scholarly journals Renal sympathetic denervation for resistant hypertension: where do we stand after more than a decade

2020 ◽  
Vol 42 (1) ◽  
pp. 67-76
Author(s):  
Marco Antônio Peliky Fontes ◽  
Lucas Alexandre Santos Marzano ◽  
Carina Cunha Silva ◽  
Ana Cristina Simões e Silva
Keyword(s):  
Resistant Hypertension ◽  
Renal Denervation ◽  
Time Window ◽  
Sympathetic Nerves ◽  
Pressure Control ◽  
Short Review ◽  
Renal Sympathetic Denervation ◽  
Number Of Patients ◽  
Current Availability ◽  
Renal Sympathetic

Abstract Despite the current availability of safe and efficient drugs for treating hypertension, a substantial number of patients are drug-resistant hypertensives. Aiming this condition, a relatively new approach named catheter-based renal denervation was developed. We have now a clinically relevant time window to review the efficacy of renal denervation for treating this form of hypertension. This short review addresses the physiological contribution of renal sympathetic nerves for blood pressure control and discusses the pros and cons of renal denervation procedure for the treatment of resistant hypertension.

scholarly journals Renal Sympathetic Denervation for the Treatment of Difficult-to-Control or Resistant Hypertension

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Vasilios Papademetriou ◽  
Michalis Doumas ◽  
Konstantinos Tsioufis
Keyword(s):  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Sympathetic Denervation ◽  
Renal Sympathetic Denervation ◽  
Major Health Problem ◽  
Number Of Patients ◽  
Recovery Times ◽  
Potential Applications ◽  
Future Potential ◽  
Renal Sympathetic

Hypertension represents a major health problem with an appalling annual toll. Despite the plethora of antihypertensive drugs, hypertension remains resistant in a considerable number of patients, thus creating the need for alternative strategies, including interventional approaches. Recently, catheter-based renal sympathetic denervation has been shown to be fairly safe and effective in patients with resistant hypertension. Pathophysiology of kidney function, interaction and crosstalk between the kidney and the brain, justifies the use of renal sympathetic denervation in the treatment of hypertension. Data from older studies have shown that sympathectomy has effectively lowered blood pressure and prolonged life expectancy of hypertensive patients, but at considerable cost. Renal sympathetic denervation is devoid of the adverse effects of surgical sympathectomy, due to its localized nature, is minimally invasive, and provides short procedural and recovery times. This paper outlines the pathophysiological background for renal sympathetic denervation, describes the past and the present of this interventional approach, and considers several future potential applications.

Abstract 15206: Sustained Beneficial Effects of Multi-Electrode Renal Sympathetic Denervation on Cardiac Adaptations in Resistant Hypertension: A 24-months Follow-Up Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kyriakos Dimitriadis ◽  
Costas Tsioufis ◽  
Alexandros Kasiakogias ◽  
Panayiotis Vasileiou ◽  
Aggelos Papanikolaou ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Resistant Hypertension ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Sympathetic Denervation ◽  
Renal Sympathetic Denervation ◽  
Number Of Patients ◽  
Lv Mass ◽  
Renal Sympathetic

Introduction: The favorable impact of renal sympathetic denervation (RDN) on cardiac parameters such as on left ventricular (LV) morphology, geometry and function has been shown up to 6 months after the procedure using diverse ablation systems. Hypothesis: Multi-electrode catheter-based renal sympathetic RDN may have favorable effects on LV structural and functional indices in patients with resistant hypertension after a follow-up of 24 months. Methods: Twenty patients with resistant hypertension [age: 57±10 years, 13 males, office blood pressure (BP): 182/97±19/18 mmHg under 4.5±0.6 drugs] who underwent RDN were followed-up for 24 months. A full transthoracic echocardiographic study was performed in all patients and LV mass was calculated using the Devereux formula and was indexed for body surface area and height. Results: Average office BP was reduced to 148±21/85±14 mmHg at 12 months and to 143±23/80±14 mmHg at 24 months (p<0.001 for all). In the RDN group, LV mass index was significantly reduced from 136±20.1 g/m 2 (56.5±8.7 g/m 2.7 ) to 121±16.6 g/m 2 (50.6±6 g/m 2.7 ) at 12 months and to 115.6±23.3 g/m 2 (48.8±9.3 g/m 2.7 ) at 24 months (p<0.01 for all). RDN decreased mean interventricular septum thickness from 12.1±1.2 mm to 11.4±0.9 mm at 12 months and to 11.3±0.9 mm at 24 months (p<0.05 for all). After RDN, the number of patients with concentric LV hypertrophy (i.e. relative wall thickness >0.42 and LV mass >48 g/m 2.7 for male and >44 g/m 2.7 for female) decreased from 16 patients (80%) at baseline to 10 patients (50%) at 12 months, and to 7 patients (36.8%) at 24 months. Regarding diastolic function RDN caused an increase in mitral valve E'/A' ratio from 0.62±0.28 to 0.70±0.25 at 12 months and to 0.84±0.32 at 24 months (p<0.05 for all) and a decrease in the E/E' ratio from 14.8±6.1 to 11.8±3.7 at 12 months and to 9.7±4 at 24 months (p<0.05 for all). Conclusions: This the first study to show that multi-electrode RDN results in a significant and sustained improvement of diastolic function and attenuation of LV mass index in increased cardiovascular risk resistant hypertensive patients after a follow-up of 24 months. These results suggest long-term pleiotropic cardiovascular benefits of RDN therapy in the setting of resistant hypertension.

scholarly journals Quantification of Renal Sympathetic Vasomotion as a Novel End Point for Renal Denervation

Hypertension ◽  
2020 ◽  
Vol 76 (4) ◽  
pp. 1247-1255
Author(s):  
Peter Ricci Pellegrino ◽  
Irving H. Zucker ◽  
Yiannis S. Chatzizisis ◽  
Han-Jun Wang ◽  
Alicia M. Schiller
Keyword(s):  
Renal Denervation ◽  
Sympathetic Nerves ◽  
Intrathecal Administration ◽  
Renal Sympathetic Denervation ◽  
Interventional Treatment ◽  
Vascular Control ◽  
Renal Vasculature ◽  
Windkessel Model ◽  
Renal Vascular ◽  
Renal Sympathetic

Renal sympathetic denervation, a potentially revolutionary interventional treatment for hypertension, faces an existential problem due to the inability to confirm successful ablation of the targeted renal sympathetic nerves. Based on the observation that renal sympathetic nerve activity exerts rhythmic, baroreflex-driven, and vasoconstrictive control of the renal vasculature, we developed a novel technique for identifying rhythmic sympathetic vascular control using a time-varying, 2-component Windkessel model of the renal circulation. This technology was tested in 2 different animal models of renal denervation; 10 rabbits underwent chronic, surgical renal denervation, and 9 pigs underwent acute, functional renal denervation via intrathecal administration of ropivacaine. Both methods of renal denervation reduced negative admittance gain, negative phase shift renal vascular control at known sympathetic vasomotor frequencies, consistent with a reduction in vasoconstrictive, baroreflex-driven renal sympathetic vasomotion. Classic measures like mean renal blood flow and mean renal vascular resistance were not significantly affected in either model of renal denervation. Renal sympathetic vasomotion monitoring could provide intraprocedural feedback for interventionists performing renal denervation and serve more broadly as a platform technology for the evaluation and treatment of diseases affecting the sympathetic nervous system.

scholarly journals Magnetic-Resonance Tomography for Anthropometric Value of Kidneys and Adrenals in Prognosis Efficiency of Renal Sympathetic Denervation in Patients with Treatment-Resistant Hypertension

2017 ◽  
pp. 58-64
Author(s):  
N. I. Ryumshina ◽  
P. I. Lukyanenok ◽  
V. F. Mordovin ◽  
V. Yu. Usov
Keyword(s):  
Arterial Pressure ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Left Kidney ◽  
Magnetic Resonance Tomography ◽  
Sympathetic Nerves ◽  
Renal Sympathetic Denervation ◽  
Intravenous Contrast ◽  
Quantitative Calculation ◽  
Mri Studies

Aim: to evaluate the possible role of contrast-enhanced MRI studies  of the kidneys in prognosis of clinical effect of the renal denervation treatment of the resistant hypertension.Material and methods. 24 patients (57.8 ± 8.75 years) with  resistant hypertension were included, in everybody the  radiofrequency ablation (RFA) of the sympathetic nerves of renal  arteries was carried out. The average 24-h monitor of the arterial  pressure was as 137–210/57–148 mm Hg. The MRI studies were  performed using MRI scanner “Titan Vantage” (by “Toshiba Medical  Ltd”, with the field induction 1.5 Т). After this the intravenous  contrast enhancement has been carried out (with 0.5 М solution, 0.2 ml/Kg), with repeat acquisition of Т1-weighted spin-echo images in3–5 min after contrast injection.Results.MRI was employed for quantitative calculation of renal  volumes of cortex, medulla and of kidney as total, as well as of  suprarenal’s volume. Significant negative correlation of postoperation decrease of arterial pressure has been detected with both volume of renal cortex, as {Decrease in AP = 42.7–0.35 • (V left kidney)}, and  also with mass of the right suprarenal gland as {Decrease in  SAP = 16.5–6.78 • • (V right suprarenal)}.Conclusion.The anatomic quantitative data of the preoperativeMRI studies of the kidneys can be employed as prognostic tool in  patients referred to the renal denervation treatment of the resistant hypertension.

scholarly journals Renal Sympathetic Denervation – A Review of Applications in Current Practice

2011 ◽  
Vol 9 (1) ◽  
pp. 54 ◽  
Author(s):  
Vikas Kapil ◽  
Ajay K Jain ◽  
Melvin D Lobo ◽  
◽  
◽  
...  
Keyword(s):  
Resistant Hypertension ◽  
Current Knowledge ◽  
Pressure Control ◽  
Evidence Base ◽  
Sympathetic Denervation ◽  
Renal Sympathetic Denervation ◽  
High Morbidity ◽  
Randomised Controlled ◽  
Interventional Therapies ◽  
Renal Sympathetic

Resistant hypertension is associated with high morbidity and mortality despite numerous pharmacological strategies. A wealth of preclinical and clinical data have demonstrated that resistant hypertension is associated with elevated renal and central sympathetic tone. The development of interventional therapies to modulate the sympathetic nervous system potentially represents a paradigm shift in the strategy for blood pressure control in this subset of patients. Initial first-in-man and pivotal, randomised controlled trials of endovascular, radio-frequency renal sympathetic denervation have spawned numerous iterations of similar technology, as well as many novel concepts for achieving effective renal sympatholysis. This review details the current knowledge of these devices and the evidence base behind each technology.

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