in arterial pressure following renal denervation remain unclear, and experimental studies indicate dependence on more than simply reduced renal sympathetic activity. These and other related issues are discussed in this paper. Our perspective is that renal denervation works if done properly and used in the appropriate patient population. New studies with new approaches and catheters and appropriate controls will be starting later this year to reassess the efficacy and safety of renal denervation in humans.

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The Possibility of the Second Generation Antipsychotic-Olanzapine to Cause Severe Akathisia in a Drug Naive Patient -A Case Report

International Journal of Psychiatry ◽

10.33140/ijp.05.01.01 ◽

2020 ◽

Vol 5 (1) ◽

Keyword(s):

Emergency Department ◽

Case Report ◽

Rating Scale ◽

Psychiatric History ◽

Naive Patient ◽

The Family ◽

Drug Naïve ◽

Second Generation Antipsychotic ◽

Severe Anxiety ◽

Drug Naive Patient

Here we are presenting this case of 26 years old gentleman with no past psychiatric history who presented initially to the emergency department with anxiety and depressive symptoms in the context of ongoing stressors, diagnosed as a case of severe anxiety and started on neuroleptic medication. A few days later, it was reported by the family that the patient was moving around and only sit for a few minutes before starting to move again in response to an urge to keep moving. Barnes Akathisia-Rating Scale was administered and indicated severe akathisia. The patient started on Mirtazapine 15 mg and Propranolol 20 mg twice daily, and he dramatically improved in a few days.

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Catheter-based ultrasound renal denervation in patients with resistant hypertension: the randomized, controlled REQUIRE trial

Hypertension Research ◽

10.1038/s41440-021-00754-7 ◽

2021 ◽

Author(s):

Kazuomi Kario ◽

Yoshiaki Yokoi ◽

Keisuke Okamura ◽

Masahiko Fujihara ◽

Yukako Ogoyama ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Resistant Hypertension ◽

Renal Denervation ◽

Blood Pressure Reduction ◽

Control Group ◽

Pressure Reduction ◽

Sham Control ◽

Sham Procedure ◽

Significant Difference

Abstract Renal denervation is a promising new non-pharmacological treatment for resistant hypertension. However, there is a lack of data from Asian patients. The REQUIRE trial investigated the blood pressure-lowering efficacy of renal denervation in treated patients with resistant hypertension from Japan and South Korea. Adults with resistant hypertension (seated office blood pressure ≥150/90 mmHg and 24-hour ambulatory systolic blood pressure ≥140 mmHg) with suitable renal artery anatomy were randomized to ultrasound renal denervation or a sham procedure. The primary endpoint was change from baseline in 24-hour ambulatory systolic blood pressure at 3 months. A total of 143 patients were included (72 renal denervation, 71 sham control). Reduction from baseline in 24-hour ambulatory systolic blood pressure at 3 months was not significantly different between the renal denervation (−6.6 mmHg) and sham control (−6.5 mmHg) groups (difference: −0.1, 95% confidence interval −5.5, 5.3; p = 0.971). Reductions from baseline in home and office systolic blood pressure (differences: –1.8 mmHg [p = 0.488] and −2.0 mmHg [p = 0.511], respectively), and medication load, did not differ significantly between the two groups. The procedure-/device-related major adverse events was not seen. This study did not show a significant difference in ambulatory blood pressure reductions between renal denervation and a sham procedure in treated patients with resistant hypertension. Although blood pressure reduction after renal denervation was similar to other sham-controlled studies, the sham group in this study showed much greater reduction. This unexpected blood pressure reduction in the sham control group highlights study design issues that will be addressed in a new trial. Clinical trial registration NCT02918305 (http://www.clinicaltrials.gov).

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