scholarly journals Comparison of Long‐Term Outcomes for Responders Versus Non‐Responders Following Renal Denervation in Resistant Hypertension

2021 ◽  
Author(s):  
Karl Fengler ◽  
Paul Reimann ◽  
Karl‐Philipp Rommel ◽  
Karl‐Patrik Kresoja ◽  
Stephan Blazek ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Blood Pressure Response ◽  
Sympathetic Denervation ◽  
Major Adverse Cardiovascular Events ◽  
Renal Sympathetic Denervation ◽  
Recent Trial ◽  
Renal Sympathetic

Background Recent trial results support the efficacy of renal sympathetic denervation in lowering blood pressure (BP). While BP reduction in general is associated with a clinically meaningful reduction in cardiovascular events and mortality, such a relationship has not been described for patients undergoing renal sympathetic denervation. Methods and Results Clinical events were assessed in patients who underwent renal sympathetic denervation at our center using telephone‐ and clinical follow‐up, interviews with general practitioners, as well as review of hospital databases. Event rates were compared between BP responders (≥5 mm Hg 24‐hour ambulatory BP reduction) and non‐responders; 296 patients were included. Compared with baseline, 24‐hour systolic ambulatory BP was reduced by 8.3±12.2 mm Hg and diastolic BP by 4.8±7.0 mm Hg ( P <0.001 for both) after 3 months. One hundred eighty patients were classified as BP responders and 116 as non‐responders. During a median follow‐up time of 48 months, significantly less major adverse cardiovascular events (cardiovascular death, stroke, myocardial infarction, critical limb ischemia, renal failure) occurred in responders than in non‐responders (22 versus 23 events, hazard ratio [HR], 0.53 [95% CI, 0.28 to 0.97], P =0.041). This was consistent after adjustment for potential confounders as well as confirmed by propensity‐score matching. A proportional relationship was found between BP reduction after 3 months and frequency of major adverse cardiovascular events (HR, 0.75 [95% CI, 0.58 to 0.97] per 10 mm Hg 24‐hour systolic ambulatory BP reduction). Conclusions Based on these observational data, blood pressure response to renal sympathetic denervation is associated with improved long‐term clinical outcome.

scholarly journals Renal sympathetic denervation in patients with resistant hypertension. Results of long-term prospective follow-up

2021 ◽  
Vol 27 (3) ◽  
pp. 318-332
Author(s):  
M. V. Ionov ◽  
I. V. Emelyanov ◽  
Yu. S. Yudina ◽  
S. A. Panarina ◽  
D. A. Zverev ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Randomized Clinical Trials ◽  
Sympathetic Denervation ◽  
Reference Level ◽  
Renal Sympathetic Denervation ◽  
Positive Trend ◽  
Term Efficacy ◽  
Renal Sympathetic

Objective. Renal sympathetic denervation (RDN) is one of the invasive treatment options for the patients with hypertension (HTN) who are resistant to antihypertensive therapy (AHT). The short-term efficacy of RDN has been proven in a number of randomized clinical trials, but remains controversial, the data on its long-term efficacy are limited. The aim of our study was to evaluate the natural course of HTN, to assess long-term major adverse cardiovascular events (MACE) and other outcomes, as well as AHT efficacy and its features in patients with resistant HTN after bilateral RDN during extended prospective follow-up. Design and methods. We included 22 patients with truly resistant HTN (median 57 y. o., 9 males), in whom RDN was performed during 2012–2015 in the clinical center of excellence. We assessed initial and further (after 1 year and after ≥ 5 years) clinical, laboratory and anthropometric parameters, as well as detailed AHT history. Long-term MACE and other clinically significant outcomes were recorded. At baseline and follow-up, the quality of life (QoL) was determined with the use of EQ-5D questionnaire at all time points. Multiple linear regression was used to find possible predictors of the efficacy of RDN. Results. A significant and sustained drop in office and ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) was observed at 12 months after RDN compared to baseline values (∆ –24 and –12 mm Hg, p < 0,005; ∆ –10 and –7 mm Hg, p < 0,05, respectively). There were 7 patients with office SBP on-target, and 12 patients were considered responders (∆ SBP > 10 mm Hg). These numbers increased to 10 and 14 patients after ≥ 5 years after RDN. A causal relationship between changes in office SBP was found only for the baseline SBP (β -0,6, p = 0,02). No differences in the number of medications were noted during follow-up (4,4; 4,1 and 4,1 drugs, p = 0,41). During the follow-up 10 MACE occurred and 5 patients were diagnosed with various types of cancer; there were no fatal outcomes. The QoL significantly improved a year after RDN (+9,7 points, p = 0,01), however, a negative trend was observed in the next 5 years with return to reference level. No association was observed between BP and QoL changes at two timepoints. Conclusions. The RDN shows a pronounced clinical effect in patients with resistant HTN up to 5 years, and is not accompanied by an AHT intensification, but is not associated with QoL changes. The initial positive trend for QoL completely harked back after 5 years which may be associated with the development of MACE. The only predictor of RDN positive effect is baseline SBP level.

scholarly journals Renal Denervation in the Most Serious Form of Resistant Arterial Hypertension

2016 ◽  
pp. 909-916 ◽  
Author(s):  
J. ŠOCHMAN ◽  
M. BÜRGELOVÁ ◽  
J. H. PEREGRIN
Keyword(s):  
Blood Pressure ◽  
Severe Hypertension ◽  
Antihypertensive Agents ◽  
Repeated Measurements ◽  
Sympathetic Denervation ◽  
Uncontrolled Hypertension ◽  
Renal Sympathetic Denervation ◽  
Similar Response ◽  
Renal Sympathetic

The aim of our observation was to establish whether or not renal sympathetic denervation (RSD) may help control blood pressure (BP) levels in patients with severe hypertension refractory to pharmacological therapy. Out of a group of 12 patients, candidates for RSD, with uncontrolled hypertension and a systolic BP over 190 mm Hg on repeated measurements despite optimal medication, four patients were excluded for multiple renal arteries and one for hyperaldosteronism. Seven patients had RSD using a Symplicity device (5M, 2 F) with a mean age of 64.9 years. While all were followed up for a minimum of 6 months, follow-up duration in the majority of them was substantially longer (12-20 months). At six months post-RSD, six of the seven patients showed a decrease in systolic BP by at least 15 mm Hg while receiving the same or fewer doses of antihypertensive agents. A similar response was seen in diastolic BP. The BP decrease was maintained throughout whole follow-up. In a small group of patients with severe hypertension, we demonstrated that renal sympathetic denervation is capable of reducing blood pressure even in patients with severe hypertension.

scholarly journals Renal Sympathetic Denervation in Resistant Arterial Hypertension: Long Term and Updated Results

2019 ◽  
pp. 129-133 ◽  
Author(s):  
J.H. Peregrin ◽  
J. Novotný ◽  
T. Rohál ◽  
J. Šochman
Keyword(s):  
Arterial Hypertension ◽  
Beneficial Effect ◽  
Sympathetic Denervation ◽  
Renal Sympathetic Denervation ◽  
Group Of Seven ◽  
Post Procedure ◽  
Resistant Arterial Hypertension ◽  
Renal Sympathetic

The present paper is an extension to our earlier publication (Šochman et al. 2016) documenting a beneficial effect of renal sympathetic denervation on pharmacologically uncontrollable hypertension in a group of seven patients followed up for 1-2 years post-procedure. The same patients remained on ambulatory follow-up for another 5-6 years, with the beneficial effect persisting throughout the follow-up period while on the same medication.

Predictors for profound blood pressure response in patients undergoing renal sympathetic denervation

2018 ◽  
Vol 36 (7) ◽  
pp. 1578-1584 ◽  
Author(s):  
Karl Fengler ◽  
Karl-Philipp Rommel ◽  
Stephan Blazek ◽  
Maximilian von Roeder ◽  
Christian Besler ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Response ◽  
Pressure Response ◽  
Sympathetic Denervation ◽  
Renal Sympathetic Denervation ◽  
Renal Sympathetic
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