Achieving Renal Denervation: Catheter-Based and Surgical Management for Neural Ablation in the Management of Hypertension

2012 ◽  
Vol 7 (5) ◽  
pp. 314-322
Author(s):  
Neel R. Sodha ◽  
Hans J. Moore ◽  
Vasilios Papademetriou ◽  
Gregory D. Trachiotis
Keyword(s):  
Surgical Management ◽  
Neural Activity ◽  
Renal Denervation ◽  
Cardiovascular Morbidity ◽  
Morbidity And Mortality ◽  
Alternative Strategies ◽  
Baroreflex Activation Therapy ◽  
Conventional Management ◽  
Cardiovascular Morbidity And Mortality ◽  
Activation Therapy

Hypertension refractory to conventional management with medication remains a significant cause of cardiovascular morbidity and mortality. Alternative strategies are warranted in this subgroup of patients. The target of these strategies centers around sympathetic neural activity, which is thought to play a key role in hypertension. We will review the historic and current approaches toward altering sympathetic neural activity, specifically discussing surgical sympathectomy, catheter-based renal denervation strategies, and baroreflex activation therapy.

New Drugs and Interventional Strategies for the Management of Hypertension

2020 ◽  
Vol 26 ◽  
Author(s):  
Theodoros Christophides ◽  
Alberto Somaschini ◽  
Andrea Demarchi ◽  
Stefano Cornara ◽  
Maria Androulaki ◽  
...  
Keyword(s):  
Antihypertensive Treatment ◽  
Renal Denervation ◽  
New Drugs ◽  
Uncontrolled Hypertension ◽  
Good Tolerability ◽  
Baroreflex Activation Therapy ◽  
Cardiovascular Morbidity And Mortality ◽  
Tailored Approach ◽  
Activation Therapy ◽  
The Individual

: Essential hypertension is an important cause of cardiovascular morbidity and mortality worldwide with significant clinical and economical implications. The field of antihypertensive treatment already numbers numerous agents and class of drugs. However, despite these, patients are still developing uncontrolled hypertension hence the continuous need for novel agents, with good tolerability. Advances in this field are focussing both on pharmacotherapy, with developments in traditional and non-traditional targets, as well as interventional techniques such as renal denervation and baroreflex activation therapy. It is likely that future strategies may involve a tailored approach to the individual patient, with genetic modulation playing a key role.

Device Therapy of Hypertension

2021 ◽  
Vol 128 (7) ◽  
pp. 1080-1099
Author(s):  
Felix Mahfoud ◽  
Markus P. Schlaich ◽  
Melvin D. Lobo
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Blood Pressure Control ◽  
Carotid Body ◽  
Renal Denervation ◽  
Pressure Control ◽  
Hypertension Control ◽  
Baroreflex Activation Therapy ◽  
Improve Blood Pressure Control ◽  
Activation Therapy

In the past decade, efforts to improve blood pressure control have looked beyond conventional approaches of lifestyle modification and drug therapy to embrace interventional therapies. Based upon animal and human studies clearly demonstrating a key role for the sympathetic nervous system in the etiology of hypertension, the newer technologies that have emerged are predominantly aimed at neuromodulation of peripheral nervous system targets. These include renal denervation, baroreflex activation therapy, endovascular baroreflex amplification therapy, carotid body ablation, and pacemaker-mediated programmable hypertension control. Of these, renal denervation is the most mature, and with a recent series of proof-of-concept trials demonstrating the safety and efficacy of radiofrequency and more recently ultrasound-based renal denervation, this technology is poised to become available as a viable treatment option for hypertension in the foreseeable future. With regard to baroreflex activation therapy, endovascular baroreflex amplification, carotid body ablation, and programmable hypertension control, these are developing technologies for which more human data are required. Importantly, central nervous system control of the circulation remains a poorly understood yet vital component of the hypertension pathway and mandates further investigation. Technology to improve blood pressure control through deep brain stimulation of key cardiovascular control territories is, therefore, of interest. Furthermore, alternative nonsympathomodulatory intervention targeting the hemodynamics of the circulation may also be worth exploring for patients in whom sympathetic drive is less relevant to hypertension perpetuation. Herein, we review the aforementioned technologies with an emphasis on the preclinical data that underpin their rationale and the human evidence that supports their use.

STUDY OF MICROALBUMINURIA IN PATIENTS WITH NORMOGLYCEMIC HYPERTENSION

2021 ◽  
pp. 68-70
Author(s):  
Ketan Prajapati ◽  
Sanket Makwana ◽  
M. J. Sonagara
Keyword(s):  
Body Mass Index ◽  
Essential Hypertension ◽  
Body Mass ◽  
Independent Predictor ◽  
Blood Pressure Measurement ◽  
Cardiovascular Morbidity ◽  
Morbidity And Mortality ◽  
Hypertensive Patients ◽  
Arterial Blood ◽  
Cardiovascular Morbidity And Mortality

INTRODUCTION:Hypertension is one of the most important risk factors for cardiovascular disease. The incidence of microalbuminuria is more common among hypertensive patients, even in nondiabetic patients. Microalbuminuria is an independent predictor of cardiovascular morbidity and mortality in patients with essential hypertension. Therefore, current guidelines recommend routine screening of microalbuminuria in hypertensive patients to ensure appropriate interventions are initiated early in the disease process before progression to chronic kidney disease and/or renal failure. AIMS & OBJECTIVES:This study is done to estimate the prevalence of microalbuminuria in patients with normoglycemic hypertension and to identify other variables associated with it. MATERIAL & METHODS:In this study, we randomly selected 100 patients with essential hypertension based on inclusion and exclusion criteria. CBC, renal function test, 24-hour urine albumin excretion (UAE), Body mass index (BMI), and arterial blood pressure measurement were done among all selected patients. Data entry was done in Microsoft Ofce Excel and analysis was done using the software package Epi Info (Version 7.1.5) from CDC, Atlanta, U.S.A. OBSERVATIONS & RESULTS: The study was conducted among 100 hypertensive patients out of which 74 were male and 24 were female. Out of 100 patients, microalbuminuria was present in 44 patients. Mean arterial pressure was found high among patients with microalbuminuria than patients without microalbuminuria. The presence of microalbumin in urine was found to increase with the increasing severity of hypertension. Mean body mass index and serum creatinine were found higher in the microalbuminuric group than the normoalbuminuric group. CONCLUSION:The incidence of microalbuminuria is more common among hypertensive patients, even in nondiabetic patients. The presence of microalbuminuria is an independent predictor of cardiovascular morbidity and mortality in patients with essential hypertension. Screening for microalbuminuria is a relatively simple process, should facilitate early vascular disease detection.

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