scholarly journals Renal Denervation – a Modern Option for Treating Resistant Hypertension

2020 ◽  
Vol 5 (1) ◽  
pp. 19-22
Author(s):  
Ioana Rodean ◽  
Călin Chibelean
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Nervous System ◽  
Cardiovascular Risk ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Efficacy And Safety ◽  
Important Health ◽  
Sympathetic Nervous ◽  
New Treatment

AbstractHypertension is one of the main cardiovascular risk factors, and it remains an important health problem, demonstrating an increasing incidence despite new treatment methods. Numerous risk factors that can lead to the development of difficult-to-treat or resistant hypertension have been described in the literature in recent years. In this type of hypertension, an important role is played by the sympathetic nervous system. Especially in these cases, with a sympathetic overactivation, renal denervation has proven its efficacy and safety in lowering blood pressure. In this brief clinical update, we present the results of the main studies regarding the efficacy and safety of the renal denervation technique used in the treatment of resistant hypertension.

scholarly journals Renal Denervation Therapy (RDT) in Resistant Hypertension

2012 ◽  
Vol 2 (2) ◽  
pp. 104-112
Author(s):  
Mohammad Gaffar Amin ◽  
Hasna Fahmima Haque
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Sympathetic Nervous System ◽  
Renal Artery ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Antihypertensive Drugs ◽  
Antihypertensive Agents ◽  
Radiofrequency Energy ◽  
Sympathetic Nervous

Resistant hypertension is defined as blood pressure that remains above therapeutic goal despite the use of three antihypertensive drugs including a diuretic. As much as one third of patients with arterial hypertension are treatmentrefractory as they do not reach sufficient blood pressure control despite combination antihypertensive therapy of significant duration. The hyperactivity of sympathetic nervous system (SNS) in the occurrence of treatment-resistant long standing hypertension has been established both in animal models and in clinical practice. In these patients, the kidneys play a central role as an activator of the sympathetic nervous system. The failure of purely pharmacological approaches to treat resistant hypertension has stimulated interest in invasive device-based treatments based on old concepts. In the absence of orally active antihypertensive agents, patients with severe and complicated hypertension were widely treated by surgical denervation of the kidneys until the 1960s, but this approach was associated with a high incidence of severe adverse events and a high mortality rate. A new catheter system using radiofrequency energy has been developed, allowing an endovascular approach to renal denervation and providing patients, with resistant hypertension, with a new therapeutic option that is minimally invasive and can be performed rapidly under local anaesthesia. With this method the afferent and efferent sympathetic nervous fibers surrounding the renal artery are ablated precisely keeping the renal artery intact. To date, this technique has been evaluated only in open-label trials including small numbers of highly selected resistant hypertensive patients with suitable renal artery anatomy. The available evidence suggests a significant and persistent blood pressure-lowering effect and a very low incidence of short & long term complications with no deleterious effects on renal function. These data, although promising, need confirmation in larger randomized controlled clinical trials with longerterm follow-up.DOI: http://dx.doi.org/10.3329/birdem.v2i2.12325(Birdem Med J 2012; 2(2): 104-112)

scholarly journals Efficacy and safety of renal denervation for Chinese patients with resistant hypertension using a microirrigated catheter: study design and protocol for a prospective multicentre randomised controlled trial

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e015672 ◽  
Author(s):  
Zongjun Liu ◽  
Li Shen ◽  
Weijian Huang ◽  
Xianxian Zhao ◽  
Weiyi Fang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Antihypertensive Medication ◽  
Renal Denervation ◽  
Controlled Trial ◽  
Academic Community ◽  
Chinese Patients ◽  
Efficacy And Safety ◽  
Primary Analysis ◽  
Randomised Controlled

IntroductionAvailable data show that approximately 8%–18% of patients with primary hypertension will develop resistant hypertension. In recent years, catheter-based renal denervation (RDN) has emerged as a potential treatment option for resistant hypertension. A number of observational studies and randomised controlled trials among non-Chinese patients have demonstrated its potential safety and efficacy.Methods and analysisThis is a multicentre, randomised, open-label, parallel-group, active controlled trial that will investigate the efficacy and safety of a 5F saline-irrigated radiofrequency ablation (RFA) used for RDN in the treatment of Chinese patients with resistant hypertension. A total of 254 patients who have failed pharmacological therapy will be enrolled. Eligible subjects will be randomised in a 1:1 ratio to undergo RDN using the RFA plus antihypertensive medication or to receive treatment with antihypertensive medication alone. The primary outcome measure is the change in 24 hours average ambulatory systolic blood pressure from baseline to 3 months, comparing the RDN-plus-medication group with the medication-alone group. Important secondary endpoints include the change in office blood pressure from baseline to 6 months after randomisation. Safety endpoints such as changes in renal function will also be evaluated. The full analysis set, according to the intent-to-treat principle, will be established as the primary analysis population.Ethics and disseminationAll participants will provide informed consent; the study protocol has been approved by the Independent Ethics Committee for each site. This study is designed to investigate the efficacy and safety of RDN using a 5F saline microirrigated RFA. Findings will be shared with participating hospitals, policymakers and the academic community to promote the clinical management of resistant hypertension in China.Trial registrationClinicalTrials.gov ID:NCT02900729; pre-results.

scholarly journals Response to Blood Pressure and Sympathetic Nervous System Response to Renal Denervation

Hypertension ◽  
2013 ◽  
Vol 61 (2) ◽  
Author(s):  
Karsten Heusser ◽  
Jens Tank ◽  
Julia Brinkmann ◽  
Bernhard Schmidt ◽  
Jan Menne ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Sympathetic Nervous System ◽  
Renal Denervation ◽  
System Response ◽  
Sympathetic Nervous

scholarly journals SPECULATIONS ОN BLOOD PRESSURE INCREASE MECHANISMS IN RENAL ARTERY CLIPPED WISTAR RATS

2013 ◽  
Vol 19 (3) ◽  
pp. 221-226
Author(s):  
N. V. Kuzmenko ◽  
M. G. Pliss ◽  
N. S. Rubanova ◽  
V. A. Tsyrlin
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Sympathetic Nervous System ◽  
Renal Artery ◽  
Renovascular Hypertension ◽  
Wistar Rats ◽  
Renal Denervation ◽  
Renal Nerves ◽  
Blood Pressure Elevation ◽  
Sympathetic Nervous

Objective.To examine the mechanisms underlying the activation of the sympathetic nervous system and blood pressure elevation in vasorenal hypertension in the male Wistar rats weighing 250–300 g.Design and methods.We observed the development of renovascular hypertension, beat-to-beat interval and heart rate variability in animals with intact renal nerves and denervated ischemic kidney for 8 weeks after renal artery clamping. Eight weeks later after renal artery clamping in hypertensive rats with denervated ischemic kidney, both-sided renal denervation was performed, and blood pressure was monitored for 6 weeks.Results.Although the ischemic kidney denervation reduces the activity of the sympathetic nervous system, it does not prevent renovascular hypertension development. However, both-sided renal denervation leads to the normalization of blood pressure in the rats with stable renovascular hypertension.Conclusion.We suggest that increased afferent fl ow from structural formations of the ischemic kidney plays an important role for the increased sympathetic nervous system activity.

scholarly journals Blood Pressure and Sympathetic Nervous System Response to Renal Denervation

Hypertension ◽  
2013 ◽  
Vol 61 (2) ◽  
Author(s):  
Markus Schlaich ◽  
Dagmara Hering ◽  
Gavin Lambert ◽  
Elisabeth Lambert ◽  
Murray Esler
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Sympathetic Nervous System ◽  
Renal Denervation ◽  
System Response ◽  
Sympathetic Nervous

scholarly journals Renal Denervation for Uncontrolled and Resistant Hypertension: Systematic Review and Network Meta-Analysis of Randomized Trials

2021 ◽  
Vol 10 (4) ◽  
pp. 782
Author(s):  
Jonathan Silverwatch ◽  
Kristen E. Marti ◽  
Mi T. Phan ◽  
Hinali Amin ◽  
Yuani M. Roman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Meta Analysis ◽  
Pressure Effects ◽  
Efficacy And Safety ◽  
Comparative Efficacy ◽  
Serious Adverse Events ◽  
Main Renal Artery ◽  
Meta Analyses

Comparative efficacy and safety of renal denervation (RDN) interventions for uncontrolled (UH) and resistant hypertension (RH) is unknown. We assessed the comparative efficacy and safety of existing RDN interventions for UH and RH. Six search engines were searched up to 1 May 2020. Primary outcomes were mean 24-h ambulatory and office systolic blood pressure (SBP). Secondary outcomes were mean 24-h ambulatory and office diastolic blood pressure (DBP), clinical outcomes, and serious adverse events. Frequentist random-effects network meta-analyses were used to evaluate effects of RDN interventions. Twenty randomized controlled trials (RCTs) (n = 2152) were included, 15 in RH (n = 1544) and five in UH (n = 608). Intervention arms included radiofrequency (RF) in main renal artery (MRA) (n = 10), RF in MRA and branches (n = 4), RF in MRA+ antihypertensive therapy (AHT) (n = 5), ultrasound (US) in MRA (n = 3), sham (n = 8), and AHT (n = 9). RF in MRA and branches ranked as the best treatment to reduce 24-h ambulatory, daytime, and nighttime SBP and DBP versus other interventions (p-scores: 0.83 to 0.97); significant blood pressure effects were found versus sham or AHT. RF in MRA+AHT was the best treatment to reduce office SBP and DBP (p-scores: 0.84 and 0.90, respectively). RF in MRA and branches was the most efficacious versus other interventions to reduce 24-h ambulatory SBP and DBP in UH or RH.

scholarly journals Renal denervation: a new life of the technology

2020 ◽  
Vol 5 (4) ◽  
pp. 117-125
Author(s):  
T. Y. Chichkova ◽  
S. E. Mamchur ◽  
M. P. Romanova ◽  
E. A. Khomenko
Keyword(s):  
Blood Pressure ◽  
Renal Denervation ◽  
High Efficiency ◽  
Patient Adherence ◽  
Controlled Trial ◽  
Uncontrolled Hypertension ◽  
Efficacy And Safety ◽  
Patient Groups ◽  
Sympathetic Nervous ◽  
Randomised Controlled

Renal denervation (RDN) is a method of the sympathetic nervous system modulation which has been specifically developed for the treatment of resistant hypertension. Initial reports demonstrating high efficiency of RDN in such patients propelled the development of the technology, yet a specific randomised controlled trial Symplicity HTN-3 did not show its benefits. Data from the subsequent RCTs SPYRAL HTN-OFF MED and SPYRAL HTN-ON MED have shown that RDN reduces both office and daily blood pressure, does not depend on the patient adherence, and is efficient in patients with uncontrolled hypertension even in the absence of drug therapy. This review summarises the data on the efficacy and safety of the technology, its organoprotective effects, and also discusses the benefits of the RDN in different patient groups.

Haematocrit: Relationships with Blood Lipids, Blood Pressure and other Cardiovascular Risk Factors

1994 ◽  
Vol 72 (01) ◽  
pp. 058-064 ◽  
Author(s):  
Goya Wannamethee ◽  
A Gerald Shaper
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Body Mass Index ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Alcohol Intake ◽  
Blood Lipids ◽  
The Other ◽  
The Relationship

SummaryThe relationship between haematocrit and cardiovascular risk factors, particularly blood pressure and blood lipids, has been examined in detail in a large prospective study of 7735 middle-aged men drawn from general practices in 24 British towns. The analyses are restricted to the 5494 men free of any evidence of ischaemic heart disease at screening.Smoking, body mass index, physical activity, alcohol intake and lung function (FEV1) were factors strongly associated with haematocrit levels independent of each other. Age showed a significant but small independent association with haematocrit. Non-manual workers had slightly higher haematocrit levels than manual workers; this difference increased considerably and became significant after adjustment for the other risk factors. Diabetics showed significantly lower levels of haematocrit than non-diabetics. In the univariate analysis, haematocrit was significantly associated with total serum protein (r = 0*18), cholesterol (r = 0.16), triglyceride (r = 0.15), diastolic blood pressure (r = 0.17) and heart rate (r = 0.14); all at p <0.0001. A weaker but significant association was seen with systolic blood pressure (r = 0.09, p <0.001). These relationships remained significant even after adjustment for age, smoking, body mass index, physical activity, alcohol intake, lung function, presence of diabetes, social class and for each of the other biological variables; the relationship with systolic blood pressure was considerably weakened. No association was seen with blood glucose and HDL-cholesterol. This study has shown significant associations between several lifestyle characteristics and the haematocrit and supports the findings of a significant relationship between the haematocrit and blood lipids and blood pressure. It emphasises the role of the haematocrit in assessing the risk of ischaemic heart disease and stroke in individuals, and the need to take haematocrit levels into account in determining the importance of other cardiovascular risk factors.

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