Russian Medical Society for Arterial Hypertension expert consensus. Resistant hypertension: detection and management

The diagnosis of resistant arterial hypertension allows us to single out a separate group of patients in whom it is necessary to use special diagnostic methods and approaches to treatment. Elimination of reversible factors leading to the development of resistant arterial hypertension, such as non-adherence to therapy, inappropriate therapy, secondary forms of arterial hypertension, leads to an improvement in the patient's prognosis. Most patients with resistant hypertension should be evaluated to rule out primary aldosteronism, renal artery stenosis, chronic kidney disease, and obstructive sleep apnea. The algorithm for examining patients, recommendations for lifestyle changes and a step-by-step therapy plan can improve blood pressure control. It is optative to use the most simplified treatment regimen and long-acting combined drugs. For a separate category of patients, it is advisable to perform radiofrequency denervation of the renal arteries.

Interventional Treatments for Acute and Chronic Pain: Systematic Review

Objective. To evaluate the benefits and harms of selected interventional procedures for acute and chronic pain that are not currently covered by the Centers for Medicare & Medicaid Services (CMS) but are relevant for and have potential utility for use in the Medicare population, or that are covered by CMS but for which there is important uncertainty or controversy regarding use. Data sources. Electronic databases (Ovid® MEDLINE®, PsycINFO®, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews) to April 12, 2021, reference lists, and submissions in response to a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) for 10 interventional procedures and conditions that evaluated pain, function, health status, quality of life, medication use, and harms. Random effects meta-analysis was conducted for vertebral compression fracture; otherwise, outcomes were synthesized qualitatively. Effects were classified as small, moderate, or large using previously defined criteria. Results. Thirty-seven randomized trials (in 48 publications) were included. Vertebroplasty (13 trials) is probably more effective at reducing pain and improving function in older (>65 years of age) patients, but benefits are small (less than 1 point on a 10-point pain scale). Benefits appear smaller (but still present) in sham-controlled (5 trials) compared with usual care controlled trials (8 trials) and larger in trials of patients with more acute symptoms; however, testing for subgroup effects was limited by imprecision. Vertebroplasty is probably not associated with increased risk of incident vertebral fracture (10 trials). Kyphoplasty (2 trials) is probably more effective than usual care for pain and function in older patients with vertebral compression fracture at up to 1 month (moderate to large benefits) and may be more effective at >1 month to ≥1 year (small to moderate benefits) but has not been compared against sham therapy. Evidence on kyphoplasty and risk of incident fracture was conflicting. In younger (below age for Medicare eligibility) populations, cooled radiofrequency denervation for sacroiliac pain (2 trials) is probably more effective for pain and function versus sham at 1 and 3 months (moderate to large benefits). Cooled radiofrequency for presumed facet joint pain may be similarly effective versus conventional radiofrequency, and piriformis injection with corticosteroid for piriformis syndrome may be more effective than sham injection for pain. For the other interventional procedures and conditions addressed, evidence was too limited to determine benefits and harms. Conclusions. Vertebroplasty is probably effective at reducing pain and improving function in older patients with vertebral compression fractures; benefits are small but similar to other therapies recommended for pain. Evidence was too limited to separate effects of control type and symptom acuity on effectiveness of vertebroplasty. Kyphoplasty has not been compared against sham but is probably more effective than usual care for vertebral compression fractures in older patients. In younger populations, cooled radiofrequency denervation is probably more effective than sham for sacroiliac pain. Research is needed to determine the benefits and harms of the other interventional procedures and conditions addressed in this review.

Cooled Radiofrequency Ablation of the Articular Sensory Branches of the Obturator and Femoral Nerves using Fluoroscopy and Ultrasound Guidance: A Large Retrospective Study

BACKGROUND: We previously reported on a combined technique and initial data of hip denervation using an anterior approach and cooled radiofrequency. OBJECTIVES: A large retrospective study to evaluate the long-term effectiveness of cooled radiofrequency ablation (CRFA) in the general chronic hip pain population. STUDY DESIGN: Retrospective electronic chart review. SETTING: A single specialty private practice. METHODS: Retrospective chart review of 235 consecutive (CRFA) in 136 patients with chronic hip pain. RESULTS: Out of 235 CRFA, 178 (96 initial procedures and 82 repeats) were performed in 84 patients with 12 or more months follow-up. The average decrease in visual analog scale (VAS) pain scores was 7.3 ± 1.3 to 2.3 ± 1.5 and 2.48 ± 1.5 for the first and second diagnostic block, respectively, and was statistically significant (P < 0.001). Similarly, the average decrease in VAS pain scores at 6 and 12 months after CRFA denervation was 3.44 ± 2.5 and 4.23 ± 2.5, respectively; P < 0.001. Out of the 96 initial procedures in 84 patients, 66 procedures (69%) provided more than 50% relief at 6 months, and 50 (52%) at 12 months. There were 82 repeat denervations in 36 patients. Repeated procedures in the same patients provided a similar degree of pain relief with no statistically significant difference in the median pain scores (2.8 ± 2.1 cm vs 3.1 ± 1.7 cm ; P = 0.197) or time interval of pain relief (12.7 ± 10.9 vs 10.3 ± 4.7; P = 0.508). There were 3 minor complications. LIMITATIONS: Retrospective nature of the study. CONCLUSION: Improvements in pain scores and longevity of pain relief from chronic hip pain using a simple, anterior approach to radiofrequency denervation of the lateral obturator and lateral femoral nerves justifies further randomized prospective trials. Repeated CRFAs demonstrated consistency in pain relief and absolute safety of repeated denervation. KEY WORDS: Hip denervation, degenerative joint disease, chronic hip pain, radiofrequency denervation, lateral obturator nerve, lateral femoral nerve

Russian medical society on arterial hypertension (RMSAH) Consensus of Experts on the use of radiofrequency denervation of the renal arteries in patients with arterial hypertension

Hyperactivity of the sympathetic nervous system is one of the basic mechanisms in the development of arterial hypertension (AH). Transcatheter renal artery denervation is aimed to destroy the renal sympathetic afferent and efferent nerves to achieve a sustained reduction in blood pressure. Since 2017, all II generation studies have demonstrated that sympathetic denervation provides clinically significant BP reduction. Russian Medical Society for Arterial Hypertension (RMSAH) experts consider SD as a possible addition to the antihypertensive strategy in patients with uncontrolled AH and recommend denervation of the renal arteries in registers and clinical trials. On the basis of existing randomized clinical trials, as well as the experience of radiofrequency denervation in Russia, the experts of RMSAH present a consensus and view of the current situation in the field of renal denervation.