scholarly journals Renal Denervation for Treating Resistant Hypertension: Current Evidence and Future Insights from a Global Perspective

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Y. Castro Torres ◽  
Richard E. Katholi
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Pressure Control ◽  
Reduce Blood Pressure ◽  
Global Perspective ◽  
Current Evidence ◽  
Consensus Statements ◽  
Stage 1

Adequate blood pressure control represents an important goal for all physicians due to the complications of hypertension which reduce patients' quality of life. A new interventional strategy to reduce blood pressure has been developed for patients with resistant hypertension. Catheter-based renal denervation has demonstrated excellent results in recent investigations associated with few side effects. With the growing diffusion of this technique worldwide, some medical societies have published consensus statements to guide physicians how to best apply this procedure. Questions remain to be answered such as the long-term durability of renal denervation, the efficacy in patients with other sympathetically mediated diseases, and whether renal denervation would benefit patients with stage 1 hypertension.

scholarly journals Effect of renal denervation on long-term outcomes in patients with resistant hypertension

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Bo Liang ◽  
Yi Liang ◽  
Rui Li ◽  
Ning Gu
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Pressure Control ◽  
Treatment Method ◽  
Control Effect ◽  
First Choice ◽  
Long Term Follow Up

AbstractIncreasing studies strongly prove that renal denervation, a minimally invasive surgery, is a promising new non-drug treatment method that can effectively control blood pressure in patients with resistant hypertension, but the evaluation of the long-term blood pressure control effect of renal denervation for resistant hypertension is still lacking. Here, we critically review current long-term follow-up data about the use of renal denervation for RH to comprehensively evaluate the effectiveness of renal denervation for RH, and to provide practical guidance for practitioners who are establishing a renal denervation service. Limited by the current research, many problems need to be solved before renal denervation is applied to RH. In addition, ambulatory blood pressure should be the first choice for the evaluation of blood pressure. Finally, the continuous antihypertensive effect of renal denervation in different renal denervation systems also needs to be strictly compared.

scholarly journals Resistant Hypertension: A Real Entity Requiring Special Treatment?

2016 ◽  
Vol 11 (1) ◽  
pp. 8
Author(s):  
Stefano Taddei ◽  
Rosa Maria Bruno ◽  
◽  
◽  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Antihypertensive Drugs ◽  
Pressure Control ◽  
Clinical Situation ◽  
Special Treatment ◽  
Separate Clinical Entity ◽  
Real Entity ◽  
Definition Of

Resistant hypertension (RH) was defined many years ago as a clinical situation in which blood pressure remains uncontrolled despite concomitant intake of at least three antihypertensive drugs (one of them preferably being a diuretic) at full doses. This operative definition was aimed at identifying a subset of hypertensive patients requiring a more extensive clinical workup in order to achieve an adequate blood pressure control. An oversimplification of this picture led to consider RH as a separate clinical entity requiring special, expensive treatments, such as renal denervation and baroreceptor activating therapy. In this review we will discuss the utility and the shortcomings of the definition of RH and the possible consequences for treatment.

scholarly journals Long-term benefit of renal denervation on blood pressure control in a patient with hemorrhagic stroke

2019 ◽  
Vol 7 ◽  
pp. 2050313X1987097
Author(s):  
Francesco Versaci ◽  
Giuseppe Andò ◽  
Marcello Chiocchi ◽  
Francesco Romeo
Keyword(s):  
Blood Pressure ◽  
Renal Denervation ◽  
Hemorrhagic Stroke ◽  
Blood Pressure Reduction ◽  
Pressure Control ◽  
Refractory Hypertension ◽  
Sustained Efficacy ◽  
Term Benefit

A 49-year-old man with malignant hypertension had been admitted with hemorrhagic stroke. Refractory hypertension had been observed during hospitalization and the decision had been made to perform renal denervation. A significant blood pressure reduction was obtained immediately after renal denervation and persists at 2-year follow-up. This case demonstrates the long-term sustained efficacy of renal denervation performed in the acute phase of hemorrhagic stroke. In addition, it supports the notion that renal denervation–induced normalization of blood pressure may contribute to better outcomes in a challenging setting such as intracranial bleeding.

Renal denervation: current implications and future perspectives

2013 ◽  
Vol 126 (1) ◽  
pp. 41-53 ◽  
Author(s):  
Jianzhong Xu ◽  
Dagmara Hering ◽  
Yusuke Sata ◽  
Antony Walton ◽  
Henry Krum ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Interventional Procedure ◽  
Strong Association ◽  
Blood Pressure Reduction ◽  
Pressure Control ◽  
Renal Nerves ◽  
Renal Nerve ◽  
Disease States

SNS (sympathetic nervous system) activation is a common feature of arterial hypertension and has been demonstrated to contribute to the development and progression of the hypertensive state. Persuasive evidence suggests a strong association between SNS overactivity and variety of disease states, including chronic renal failure, insulin resistance, congestive heart failure, sleep apnoea, ventricular arrhythmias and others. Although sympatholytic agents are available to target SNS overactivity pharmacologically, they are not widely used in clinical practice, leaving the SNS unopposed in many patients. The recent introduction of catheter-based renal denervation as an alternative approach to target the SNS therapeutically has been demonstrated to result in a clinically relevant blood pressure reduction in patients with resistant hypertension, presumably through its effects on both efferent and afferent renal nerve traffic. Available data on this interventional procedure demonstrate a favourable vascular and renal safety profile. Preliminary data obtained primarily from small and mostly uncontrolled studies in related disease states often characterized by overactivity of the SNS are promising, but require confirmation in appropriately designed clinical trials. In the present paper, we briefly review the physiology of the renal nerves and their role in hypertension and other relevant disease states, summarize the data currently available from clinical studies pertaining to the safety and efficacy of renal denervation in resistant hypertension, discuss potential future implications and the available data supporting such a role for renal denervation, and describe some of the newer devices currently under investigation to achieve improved blood pressure control via renal denervation.

DYNAMICS OF FUNCTIONAL STATE OF KIDNEYS IN PATIENTS WITH RESISTANT HYPERTENSION AND CHRONIC KIDNEY DISEASE ACCORDING TO LONG-TERM FOLLOW-UP

2020 ◽  
pp. 5-11
Author(s):  
O. O. Matova ◽  
K. I. Serbeniuk ◽  
L. V. Bezrodna ◽  
V. B. Bezrodnyi ◽  
V. V. Radchenko
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Antihypertensive Therapy ◽  
Functional State ◽  
Resistant Hypertension ◽  
Pressure Control

Resistant hypertension and chronic kidney disease are closely related from a pathogenetic and clinical point of view. To study the dynamics of functional state of kidneys and as well as to identify the predictors of its improvement, 117 patients with resistant hypertension were examined. Dynamic follow−up of patients included monitoring of antihypertensive therapy, blood pressure, biochemical and humoral parameters during 3, 6 and 36 months of treatment. The findings have shown that a significant long−term improvement in blood pressure control in the patients with chronic kidney disease improves their function and also has a nephroprotective effect in patients without any signs of renal damage. The established prognostic value of the higher initial creatinine content for the improvement of renal function in patients with resistant hypertension is stipulated with a positive effect of antihypertensive therapy on the glomerular filtration rate dynamics. The close association between improved renal function and lower baseline levels of interleukin 6 as well as an active renin in the blood may indicate a role for systemic inflammation and renin−angiotensin−aldosterone system activity in the renal dysfunction development. Prolonged improvement in blood pressure control in the patients with resistant hypertension without diabetes is associated with a stable level of urinary albumin excretion, whereas in patients with diabetes, an albuminuria increases over time. The study concluded that independent predictors of improved renal function in patients with resistant hypertension are higher baseline creatinine and lower glomerular filtration rate, lower concentrations of interleukin 6, active renin and plasma potassium. Key words: resistant arterial hypertension, chronic kidney disease, functional state of kidneys, antihypertensive therapy.

scholarly journals Is Resistance Futile?

2019 ◽  
pp. 129-146
Author(s):  
Harneet K. Walia ◽  
Meghna P. Mansukhani
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Resistant Hypertension ◽  
Large Body ◽  
Pressure Control ◽  
Reduce Blood Pressure ◽  
Improve Blood Pressure Control ◽  
Obstructive Sleep ◽  
High Prevalence ◽  
The Relationship

Obstructive sleep apnea (OSA) is highly prevalent in patients with hypertension, particularly in the resistant hypertension population. A large body of evidence supports the association between OSA and incident hypertension independent of confounding risk factors. This chapter discusses the relationship between OSA and hypertension and resistant hypertension, including the prevalence, epidemiology, and pathophysiologic mechanisms linking these conditions. Treatment of OSA has been shown to reduce blood pressure in patients with hypertension, and the reduction is more marked in those with resistant hypertension. Given the high prevalence of OSA in patients with resistant hypertension, clinicians should be cognizant about screening and evaluating for OSA in patients with resistant hypertension, as treatment of OSA can improve blood-pressure control.

scholarly journals Copeptin Levels in Patients With Treatment-Resistant Hypertension Before and 6 Months After Renal Denervation

2019 ◽  
Author(s):  
Agnes Bosch ◽  
Axel Schmid ◽  
Christian Ott ◽  
Dennis Kannenkeril ◽  
Marina V Karg ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Renal Artery ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Treatment Resistant ◽  
Clinical Trial Registration ◽  
All Cause Mortality ◽  
Stage 1

Abstract BACKGROUND Copeptin, the C-terminal peptide of provasopressin, is released from the neurohypophysis and reflects the activity of the hormone arginine vasopressin in patients with hypertension. Elevated copeptin levels are associated with increased cardiovascular and all-cause mortality. The aim of this study is to compare copeptin levels in patients with treatment-resistant hypertension (TRH) before and 6 months after renal denervation (RDN). METHODS Copeptin was measured in 34 patients with TRH and 30 patients with primary hypertension stage 1 or 2 (HT). In addition, copeptin levels were measured in patients with TRH at 6-month follow-up visit after RDN. RDN was performed by an experienced interventionalist applying at least 4 ablations longitudinally and rotationally within the lengths of each renal artery to cover a full 4-quadrant ablation. RESULTS In patients with TRH 24-hour ambulatory blood pressure (BP) decreased from 154 ± 15/87 ± 12 mm Hg to 146 ± 13/83 ± 7.9 mm Hg after RDN (systolic: P = 0.001, diastolic: P = 0.034). There was no significant change in copeptin levels in these 34 patients with TRH before vs. 6 months after RDN (median 8.4 [interquartile range 3.6–14] vs. 8.5 [4.5–13] pmol/l, P = 0.334). Patients with TRH had higher copeptin levels (P = 0.024) than patients with HT (24-hour ambulatory BP: 142 ± 11/91 ± 8.3 mm Hg, copeptin: 4.2 [2.8–6.3] pmol/l). CONCLUSION Patients with TRH showed 2-fold higher copeptin levels than patients with HT. RDN did not lead to any change of copeptin levels in patients with TRH 6 months after procedure despite significant fall in BP. CLINICAL TRIAL REGISTRATION NCT01318395, NCT01687725

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