Interventional Therapies for Resistant Hypertension: A Brief Update

2016 ◽  
Vol 11 (1) ◽  
pp. 65
Author(s):  
Lisa Brandon ◽  
◽  
◽  
Faisal Sharif
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Management Options ◽  
Arteriovenous Shunts ◽  
Significant Difference ◽  
Activation Therapy ◽  
Renal Artery Denervation ◽  
Baroreceptor Activation ◽  
And Control ◽  
Interventional Therapies

Resistant hypertension remains a clinical challenge with few management options beyond maximisation of medications. Catheterbased renal artery denervation (RDN) was proposed in 2009 as a possible therapy for resistant hypertension and early feasibility trials caused excitement among cardiologists and antihypertensive specialists, showing remarkable and sustained blood pressure reductions. In 2014, enthusiasm for RDN dampened following the SYMPLICITY 3 trial results, which showed no statistically significant difference in blood pressure between the intervention and control arms. However, hope remains for the improved management of resistant hypertension; procedural understanding, technological advancements and alternative targets – such as baroreceptor activation therapy and arteriovenous shunts – may aid the identification of those patients for whom specific interventional therapies will be effective.

scholarly journals Interventional Therapies for Resistant Hypertension: A Brief Update

2016 ◽  
Vol 11 (1) ◽  
pp. 65
Author(s):  
Lisa Brandon ◽  
◽  
◽  
Faisal Sharif
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Management Options ◽  
Arteriovenous Shunts ◽  
Significant Difference ◽  
Activation Therapy ◽  
Renal Artery Denervation ◽  
Baroreceptor Activation ◽  
And Control ◽  
Interventional Therapies

Resistant hypertension remains a clinical challenge with few management options beyond maximisation of medications. Catheterbased renal artery denervation (RDN) was proposed in 2009 as a possible therapy for resistant hypertension and early feasibility trials caused excitement among cardiologists and antihypertensive specialists, showing remarkable and sustained blood pressure reductions. In 2014, enthusiasm for RDN dampened following the SYMPLICITY 3 trial results, which showed no statistically significant difference in blood pressure between the intervention and control arms. However, hope remains for the improved management of resistant hypertension; procedural understanding, technological advancements and alternative targets – such as baroreceptor activation therapy and arteriovenous shunts – may aid the identification of those patients for whom specific interventional therapies will be effective.

scholarly journals Recent advances in understanding and managing resistant/refractory hypertension

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 169 ◽  
Author(s):  
Michael Doumas ◽  
Konstantinos P Imprialos ◽  
Manolis S Kallistratos ◽  
Athanasios J Manolis
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Uncontrolled Hypertension ◽  
Renal Sympathetic Denervation ◽  
Refractory Hypertension ◽  
European Guidelines ◽  
Carotid Baroreceptor ◽  
Activation Therapy ◽  
Baroreceptor Activation ◽  
Line Drug

The management of resistant hypertension presents several challenges in everyday clinical practice. During the past few years, several studies have been performed to identify efficient and safe pharmacological and non-pharmacological options for the management of such patients. The Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2) trial demonstrated significant benefits with the use of spinorolactone as a fourth-line drug for the treatment of resistant hypertension over doxazosin and bisoprolol. In addition, recent data support that spironolactone may demonstrate superiority over central acting drugs in such patients, as well. Based on the European guidelines, spironolactone is recommended as the fourth-line drug option, followed by amiloride, other diuretics, doxazosin, bisoprolol or clonidine.  Among several device-based approaches, renal sympathetic denervation had fallen into hibernation after the disappointing results of the Renal Denervation in Patients With Uncontrolled Hypertension (SYMPLICITY HTN) 3 trial. However, the technique re-emerged at the epicenter of the clinical and research interest after the favorable results of three sham-controlled studies, which facilitated novel catheters and techniques to perform the denervation. Significant results of iliac anastomosis on blood pressure levels have also been demonstrated. Nevertheless, the technique-related adverse events resulted in withdrawal of this interventional approach. Last, the sympatholytic properties of the carotid baroreceptor activation therapy were associated with significant blood pressure reductions in patients with resistant hypertension, which need to be verified in larger controlled trials. Currently device-based approaches are recommended only in the setting of clinical trials until more safety and efficacy data become available.

scholarly journals 12-Month Blood Pressure Results of Catheter-Based Renal Artery Denervation for Resistant Hypertension

2015 ◽  
Vol 65 (13) ◽  
pp. 1314-1321 ◽  
Author(s):  
George L. Bakris ◽  
Raymond R. Townsend ◽  
John M. Flack ◽  
Sandeep Brar ◽  
Sidney A. Cohen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Resistant Hypertension ◽  
Renal Artery Denervation

scholarly journals Investigation of the effect of the virtual reality application on experimental pain severity in healthy

2019 ◽  
Vol 65 (3) ◽  
pp. 446-451
Author(s):  
Dilek Karaman ◽  
Funda Erol ◽  
Dilek Yılmaz ◽  
Yurdanur Dikmen
Keyword(s):  
Blood Pressure ◽  
Virtual Reality ◽  
Control Group ◽  
Control Groups ◽  
Adult Type ◽  
Significant Difference ◽  
The Mean ◽  
And Control ◽  
Experimental Group ◽  
Virtual Reality Application

SUMMARY OBJECTIVE: This study aimed to investigate the effect of virtual reality application on experimental ischemic pain created with a blood pressure instrument in healthy volunteers. METHODS: The research sample consisted of 172 volunteer adult students who conformed to the inclusion criteria. These individuals were assigned into an experimental (n=86) and a control group (n=86) by a simple randomization method. All individuals in the experimental and control groups wereexperimentally subjected to pain for two minutes by applying 260 mmHg of pressure 3-4 cm above the antecubital region of the left arm with an aneroid adult-type blood pressure instrument. During the procedure, the volunteers in the experimental group watched virtual reality images, while those in the control group received no intervention. Immediately after the procedure, the pain levels of the individuals in both groups were assessed with a Visual Analog Scale (VAS). RESULTS: We found that the mean pain score of the individuals in the experimental group was 2.62±1.82, and that of individuals in the control group was 5.75±1.65. Results of the statistical analysis showed a statistically significant difference between the mean pain scores of the individuals in the experimental and control groups (p<0.001). CONCLUSION: This study found that the use of virtual reality was effective in reducing the level of pain in healthy individuals. This method used a smartphone with widespread availability and ease of transportation, which can be used by health professionals as a non-pharmacological method in the management of pain.

scholarly journals The Effect of Neuropeptide Y (NPY) rs 16147 Gene Polymorphism on the Blood Pressure of Chronic Kidney Disease Patients and Control Healthy in Medan, Indonesia

2021 ◽  
Vol 8 (8) ◽  
pp. 319-326
Author(s):  
Gabriel Pardamean ◽  
Riri Andri Muzasti ◽  
Syafrizal Nasution
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gene Polymorphism ◽  
Systolic Blood Pressure ◽  
Neuropeptide Y ◽  
Dna Analysis ◽  
Pathological Condition ◽  
Significant Difference ◽  
And Control

Introduction: Chronic Kidney Disease (CKD) is a pathological condition that occurs gradually and is irreversible, characterized by structural and functional abnormalities in the kidneys that lasts for more than three months. The C allele in the Neuropeptide Y (NPY) RS16147 gene is closely related to an increase in the incidence of hypertension, a decrease in glomerular filtration rate, and an increase in total cholesterol levels in CKD patients. Objective: To determine the effect of the NPY RS16147 gene polymorphism on the blood pressure of chronic kidney disease patients and control healthy in Medan Indonesia. Methods: This study is an analytical study with a case-control design at the Haji Adam Malik General Hospital Medan from July to August 2020. All subjects had Deoxyribonucleic Acid (DNA) analysis using Polymerase Chain Reaction Restriction Fragment Length Polymorphism (PCR-RFLP) method. Results: We obtained 100 study subjects, 43 was CKD patients with dialysis, 31 CKD patients without dialysis, and 26 control healthy groups. In this study, there were differences in the trend genotypes of NPY RS16147 polymorphism with the incidence of CKD and control healthy. We obtained a significant difference the mean systolic blood pressure patients with genotypes TT (139,05±21,42) and TC/CC (151,32±22,26) as evidenced by the value of P = 0.00 (≤0.05). The presence of the "C" allele in the NPY RS16147 gene sample increased blood pressure in all study subjects significantly (P=0.028; ≤0.05). Conclusion: the "C" allele in the NPY RS16147 gene affects systolic blood pressure. Keywords: NPY RS16147 polymorphism, Chronic kidney disease, Blood pressure.

scholarly journals Safety and Efficacy of Ginkgo-Damole and Nitroglycerin or Sodium Nitroprusside on Hypertensive Cerebropathies: A Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Li Peng ◽  
Wei-kun Zhao ◽  
Tong-tong Xu ◽  
Qi Wu ◽  
Pan Lu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sodium Nitroprusside ◽  
Meta Analysis ◽  
Control Group ◽  
Clinical Effects ◽  
Observation Group ◽  
Control Groups ◽  
Safety And Efficacy ◽  
Significant Difference ◽  
And Control

Objective. To systematically evaluate the safety and efficacy of ginko-damole combined with nitroglycerin or unitary sodium nitroprusside on hypertensive cerebropathy. Methods. Four Chinese databases (VIP, CBM, Wanfang database, and CNKI database) and three English databases (Cochrane, PubMed, and EMBASE) were used to screen randomised controlled trials (RCTs) on treatments of hypertensive cerebropathy using both ginko-damole and nitroglycerin or unitary sodium nitroprusside. Outcomes included clinical effect, blood pressure after treatment, and adverse effects. These indicators were then analysed statistically using the RevMan 5.3 and Stata 12.0 software. Results. Altogether, 16 RCTs including 1507 patients with hypertensive cerebropathy were included in the present meta-analysis, of which, 755 patients treated with combined ginko-damole and nitroglycerin were included in the observation group and 752 patients treated with sodium nitroprusside were included in the control group. The curative effect of the observation group was significantly better than that of the control group (RR: 1.115 [1.077, 1.155], p<0.05). DBPs of the observation and control groups were both lower after treatment, and no significant difference was observed between the observation and control groups (MD: −1.072 [−2.578, 0.434], p>0.05). SBPs in the observation group were significantly lower than those in the control group (MD: −2.842 [−5.222, −0.462], p<0.05). The probability of adverse response in both groups did not differ significantly (RR: 0.752 [0.412, 1.374], p>0.05). Conclusion. Compared with sodium nitroprusside, the combined ginkgo-damole and nitroglycerin could better control blood pressure in patients with hypertensive cerebropathy and showed enhanced clinical effects and improved safety. However, due to poor quality of the included studies, results of the present meta-analysis should be confirmed by more stringent RCTs.

Hypotensive Effect of Hydroalcoholic Ziziphus jujuba Extract on Normotensive Rats

2019 ◽  
Vol 15 (7) ◽  
pp. 712-717
Author(s):  
Reza Mohebbati ◽  
Maryam Rahimi ◽  
Kosar Bavarsad ◽  
Farimah Beheshti ◽  
Abolfazl KhajaviRad ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Hypotensive Effect ◽  
Inhibitory Effect ◽  
Control Group ◽  
Hydroalcoholic Extract ◽  
Cardiovascular Parameters ◽  
Significant Difference ◽  
Ziziphus Jujuba ◽  
In The Beginning ◽  
And Control

Objective: Ziziphus jujuba (Z.J) is a medicinal plant with several properties such as antioxidant, antibacterial, hypnotic and wound healing activity. It also has lowering blood pressure effect and people use it to treat hypertension. In the present study, the effect of hydroalcoholic extract of Z.J on cardiovascular parameters in the normotensive rats was investigated. Methods: Animal groups include: 1) Sham, only cannulation of artery 2) saline, received saline for four weeks 3-5) Z.J groups (100, 200 and 400 mg/kg) that treated with Z.J via gavage for four weeks. In the experiment day (28th Day) femoral artery of all rats cannulated and Systolic Blood Pressure (SBP), Mean Atrial Pressure (MAP) and Heart Rate (HR) recorded by a power lab system. The weight of animal in all groups also was recorded in the beginning and the last day of experiment. Results: There was no significant difference in HR, SBP and MAP parameters between sham and control groups. The SBP and MAP in higher doses of Z.J (200 and 400 mg) significantly decreased compared to control group. The HR only in dose 200 mg of Z.J significantly decreased than the control group. Conclusion: The results of present study show that hydroalcoholic extract of Z.J has an inhibitory effect on basal cardiovascular parameters and its best effects have been shown in dose 200 mg/kg.

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