Renal denervation alters ambulatory blood pressure-derived salt sensitivity index in patients with uncontrolled hypertension

IntroductionMasked uncontrolled hypertension (MUCH) carries an increased risk of cardiovascular (CV) complications and can be identified through combined use of office (O) and ambulatory (A) blood pressure (BP) monitoring (M) in treated patients. However, it is still debated whether the information carried by ABPM should be considered for MUCH management. Aim of the MASked-unconTrolled hypERtension management based on OBP or on ambulatory blood pressure measurement (MASTER) Study is to assess the impact on outcome of MUCH management based on OBPM or ABPM.Methods and analysisMASTER is a 4-year prospective, randomised, open-label, blinded-endpoint investigation. A total of 1240 treated hypertensive patients from about 40 secondary care clinical centres worldwide will be included -upon confirming presence of MUCH (repeated on treatment OBP <140/90 mm Hg, and at least one of the following: daytime ABP ≥135/85 mm Hg; night-time ABP ≥120/70 mm Hg; 24 hour ABP ≥130/80 mm Hg), and will be randomised to a management strategy based on OBPM (group 1) or on ABPM (group 2). Patients in group 1 will have OBP measured at 0, 3, 6, 12, 18, 24, 30, 36, 42 and 48 months and taken as a guide for treatment; ABPM will be performed at randomisation and at 12, 24, 36 and 48 months but will not be used to take treatment decisions. Patients randomised to group 2 will have ABPM performed at randomisation and all scheduled visits as a guide to antihypertensive treatment. The effects of MUCH management strategy based on ABPM or on OBPM on CV and renal intermediate outcomes (changing left ventricular mass and microalbuminuria, coprimary outcomes) at 1 year and on CV events at 4 years and on changes in BP-related variables will be assessed.Ethics and disseminationMASTER study protocol has received approval by the ethical review board of Istituto Auxologico Italiano. The procedures set out in this protocol are in accordance with principles of Declaration of Helsinki and Good Clinical Practice guidelines. Results will be published in accordance with the CONSORT statement in a peer-reviewed scientific journal.Trial registration numberNCT02804074; Pre-results.

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Ambulatory blood pressure may be designed as the primary efficacy outcome in clinical trials on renal denervation

International Journal of Cardiology ◽

10.1016/j.ijcard.2014.07.192 ◽

2014 ◽

Vol 176 (3) ◽

pp. 1262-1263

Author(s):

Yutang Wang

Keyword(s):

Blood Pressure ◽

Clinical Trials ◽

Ambulatory Blood Pressure ◽

Renal Denervation ◽

Primary Efficacy ◽

Primary Efficacy Outcome ◽

Efficacy Outcome

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A cautious view of the relationship between ambulatory blood pressure monitoring data and salt-sensitivity of blood pressure

Journal of Hypertension ◽

10.1097/hjh.0b013e328363525f ◽

2013 ◽

Vol 31 (9) ◽

pp. 1909 ◽

Cited By ~ 3

Author(s):

Fernando Elijovich ◽

Cheryl L. Laffer

Keyword(s):

Blood Pressure ◽

Ambulatory Blood Pressure Monitoring ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Salt Sensitivity ◽

Monitoring Data ◽

Pressure Monitoring ◽

The Relationship

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Proposal of a new strategy for ambulatory blood pressure profile-based management of resistant hypertension in the era of renal denervation

Hypertension Research ◽

10.1038/hr.2013.19 ◽

2013 ◽

Vol 36 (6) ◽

pp. 478-484 ◽

Cited By ~ 41

Author(s):

Kazuomi Kario

Keyword(s):

Blood Pressure ◽

Ambulatory Blood Pressure ◽

Resistant Hypertension ◽

Renal Denervation ◽

Pressure Profile ◽

Blood Pressure Profile ◽

New Strategy

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Ambulatory Blood Pressure Control Pattern in Hypertensive Patients at Tikur Anbesa Specialized Hospital: A Cross Sectional Study

10.21203/rs.3.rs-763121/v1 ◽

2021 ◽

Author(s):

MULUALEM ALEMAYEHU ◽

Sintayehu Abebe ◽

Dejuma Yadeta ◽

Bekele Alemayehu

Keyword(s):

Blood Pressure ◽

Ambulatory Blood Pressure ◽

Addis Ababa ◽

Cross Sectional Study ◽

Uncontrolled Hypertension ◽

Sectional Study ◽

Ethical Guidelines ◽

Cross Sectional ◽

Hypertensive Patients ◽

Control Pattern

Abstract Background: Hypertension is the most common cardiovascular problem globally with a particularly increasing burden in developing countries like Ethiopia. Ambulatory blood pressure (ABPM) is superior to office blood pressure (OBP) measurement for diagnosing, prognosticating and following treatment efficacy for hypertension. There is no available data on ABPM control pattern in Ethiopians. This study will determine the ABPM control patterns in Ethiopian hypertensive patients on treatment. Material and Methods: This was a cross sectional study in hypertensive patients at Tikur Anbessa Specialized Hospitals outpatient departments carried out during January to May 2021. ABPM values of 244 consecutively sampled patients were analyzed. All patients had their BP monitored over 24 h with a Tonoport V (GE CS V6 71), and the data was interpreted using GE CardiosoftTM ABPM software in accordance with European Society of hypertension guidelines. Ethical clearance was given by Addis Ababa University Institutional Review Board and the study was conducted in compliance to standard ethical guidelines.Results: The study involved 244 adult hypertensive patients; mean age of the patients was 59.4years and, 54% were females. 58.6% of patients had controlled OBP, while only 45.1% had controlled ABPM. The mean OBP was 137 (19)/81 (10) mmHg and mean 24-hr ABP was 137 (16)/81 (10) mmHg; mean daytime BP was 136/79 ± 17/11 mmHg; mean night‑time BP, 138/84 ± 16/11 mmHg. Mean ABPM values were not significantly different between men and women. Comparison of ABPM values with OBP revealed high prevalence of the white coat effect (32%) and masked uncontrolled hypertension (46%). Presence of comorbidities particularly diabetes predicted poor ABPM control.Conclusion: More than half of patients had uncontrolled BP as per ABPM criteria and significant discrepancy exists between ABPM and OBP in assessing adequacy of BP control. Guiding management decisions using ABPM can improve BP control rates.

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Radiofrequency renal denervation with mono-electrode and multi-electrode device for treatment in patient with uncontrolled hypertension: results of a 6-month follow-up

Systemic Hypertension ◽

10.26442/2075082x.2020.1.200077 ◽

2020 ◽

Vol 17 (1) ◽

pp. 46-50 ◽

Cited By ~ 1

Author(s):

Regina A. Agaeva ◽

Nikolai M. Danilov ◽

Galina V. Shchcelkova ◽

Yuri G. Matchin ◽

Irina E. Chazova

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Renal Denervation ◽

Blood Pressure Monitoring ◽

Hypotensive Effect ◽

Uncontrolled Hypertension ◽

Pressure Monitoring ◽

Group A ◽

Group B

Aim. To study the efficacy and safety of radiofrequency renal denervation with mono-electrode and multi-electrode devices in patients with uncontrolled arterial hypertension during а 6-month follow-up period. Materials and methods. The study included 52 patients with uncontrolled arterial hypertension, while receiving multicomponent antihypertensive therapy, including diuretic. Patients underwent radiofrequency renal denervation with a mono-electrode (group A; n=27) and multi-electrode devices (group B; n=25). The effectiveness of the procedure was study according to office blood pressure (BP) and ambulatory blood pressure monitoring (ABPM). Results. In group A and B, according to office BP after 6 months, there decreased in SBP/DBP by 32/14 and 30/10 mmHg (р=0.00001/р=0.00001 and p=0.00001/0.0004) respectively. According to ABPM, in group A there was a decrease in the average daily SBP and DBP by 7 and 4 mmHg (р=0.01 and р=0.03) respectively. According to ABPM, after 6 months in group B, there was a decrease in the average daily SBP and DBP by 12 and 6 mmHg (р=0.0003 and р=0.0007) respectively. Conclusions. The results confirm the safety and effectiveness of radiofrequency renal denervation. RDN of the distal branches of the renal arteries leads to a greater hypotensive effect.

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