PRIMARY ALDOSTERONISM: THE RESULTS OF THE TREATMENT ACCORDING TO THE DATA OF RENAL ARTERIES DUPLEX SCANNING

In the structure of arterial hypertension, primary aldosteronism (РА) ranges from 5 to 15%. Changes in intrarenal hemodynamics are due to both high blood pressure and direct aldosterone level. The purpose of the study was to analyze the results of PA treatment according to ultrasound doppler scanning of renal arteries. In general, 55 patients with PA were treated. Renal arteries duplex scanning before and after the treatment was performed in 20 patients. During treatment, the normalization of Vps, Ved, S/D, PI, PI, AT, TAMX indices was recorded in patients. The RI of the interlobar arteries slightly increased, however, it remained within the reference range. The reduction of aldosterone levels led to increase of TAMX index at the level of the renal artery trunk, S/D, RI and decrease in AT at the level of the segmental arteries, as well as increase of Ved and S/D at the level of the interlobar arteries.

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Relevance of Targeting the Distal Renal Artery and Branches with Radiofrequency Renal Denervation Approaches—A Secondary Analysis from a Hypertensive CKD Patient Cohort

Journal of Clinical Medicine ◽

10.3390/jcm8050581 ◽

2019 ◽

Vol 8 (5) ◽

pp. 581 ◽

Cited By ~ 3

Author(s):

KIUCHI ◽

SCHLAICH ◽

CHEN ◽

VILLACORTA ◽

HO ◽

...

Keyword(s):

Blood Pressure ◽

Renal Artery ◽

Renal Denervation ◽

Secondary Analysis ◽

Distal Segment ◽

Renal Arteries ◽

Lowering Effect ◽

Post Hoc

We searched for an association between changes in blood pressure (BP) at 12 and 24 months after renal denervation (RDN) and the different patterns of ablation spots placement along the renal artery vasculature. We performed a post-hoc analysis of a 24‐month follow‐up evaluation of 30 patients who underwent RDN between 2011 and 2012 using our previous database. Patients who had (i) resistant hypertension, as meticulously described previously, and (ii) Chronic kidney disease (CKD) stages 2, 3 and 4. Correlations were assessed using the Pearson or Spearman correlation tests as appropriate. The mean change in systolic ambulatory BP monitoring (ABPM) compared to baseline was –19.4 ± 12.7 mmHg at the 12th (p < 0.0001) and –21.3 ± 14.1 mmHg at the 24th month (p < 0.0001). There was no correlation between the ABPM Systolic Blood Pressure (SBP)-lowering effect and the total number of ablated spots in renal arteries (17.7 ± 6.0) either at 12 (r = –0.3, p = 0.1542) or at 24 months (r = –0.2, p = 0.4009). However, correlations between systolic BP-lowering effect and the number of ablation spots performed in the distal segment and branches were significant at the 12 (r = –0.7, p < 0.0001) and 24 months (r = –0.8, p < 0.0001) follow-up. Our findings indicate a substantial correlation between the numbers of ablated sites in the distal segment and branches of renal arteries and the systolic BP-lowering effect in the long-term.

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Extended Renal Artery Denervation Is Associated with Artery Wall Lesions and Acute Systemic and Pulmonary Hemodynamic Changes: A Sham-Controlled Experimental Study

Cardiovascular Therapeutics ◽

10.1155/2020/8859663 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Aleksandr D. Vakhrushev ◽

Heber Ivan Condori Leandro ◽

Natalia S. Goncharova ◽

Lev E. Korobchenko ◽

Lubov B. Mitrofanova ◽

...

Keyword(s):

Blood Pressure ◽

Renal Artery ◽

Systolic Blood Pressure ◽

Renal Arteries ◽

Artery Wall ◽

Pulmonary Hemodynamics ◽

Pulmonary Hemodynamic ◽

Renal Artery Denervation ◽

The Impact ◽

Wall Lesions

Objectives. We sought to assess acute changes in systemic and pulmonary hemodynamics and microscopic artery lesions following extended renal artery denervation (RDN). Background. RDN has been proposed to reduce sympathetic nervous system hyperactivation. Although the effects of RDN on systemic circulation and overall sympathetic activity have been studied, data on the impact of RDN on pulmonary hemodynamics is lacking. Methods. The study comprised 13 normotensive Landrace pigs. After randomization, 7 animals were allocated to the group of bilateral RDN and 6 animals to the group of a sham procedure (SHAM). Hemodynamic measures, cannulation, and balloon-based occlusion of the renal arteries were performed in both groups. In the RDN group, radiofrequency ablation was performed in all available arteries and their segments. An autopsy study of the renal arteries was carried out in both groups. Results. The analysis was performed on 12 pigs (6 in either group) since pulmonary thromboembolism occurred in one case. A statistically significant drop in the mean diastolic pulmonary artery pressure (PAP) was detected in the RDN group when compared with the SHAM group (change by 13.0 ± 4.4 and 10.0 ± 3.0 mmHg , correspondingly; P = 0.04 ). In 5 out of 6 pigs in the RDN group, a significant decrease in systemic systolic blood pressure was found, when compared with baseline ( 98.8 ± 17.8 vs. 90.2 ± 12.6 mmHg , P = 0.04 ), and a lower mean pulmonary vascular resistance (PVR) ( 291.0 ± 77.4 vs. 228.5 ± 63.8 dyn ∗ sec ∗ c m − 5 , P = 0.03 ) after ablation was found. Artery dissections were found in both groups, with prevalence in animals after RDN. Conclusions. Extensive RDN leads to a rapid and significant decrease in PAP. In the majority of cases, RDN is associated with an acute lowering of systolic blood pressure and PVR. Extended RDN is associated with artery wall lesions and thrombus formation underdiagnosed by angiography.

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ARTERIAL HYPERTENSION IN RATS

Journal of Experimental Medicine ◽

10.1084/jem.75.5.513 ◽

1942 ◽

Vol 75 (5) ◽

pp. 513-526 ◽

Cited By ~ 17

Author(s):

Henry A. Schroeder

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Renal Artery ◽

Traumatic Injury ◽

Reliable Index ◽

Adult Rats ◽

Pentobarbital Sodium ◽

Unilateral Hydronephrosis ◽

Pentobarbital Sodium Anesthesia ◽

Normal Standards

Normal standards for the blood pressure of rats under pentobarbital sodium anesthesia have been ascertained. Arterial hypertension did not consistently follow the injection of estradiol and pitressin in adult rats, and only transient hypertension occurred after the injection of dihydroxyphenylalanine. The injection of adrenalin in oil, however, was followed by cardiac hypertrophy, and it also resulted from (a) partial constriction of one renal artery, (b) the production of unilateral hydronephrosis, (c) traumatic injury to one kidney, (d) inducing unilateral perinephritis with a cellophane membrane. The blood pressure in many of the animals became elevated. In rats the weight of the heart is probably a more reliable index of the presence of the hypertensive state than is one measurement, or two, of blood pressure under anesthesia. The latter is extremely variable, both in normal and in hypertensive animals. Rats are, however, liable to hypertension under natural circumstances, and it can be easily induced in a number of ways. The weight of the heart may then become rapidly increased. To judge from the findings in this species, rats are very susceptible to the production of the hypertensive state, in comparison with other animals.

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RENAL INSUFFICIENCY FOLLOWING TRYPSIN INJECTION INTO THE RENAL ARTERIES

Journal of Experimental Medicine ◽

10.1084/jem.68.4.485 ◽

1938 ◽

Vol 68 (4) ◽

pp. 485-504 ◽

Cited By ~ 6

Author(s):

M. Friedman ◽

L. N. Katz

Keyword(s):

Blood Pressure ◽

Renal Insufficiency ◽

Renal Artery ◽

Acute Phase ◽

Renal Arteries ◽

Renal Ischemia ◽

The Other ◽

Direct Relation ◽

Simultaneous Injection ◽

Large Sections

1. The injection of trypsin into both renal arteries of the dog was found to cause an acute necrosis of large sections of the kidney, an immediate excretory insufficiency, and a transient hypertension. 2. Dogs surviving the acute phase of the trypsin injection, developed a chronic renal excretory insufficiency with no hypertension, despite the severity and duration of the renal excretory insufficiency. 3. The application of a Goldblatt clamp to the renal artery of one of the two kidneys, previously injected with trypsin, led to a rise in blood pressure which returned at once to normal when the ischemic kidney was removed, even though the pre-existing renal excretory insufficiency was augmented. This experience demonstrated unequivocally that chronic renal excretory insufficiency and hypertension are not directly related. 4. The application of a Goldblatt clamp to the renal artery of one kidney and the simultaneous injection of trypsin into the other led to a hypertension. The later removal of the ischemic kidney led to a severe renal excretory insufficiency, at the same time the pre-existing hypertension disappeared. This indicated again that renal excretory insufficiency and renal ischemia produced different phenomena and that the former had no direct relation to hypertension.

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STUDIES ON EXPERIMENTAL HYPERTENSION

Journal of Experimental Medicine ◽

10.1084/jem.77.4.297 ◽

1943 ◽

Vol 77 (4) ◽

pp. 297-307 ◽

Cited By ~ 9

Author(s):

Harry Goldblatt ◽

Joseph R. Kahn ◽

Harvey A. Lewis

Keyword(s):

Blood Pressure ◽

Renal Artery ◽

Renal Hypertension ◽

Renal Arteries ◽

Experimental Hypertension ◽

Long Duration ◽

Humoral Mechanism ◽

Main Renal Artery ◽

Experimental Renal Hypertension ◽

The One

Persistent hypertension has been produced in the goat and sheep by constriction of the main renal arteries. The presence or absence of accompanying uremia depends upon the degree of constriction of the renal arteries. In both sheep and goat, constriction of one main renal artery also caused elevation of the blood pressure which tended to persist longer than in the dog. Excision of the one kidney with main renal artery constricted resulted in a prompt (24 hours) return of the blood pressure to normal. In the animals with hypertension of long duration but without renal excretory insufficiency, (the "benign" phase) no significant arterio- or arteriolosclerosis developed as a result of the hypertension alone. In the animals that had both hypertension and renal excretory insufficiency, (the "malignant" phase) the typical terminal arteriolar lesions developed in many organs. These lesions consisted of necrosis and fibrinoid degeneration of arterioles and necrotizing arteriolitis which should not be confused with arteriolosclerosis. The same humoral mechanism which is responsible for experimental renal hypertension in the dog and other animals also obtains in the pathogenesis of experimental renal hypertension in the sheep and goat.

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Exchangeable Sodium in Goldblatt One-Kidney One-Clip Hypertension in the Rat

Clinical Science ◽

10.1042/cs0660545 ◽

1984 ◽

Vol 66 (5) ◽

pp. 545-549 ◽

Cited By ~ 6

Author(s):

D. McAreavey ◽

W. B. Brown ◽

G. D. Murray ◽

J. I. S. Robertson

Keyword(s):

Blood Pressure ◽

Renal Artery ◽

Exchangeable Sodium ◽

Hypertensive Rats ◽

Satisfactory Explanation ◽

Active Renin ◽

Transient Rise ◽

Before And After ◽

Plasma Active Renin ◽

Made In

1. Exchangeable sodium (NaE), plasma active renin concentration and blood pressure were measured in rats with a sole remaining kidney before and after the development of hypertension induced by clipping of the single renal artery and again after unclipping. 2. Control observations were made in sham-clipped and sham-unclipped uninephrectomized rats. 3. Renal artery clipping caused hypertension and expansion of NaE, the latter being sustained throughout the 6 weeks during which the renal artery was constricted. 4. Hypertension in the clipped rats was progressive over 6 weeks, whereas the expansion of NaE was not; thus the two measurements were not significantly correlated. 5. Two rats which remained normotensive after clipping did not show expansion of NaE. 6. Plasma active renin was elevated in comparison with the sham-clipped controls on the day after clipping, but not thereafter. 7. Unclipping in hypertensive rats was followed by a return of NaE and blood pressure to control values. 8. Both the sustained expansion of NaE and the transient rise in active renin probably contribute to the development of hypertension in this model, but neither alone nor together do they provide a full satisfactory explanation.

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Radiofrequency renal arteries denervation: effectively and safely

Systemic Hypertension ◽

10.26442/sg29144 ◽

2016 ◽

Vol 13 (4) ◽

pp. 13-18

Author(s):

V A Grigin ◽

N M Danilov ◽

Yu G Matchin ◽

I E Chazova

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Essential Hypertension ◽

Statistical Analysis ◽

Renal Artery ◽

Radio Frequency ◽

Renal Arteries ◽

Laboratory Evaluation ◽

Clinical Blood Pressure

Objective. To determine the possibility of radio frequency denervation of the renal arteries (RDN) in the treatment of patients with refractory essential hypertension (GRA). Materials and methods. The study included 57 patients with a diagnosis of the guide RAG. According to the results of surveys conducted by RDA was performed of 25 patients diagnosed with essential RAG. Within 12 months after the procedure was carried out monitoring of clinical blood pressure (BP), BP monitoring (ABPM), and laboratory evaluation of renal function and renal artery ultrasound. Statistical analysis was performed using Statistica 6.1 program, significant differences were recognized when p

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Radiofrequency denervation of the renal arteries in patients with resistant arterial hypertension: 3 years of observation experience

Systemic Hypertension ◽

10.26442/2075082x.2019.4.190596 ◽

2019 ◽

Vol 16 (4) ◽

pp. 65-69

Author(s):

Nina Yu Savelyeva ◽

Anna Yu Zherzhova ◽

Ekaterina V Mikova ◽

Liudmila I Gapon ◽

Grigorii V Kolunin ◽

...

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Antihypertensive Drugs ◽

Blood Pressure Monitoring ◽

Secondary Hypertension ◽

Renal Arteries ◽

Radiofrequency Denervation ◽

Intact Kidney ◽

Resistant Arterial Hypertension

Objective. To evaluate the efficiency of radiofrequency denervation of the renal arteries in patients with resi-stant arterial hypertension during a three-year follow-up. Materials and methods. The study involved 40 patients with resistant arterial hypertension aged 27 to 70 years (mean age 54.91±9.77 years) while receiving three or more antihypertensive drugs (including diuretic) in optimal doses. The conditions for inclusion in the study were considered resistant arterial hypertension with blood pressure (BP)>160/100 mm Hg, intact kidney function - glomerular filtration rate (MDRD)>45 ml/min - and the absence of secondary hypertension. All patients had sympatic radiofrequency denervation of renal arteries; its efficiency later was estimated according to the clinical measurement and ambulatory blood pressure monitoring (ABPM). Results. The level of office BP reliably differed initially and after 3 years: DSBP -34.48±6.44 mm Hg (p=0.001), DDBP - 22.29 mm Hg (p=0.001). According to ABPM results, reliable dynamics of systolic blood pressure was not observed. The data of DBP at night were significantly lower after 36 months; DDBP was -5.37±9.77 mm Hg. Conclusions. A marked decrease in the data of office SBP and DBP was observed, which proves the long-term efficiency of radiofrequency denervation of the renal arteries in patients with resistant hypertension. Accor-ding to ABPM results after 36 months, a significant decrease was registered among the DBP indicators at night and daytime.

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Experimental hypertension in pregnant sheep

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1960.199.4.633 ◽

1960 ◽

Vol 199 (4) ◽

pp. 633-636 ◽

Cited By ~ 7

Author(s):

Louis W. Holm ◽

Yale J. Katz ◽

Harold R. Parker ◽

Leon C. Chesley ◽

Nicholas S. Assali

Keyword(s):

Blood Pressure ◽

Renal Artery ◽

Severe Hypertension ◽

Renal Arteries ◽

Renal Ischemia ◽

Experimental Hypertension ◽

Control Blood Pressure ◽

Human Hypertension ◽

Pregnant Sheep ◽

Renal Artery Constriction

Sheep with spontaneously occurring or experimentally induced toxemia of pregnancy do not develop hypertension despite the presence of a marked renal ischemia. The present study was undertaken in order to investigate whether pregnant sheep, like pregnant dogs and rats, do not exhibit hypertension when subjected to renal artery constriction. Bilateral constriction of the renal arteries was performed on pregnant ewes by a modified Goldblatt-Wakerlin technique, after control blood pressure had been recorded for several days. Blood pressure and BUN were measured throughout pregnancy and following delivery. All the animals which had renal artery constriction developed severe hypertension with retinal changes similar to those of human hypertension. The pregnancy did not affect the course of the hypertension nor did the hypertension alter the course of pregnancy.

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