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Fanelli E, Persu A. SYMPLICITY HTN-3: failure at 6 months, success at 3 years? Lancet 2022; 400:1382-1383. [PMID: 36130611 DOI: 10.1016/s0140-6736(22)01788-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Elvira Fanelli
- Department of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels 1200, Belgium; Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy
| | - Alexandre Persu
- Department of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels 1200, Belgium; Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels 1200, Belgium.
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2
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Rodrigues B, Barboza CA, Moura EG, Ministro G, Ferreira-Melo SE, Castaño JB, Nunes WMS, Mostarda C, Coca A, Vianna LC, Moreno-Junior H. Acute and Short-Term Autonomic and Hemodynamic Responses to Transcranial Direct Current Stimulation in Patients With Resistant Hypertension. Front Cardiovasc Med 2022; 9:853427. [PMID: 35360028 PMCID: PMC8962672 DOI: 10.3389/fcvm.2022.853427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/18/2022] [Indexed: 12/03/2022] Open
Abstract
Previously, we demonstrated that acute transcranial direct current stimulation (tDCS) reduced blood pressure (BP) and improved autonomic modulation in hypertensives. We hypothesized that acute and short-term tDCS intervention can promote similar benefits in resistant hypertensive patients (RHT). We assessed the impact of one (acute intervention) and ten (short-term intervention) tDCS or SHAM (20 min, each) sessions on BP, pulse interval (PI) and systolic blood pressure variabilities, humoral mechanisms associated with BP regulation, and cytokines levels. True RHT subjects (n = 13) were randomly submitted to one and ten SHAM and tDCS crossing sessions (1 week of “washout”). Hemodynamic (Finometer®, Beatscope), office BP, and autonomic variables (accessed through spectral analysis of the pulse-to-pulse BP signal, in the time and frequency domain – Fast Fourrier Transform) were measured at baseline and after the short-term intervention. 24 h-ambulatory BP monitoring was measured after acute and short-term protocols. Acute intervention: tDCS reduced BP, cardiac output, and increase high-frequency band of PI (vagal modulation to the heart). Short-term protocol: tDCS did not change BP and cardiac output parameters. In contrast, central systolic BP (−12%), augmentation index (−31%), and pulse wave velocity (34%) were decreased by the short-term tDCS when compared to SHAM. These positive results were accompanied by a reduction in the low-frequency band (−37%) and an increase of the high-frequency band of PI (+62%) compared to SHAM. These findings collectively indicate that short-term tDCS concomitantly improves resting cardiac autonomic control and pulse wave behavior and reduces central BP in RHT patients, https://ensaiosclinicos.gov.br/rg/RBR-8n7c9p.
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Affiliation(s)
- Bruno Rodrigues
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
- Laboratory of Cardiovascular Pharmacology & Hypertension, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
- *Correspondence: Bruno Rodrigues
| | - Catarina A. Barboza
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
| | - Eliezer G. Moura
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
| | - Gabriela Ministro
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
| | - Silvia E. Ferreira-Melo
- Laboratory of Cardiovascular Pharmacology & Hypertension, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Javier B. Castaño
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
| | - Wilton M. S. Nunes
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
| | - Cristiano Mostarda
- Physical Education Department, Federal University of Maranhão (UFMA), São Luís, Brazil
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lauro C. Vianna
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil
| | - Heitor Moreno-Junior
- Laboratory of Cardiovascular Pharmacology & Hypertension, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
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3
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Hering L, Rahman M, Hoch H, Markó L, Yang G, Reil A, Yakoub M, Gupta V, Potthoff SA, Vonend O, Ralph DL, Gurley SB, McDonough AA, Rump LC, Stegbauer J. α2A-Adrenoceptors Modulate Renal Sympathetic Neurotransmission and Protect against Hypertensive Kidney Disease. J Am Soc Nephrol 2020; 31:783-798. [PMID: 32086277 DOI: 10.1681/asn.2019060599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/30/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Increased nerve activity causes hypertension and kidney disease. Recent studies suggest that renal denervation reduces BP in patients with hypertension. Renal NE release is regulated by prejunctional α2A-adrenoceptors on sympathetic nerves, and α2A-adrenoceptors act as autoreceptors by binding endogenous NE to inhibit its own release. However, the role of α2A-adrenoceptors in the pathogenesis of hypertensive kidney disease is unknown. METHODS We investigated effects of α2A-adrenoceptor-regulated renal NE release on the development of angiotensin II-dependent hypertension and kidney disease. In uninephrectomized wild-type and α2A-adrenoceptor-knockout mice, we induced hypertensive kidney disease by infusing AngII for 28 days. RESULTS Urinary NE excretion and BP did not differ between normotensive α2A-adrenoceptor-knockout mice and wild-type mice at baseline. However, NE excretion increased during AngII treatment, with the knockout mice displaying NE levels that were significantly higher than those of wild-type mice. Accordingly, the α2A-adrenoceptor-knockout mice exhibited a systolic BP increase, which was about 40 mm Hg higher than that found in wild-type mice, and more extensive kidney damage. In isolated kidneys, AngII-enhanced renal nerve stimulation induced NE release and pressor responses to a greater extent in kidneys from α2A-adrenoceptor-knockout mice. Activation of specific sodium transporters accompanied the exaggerated hypertensive BP response in α2A-adrenoceptor-deficient kidneys. These effects depend on renal nerves, as demonstrated by reduced severity of AngII-mediated hypertension and improved kidney function observed in α2A-adrenoceptor-knockout mice after renal denervation. CONCLUSIONS Our findings reveal a protective role of prejunctional inhibitory α2A-adrenoceptors in pathophysiologic conditions with an activated renin-angiotensin system, such as hypertensive kidney disease, and support the concept of sympatholytic therapy as a treatment.
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Affiliation(s)
- Lydia Hering
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Masudur Rahman
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Henning Hoch
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lajos Markó
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbruck Center for Molecular Medicine, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Charité Medical Faculty Berlin, Berlin, Germany
| | - Guang Yang
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,The Shenzhen Key Laboratory of Health Sciences and Technology, Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
| | - Annika Reil
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Mina Yakoub
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Vikram Gupta
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sebastian A Potthoff
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Oliver Vonend
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Nierenzentrum, DKD Helios Medical Center, Wiesbaden, Germany
| | - Donna L Ralph
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Susan B Gurley
- Division of Nephrology and Hypertension, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Alicia A McDonough
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Lars C Rump
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Johannes Stegbauer
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany;
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4
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Hipertensión resistente: puesta al día. HIPERTENSION Y RIESGO VASCULAR 2019; 36:44-52. [DOI: 10.1016/j.hipert.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 12/30/2022]
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6
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Renal sympathetic denervation induces changes in heart rate variability and is associated with a lower sympathetic tone. Clin Res Cardiol 2018; 108:22-30. [DOI: 10.1007/s00392-018-1307-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
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7
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Campbell B, Wilkinson J, Marlow M, Sheldon M. Long-term evidence for new high-risk medical devices. Lancet 2018; 391:2194-2195. [PMID: 29893213 DOI: 10.1016/s0140-6736(18)30975-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Bruce Campbell
- University of Exeter Medical School, Exeter, UK; Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK.
| | - John Wilkinson
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Mirella Marlow
- Centre for Health Technology Evaluation, NICE, London, UK
| | - Murray Sheldon
- FDA Center for Devices and Radiological Health, Silver Spring, MD, USA
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8
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Hoogerwaard AF, de Jong MR, Elvan A. Renal Nerve Stimulation as Procedural End Point for Renal Sympathetic Denervation. Curr Hypertens Rep 2018; 20:24. [PMID: 29556850 DOI: 10.1007/s11906-018-0821-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Renal sympathetic denervation (RDN) as treatment option for hypertension has a strong rationale; however, variable effects on blood pressure (BP) have been reported ranging from non-response to marked reductions in BP. The absence of a procedural end point for RDN is one of the potential factors associated with the variable response. Studies have suggested the use of renal nerve stimulation (RNS) to adequately address this issue. This review aims to provide an overview of the clinical and experimental data available regarding the effects of RNS in the setting of RDN. RECENT FINDINGS Animal studies have shown that high-frequency electrical stimulation of the sympathetic nerves in the adventitia of the renal arteries elicits an increase in BP and leads to an increased norepinephrine spillover as a marker of increased sympathetic activity and these effects of stimulation were attenuated or blunted after RDN. In a human feasibility study using RNS both before and after RDN, similar BP responses were observed. Moreover, in patients with resistant hypertension, RNS-induced changes in BP appeared to be correlated with 24-h BP response after RDN. These data suggest that RNS is a useful tool to identify renal sympathetic nerve fibers in patients with treatment-resistant hypertension undergoing RDN, and to predict the likely effectiveness of RDN treatments. In acute procedural settings both in animal and human models, RNS elicits increase in BP and HR before RDN and these effects are blunted after RDN. Up to now, there is preliminary evidence that the RNS-induced BP changes predict 24-h ABPM outcome at follow-up in patients with resistant hypertension. Of note, studies are small sized and results of large trials comparing conventional RDN to RNS-guided RDN are warranted.
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Affiliation(s)
- Annemiek F Hoogerwaard
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Mark R de Jong
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Arif Elvan
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
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9
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Dalsgaard NB, Vilsbøll T, Knop FK. Effects of glucagon-like peptide-1 receptor agonists on cardiovascular risk factors: A narrative review of head-to-head comparisons. Diabetes Obes Metab 2018; 20:508-519. [PMID: 29024408 PMCID: PMC5836903 DOI: 10.1111/dom.13128] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/15/2017] [Accepted: 10/09/2017] [Indexed: 12/11/2022]
Abstract
Cardiovascular (CV) disease is the leading cause of death and morbidity in patients with type 2 diabetes. Five CV risk factors (blood pressure, resting heart rate, body weight, cholesterol levels and blood glucose) are monitored routinely as safety and efficacy endpoints in randomized clinical trials for diabetes therapies. To determine if different glucagon-like peptide-1 receptor agonists (GLP-1RAs) had varying effects on these CV risk factors, we reviewed 16 head-to-head trials directly comparing GLP-1RAs that included at least one of the five factors. Few trials reported statistical differences between GLP-1RAs in terms of systolic blood pressure (SBP), body weight and total cholesterol. Liraglutide increased heart rate vs its comparators in three separate trials. All GLP-1RAs reduced glycated haemoglobin (HbA1c), but exenatide twice daily and lixisenatide had statistically smaller effects compared with other GLP-1RAs. These descriptive data indicate that individual GLP-1RAs affect CV risk factors differently, potentially because of their individual pharmacokinetics and/or size. Short-acting GLP-1RAs appeared to result in smaller changes in SBP and total cholesterol compared with continuous-acting treatments, while large GLP-1RAs had a reduced effect on body weight compared with small GLP-1RAs. For glycaemic control, short-acting GLP-1RAs had a greater impact on postprandial glucose levels vs continuous-acting GLP-1RAs, but for fasting plasma glucose levels and HbA1c, continuous-acting treatments had the greater effect. No differentiating trends were obvious in heart rate data. These diverse actions of GLP-1RAs on CV risk factors should aid individualized patient treatment.
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Affiliation(s)
- Niels B. Dalsgaard
- Center for Diabetes Research, Gentofte Hospital, University of CopenhagenHellerupDenmark
| | - Tina Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, University of CopenhagenHellerupDenmark
- Steno Diabetes Center Copenhagen, University of CopenhagenGentofteDenmark
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Filip K. Knop
- Center for Diabetes Research, Gentofte Hospital, University of CopenhagenHellerupDenmark
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Basic Metabolic ResearchUniversity of CopenhagenCopenhagenDenmark
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10
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Freyhardt P, Donners R, Riemert A, Schnorr J, Stolzenburg N, Rinnenthal JL, Bernhardt U, Hamm B, Günther RW, Streitparth F. Renal denervation by CT-guided periarterial injection of hyperosmolar saline, vincristine, paclitaxel and guanethidine in a pig model. EUROINTERVENTION 2017; 12:e2262-e2270. [PMID: 27890860 DOI: 10.4244/eij-d-15-00354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the study was to evaluate the feasibility, safety and efficacy of renal sympathetic denervation with CT-guided periarterial injection of potentially neurolytic agents in pigs. METHODS AND RESULTS Unilateral injection of formulations containing either 5M hyperosmolar saline, vincristine, paclitaxel or guanethidine around the renal artery was performed in 24 normotensive pigs with six animals per group. Needle placement and injections were performed under CT fluoroscopy guidance. Blood pressure measurements and CT scans were performed immediately before and after the intervention and four weeks after treatment. After euthanasia, norepinephrine (NE) concentrations of both kidneys were determined. The renal arteries and surrounding tissue were examined histologically to evaluate nerve fibre degeneration. Procedures were technically successful with good periarterial distribution of the injectant in all but one pig in the guanethidine group. No major adverse events or post-interventional complications occurred. In the vincristine group, NE concentrations of the renal parenchyma were lower on the treated side in all pigs with a mean decrease of 53% (38%-62%, p<0.01) compared to the contralateral control. Correspondingly, histological examination revealed neural degeneration in all animals treated with vincristine. In the other groups, no significant drop of NE values, or histological signs of nerve fibre degeneration were found. CONCLUSIONS CT-guided periarterial injection of the different substances was feasible and safe. Renal sympathetic denervation was achieved with vincristine. In contrast, hyperosmolar saline, paclitaxel and guanethidine do not seem to be appropriate for renal denervation in a pig model at the dosage used.
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Affiliation(s)
- Patrick Freyhardt
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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de Jager RL, de Beus E, Beeftink MM, Sanders MF, Vonken EJ, Voskuil M, van Maarseveen EM, Bots ML, Blankestijn PJ. Impact of Medication Adherence on the Effect of Renal Denervation. Hypertension 2017; 69:678-684. [DOI: 10.1161/hypertensionaha.116.08818] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 12/13/2016] [Accepted: 01/17/2017] [Indexed: 01/01/2023]
Abstract
Randomized trials of catheter-based renal denervation (RDN) as therapy for resistant hypertension showed conflicting results in blood pressure (BP) lowering effect. Adherence to medication is modest in this patient group and may importantly drive these conflicting results. SYMPATHY is a prospective open label multicenter trial in Dutch patients with resistant hypertension. Primary outcome was change in daytime systolic ambulatory BP at 6 months. Patients were randomly assigned to RDN on top of usual care. Adherence to BP lowering drugs was assessed at baseline and follow-up, using blood samples drawn synchronously with BP measurements. Patients and physicians were unaware of the adherence assessment. Primary analyses showed a mean difference between RDN (n=95) and control (n=44) in changes in daytime systolic ambulatory BP after 6 months of 2.0 mm Hg (95% confidence interval, −6.1 to 10.2 mm Hg) in favor of control. In 80% of patients, fewer medications were detected than prescribed and adherence changed during follow-up in 31%. In those with stable adherence during follow-up, mean difference between RDN and control for daytime systolic ambulatory BP was −3.3 mm Hg (−13.7 to 7.2 mm Hg) in favor of RDN. RDN as therapy for resistant hypertension was not superior to usual care. Objective assessment of medication use shows that medication adherence is extremely poor, when patients are unaware of monitoring. Changes over time in adherence are common and affect treatment estimates considerably. Objective measurement of medication adherence during follow-up is strongly recommended in randomized trials.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01850901.
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Affiliation(s)
- Rosa L. de Jager
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Esther de Beus
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Martine M.A. Beeftink
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Margreet F. Sanders
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Evert-Jan Vonken
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Michiel Voskuil
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Erik M. van Maarseveen
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Michiel L. Bots
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Peter J. Blankestijn
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
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Beeftink MMA, Spiering W, Bots ML, Verloop WL, De Jager RL, Sanders MF, Vonken EJ, Blankestijn PJ, Voskuil M. Renal Denervation in a Real Life Setting: A Gradual Decrease in Home Blood Pressure. PLoS One 2016; 11:e0162251. [PMID: 27631608 PMCID: PMC5025101 DOI: 10.1371/journal.pone.0162251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/21/2016] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To investigate the blood pressure dynamics after renal denervation through monthly home blood pressure measurements throughout the first 12 months. METHODS A cohort of 70 patients performed highly standardized monthly home blood pressure monitoring during the first year after denervation according to the European Society of Hypertension guidelines. At baseline and 12 months follow-up, office and ambulatory blood pressure as well as routine physical and laboratory assessment was performed. RESULTS Home blood pressure decreased with a rate of 0.53 mmHg/month (95% CI 0.20 to 0.86) systolic and 0.26 mmHg/month (95% CI 0.08 to 0.44) diastolic throughout 12 months of follow-up, while the use of antihypertensive medication remained stable (+0.03 daily defined doses/month, 95% CI -0.01 to 0.08). On average, a 12 month reduction of 8.1 mmHg (95% CI 4.2 to 12.0) was achieved in home systolic blood pressure, 9.3 mmHg (95% CI -14.2 to -4.4) as measured by 24-hour ambulatory blood pressure monitoring and 15.9 mmHg (95% CI -23.8 to -7.9) on office measurements. CONCLUSION Blood pressure reduction after renal denervation occurs as a gradual decrease that extends to at least one-year follow-up. Home monitoring seems a suitable alternative for ambulatory blood pressure monitoring after renal denervation.
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Affiliation(s)
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willemien L. Verloop
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rosa L. De Jager
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Margreet F. Sanders
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Evert-jan Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter J. Blankestijn
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
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13
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de Jong MR, Adiyaman A, Gal P, Smit JJJ, Delnoy PPH, Heeg JE, van Hasselt BA, Lau EO, Persu A, Staessen JA, Ramdat Misier AR, Steinberg JS, Elvan A. Renal Nerve Stimulation–Induced Blood Pressure Changes Predict Ambulatory Blood Pressure Response After Renal Denervation. Hypertension 2016; 68:707-14. [DOI: 10.1161/hypertensionaha.116.07492] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/19/2016] [Indexed: 11/16/2022]
Abstract
Blood pressure (BP) response to renal denervation (RDN) is highly variable and its effectiveness debated. A procedural end point for RDN may improve consistency of response. The objective of the current analysis was to look for the association between renal nerve stimulation (RNS)–induced BP increase before and after RDN and changes in ambulatory BP monitoring (ABPM) after RDN. Fourteen patients with drug-resistant hypertension referred for RDN were included. RNS was performed under general anesthesia at 4 sites in the right and left renal arteries, both before and immediately after RDN. RNS-induced BP changes were monitored and correlated to changes in ambulatory BP at a follow-up of 3 to 6 months after RDN. RNS resulted in a systolic BP increase of 50±27 mm Hg before RDN and systolic BP increase of 13±16 mm Hg after RDN (
P
<0.001). Average systolic ABPM was 153±11 mm Hg before RDN and decreased to 137±10 mm Hg at 3- to 6-month follow-up (
P
=0.003). Changes in RNS-induced BP increase before versus immediately after RDN and changes in ABPM before versus 3 to 6 months after RDN were correlated, both for systolic BP (
R
=0.77,
P
=0.001) and diastolic BP (
R
=0.79,
P
=0.001). RNS-induced maximum BP increase before RDN had a correlation of
R
=0.61 (
P
=0.020) for systolic and
R
=0.71 (
P
=0.004) for diastolic ABPM changes. RNS-induced BP changes before versus after RDN were correlated with changes in 24-hour ABPM 3 to 6 months after RDN. RNS should be tested as an acute end point to assess the efficacy of RDN and predict BP response to RDN.
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Affiliation(s)
- Mark R. de Jong
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Ahmet Adiyaman
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Pim Gal
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jaap Jan J. Smit
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Peter Paul H.M. Delnoy
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jan-Evert Heeg
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Boudewijn A.A.M. van Hasselt
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Elizabeth O.Y. Lau
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Alexandre Persu
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jan A. Staessen
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Anand R. Ramdat Misier
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jonathan S. Steinberg
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Arif Elvan
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
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14
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Effects of Renal Denervation Documented in the Austrian National Multicentre Renal Denervation Registry. PLoS One 2016; 11:e0161250. [PMID: 27529426 PMCID: PMC4987037 DOI: 10.1371/journal.pone.0161250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/02/2016] [Indexed: 12/12/2022] Open
Abstract
Renal denervation (RDN) is a new procedure for treatment-resistant hypertensive patients. In order to monitor all procedures undergone in Austria, the Austrian Society of Hypertension established the investigator-initiated Austrian Transcatheter Renal Denervation (TREND) Registry. From April 2011 to September 2014, 407 procedures in 14 Austrian centres were recorded. At baseline, office and mean 24-h ambulatory blood pressure (ABP) were 171/94 and 151/89 mmHg, respectively, and patients were taking a median of 4 antihypertensive medications. Mean 24-h ABP changes after 2–6 weeks, 3, 6 and 12 months were -11/-6, -8/-4, -8/-5 and -10/-6 mmHg (p<0.05 at all measurements), respectively. The periprocedural complication rate was 2.5%. Incidence of long-term complications during follow-up (median 1 year) was 0.5%. Office BP and ABP responses showed only a weak correlation (Pearson coefficient 0.303). Based on the data from the TREND registry, ambulatory blood pressure monitoring in addition to office BP should be used for patient selection as well as for monitoring response to RDN. Furthermore, criteria for optimal patient selection are suggested.
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15
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Abstract
Renal artery stenosis is a potentially reversible cause of hypertension, and transcatheter techniques are essential to its treatment. Angioplasty remains a first-line treatment for stenosis secondary to fibromuscular dysplasia. Renal artery stenting is commonly used in atherosclerotic renal artery stenosis, although recent trials have cast doubts upon its efficacy. Renal denervation is a promising procedure for the treatment of resistant hypertension, and in the future, its indications may expand.
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Affiliation(s)
- Aaron Smith
- Department of Radiology, Section of Interventional Radiology, University of California, San Diego, CA
| | - Ron C Gaba
- Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital & Health Sciences System, Chicago, IL
| | - James T Bui
- Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital & Health Sciences System, Chicago, IL
| | - Jeet Minocha
- Department of Radiology, Section of Interventional Radiology, University of California, San Diego, CA.
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16
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Lang D, Nahler A, Lambert T, Grund M, Kammler J, Kellermair J, Blessberger H, Kypta A, Steinwender C, Auer J. Anti-Inflammatory Effects and Prediction of Blood Pressure Response by Baseline Inflammatory State in Catheter-Based Renal Denervation. J Clin Hypertens (Greenwich) 2016; 18:1173-1179. [DOI: 10.1111/jch.12844] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 01/06/2023]
Affiliation(s)
- David Lang
- Clinic of Internal Medicine 1; Kepler University Clinic; Linz Austria
| | - Alexander Nahler
- Clinic of Internal Medicine 1; Kepler University Clinic; Linz Austria
| | - Thomas Lambert
- Clinic of Internal Medicine 1; Kepler University Clinic; Linz Austria
| | - Michael Grund
- Clinic of Internal Medicine 1; Kepler University Clinic; Linz Austria
| | - Jürgen Kammler
- Clinic of Internal Medicine 1; Kepler University Clinic; Linz Austria
| | - Jörg Kellermair
- Clinic of Internal Medicine 1; Kepler University Clinic; Linz Austria
| | | | - Alexander Kypta
- Clinic of Internal Medicine 1; Kepler University Clinic; Linz Austria
| | | | - Johann Auer
- Clinic of Internal Medicine 1; Kepler University Clinic; Linz Austria
- Department of Internal Medicine 1; St. Josef Hospital; Braunau Austria
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17
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Ewen S, Cremers B, Meyer MR, Donazzan L, Kindermann I, Ukena C, Helfer AG, Maurer HH, Laufs U, Grassi G, Böhm M, Mahfoud F. Blood pressure changes after catheter-based renal denervation are related to reductions in total peripheral resistance. J Hypertens 2015; 33:2519-25. [DOI: 10.1097/hjh.0000000000000752] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Blood pressure reductions following catheter-based renal denervation are not related to improvements in adherence to antihypertensive drugs measured by urine/plasma toxicological analysis. Clin Res Cardiol 2015; 104:1097-105. [DOI: 10.1007/s00392-015-0905-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
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19
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Xiao L, Kirabo A, Wu J, Saleh MA, Zhu L, Wang F, Takahashi T, Loperena R, Foss JD, Mernaugh RL, Chen W, Roberts J, Osborn JW, Itani HA, Harrison DG. Renal Denervation Prevents Immune Cell Activation and Renal Inflammation in Angiotensin II-Induced Hypertension. Circ Res 2015; 117:547-57. [PMID: 26156232 DOI: 10.1161/circresaha.115.306010] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 07/08/2015] [Indexed: 02/06/2023]
Abstract
RATIONALE Inflammation and adaptive immunity play a crucial role in the development of hypertension. Angiotensin II and probably other hypertensive stimuli activate the central nervous system and promote T-cell activation and end-organ damage in peripheral tissues. OBJECTIVE To determine if renal sympathetic nerves mediate renal inflammation and T-cell activation in hypertension. METHODS AND RESULTS Bilateral renal denervation using phenol application to the renal arteries reduced renal norepinephrine levels and blunted angiotensin II-induced hypertension. Bilateral renal denervation also reduced inflammation, as reflected by decreased accumulation of total leukocytes, T cells, and both CD4+ and CD8+ T cells in the kidney. This was associated with a marked reduction in renal fibrosis, albuminuria, and nephrinuria. Unilateral renal denervation, which partly attenuated blood pressure, only reduced inflammation in the denervated kidney, suggesting that this effect is pressure independent. Angiotensin II also increased immunogenic isoketal-protein adducts in renal dendritic cells (DCs) and increased surface expression of costimulation markers and production of interleukin (IL)-1α, IL-1β, and IL-6 from splenic DCs. Norepinephrine also dose dependently stimulated isoketal formation in cultured DCs. Adoptive transfer of splenic DCs from angiotensin II-treated mice primed T-cell activation and hypertension in recipient mice. Renal denervation prevented these effects of hypertension on DCs. In contrast to these beneficial effects of ablating all renal nerves, renal afferent disruption with capsaicin had no effect on blood pressure or renal inflammation. CONCLUSIONS Renal sympathetic nerves contribute to DC activation, subsequent T-cell infiltration and end-organ damage in the kidney in the development of hypertension.
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Affiliation(s)
- Liang Xiao
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.)
| | - Annet Kirabo
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.)
| | - Jing Wu
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.)
| | - Mohamed A Saleh
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.)
| | - Linjue Zhu
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.)
| | - Feng Wang
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.)
| | - Takamune Takahashi
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.)
| | - Roxana Loperena
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.)
| | - Jason D Foss
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.)
| | - Raymond L Mernaugh
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.)
| | - Wei Chen
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.)
| | - Jackson Roberts
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.)
| | - John W Osborn
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.)
| | - Hana A Itani
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.)
| | - David G Harrison
- From the Department of Medicine, Divisions of Clinical Pharmacology (L.X., A.K., J.W., M.A.S., L.Z., W.C., J.R., H.A.I., D.G.H.) and Nephrology and Hypertension (T.T.), Departments of Radiology and Radiological Sciences (F.W.), Molecular Physiology and Biophysics (R.L.), and Biochemistry (R.L.M.), Vanderbilt University, Nashville, TN; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia Governorate, Egypt (M.A.S.); and Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis (J.D.F., J.W.O.).
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20
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Cordeanu M, Gaertner S, Prinz É, Bronner F, Jahn C, Hannedouche T, Stephan D. [Post-denervation renal artery stenosis - a matter of concern?]. Ann Cardiol Angeiol (Paris) 2015; 64:237-40. [PMID: 26047879 DOI: 10.1016/j.ancard.2015.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 04/28/2015] [Indexed: 11/25/2022]
Abstract
Renal denervation, an invasive technique indicated in resistant hypertension patients insufficiently controlled by antihypertensive drugs, has a good safety profile. However, an increasing number of post-denervation renal artery stenosis cases has recently been reported. We describe the case of a 49-year-old woman with resistant hypertension who was referred to our university hypertension center for renal sympathetic denervation. Her daily treatment included six antihypertensive drugs. CT angiography prior to denervation showed no renal artery stenosis or vessel wall lesions. A standard renal denervation procedure using the St Jude protocol was performed. After an initial improvement in blood pressure profile, she presented with a blood pressure impairment at 3 months after renal denervation leading to the diagnosis of a severe right renal artery stenosis.
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Affiliation(s)
- M Cordeanu
- Service d'hypertension, maladies vasculaires et pharmacologie clinique, nouvel hôpital civil, CHRU de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg, France.
| | - S Gaertner
- Service d'hypertension, maladies vasculaires et pharmacologie clinique, nouvel hôpital civil, CHRU de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg, France
| | - É Prinz
- Service de néphrologie, nouvel hôpital civil, CHRU de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg, France
| | - F Bronner
- Service de cardiologie, nouvel hôpital civil, CHRU de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg, France
| | - C Jahn
- Service de radiologie interventionnelle, nouvel hôpital civil, CHRU de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg, France
| | - T Hannedouche
- Service de néphrologie, nouvel hôpital civil, CHRU de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg, France
| | - D Stephan
- Service d'hypertension, maladies vasculaires et pharmacologie clinique, nouvel hôpital civil, CHRU de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg, France
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The Setback of Renal Denervation Should Not Backfire on Sympathetic Overactivity in Hypertension ∗. J Am Coll Cardiol 2015; 65:1322-1323. [DOI: 10.1016/j.jacc.2015.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 01/25/2015] [Indexed: 11/30/2022]
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22
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Design of renal denervation studies not confounded by antihypertensive drugs. ACTA ACUST UNITED AC 2015; 9:337-40. [PMID: 25863572 DOI: 10.1016/j.jash.2015.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 12/14/2022]
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Fadl Elmula FEM, Larstorp AC, Kjeldsen SE, Persu A, Jin Y, Staessen JA. Renal sympathetic denervation after Symplicity HTN-3 and therapeutic drug monitoring in severe hypertension. Front Physiol 2015; 6:9. [PMID: 25709581 PMCID: PMC4321349 DOI: 10.3389/fphys.2015.00009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/08/2015] [Indexed: 12/01/2022] Open
Abstract
Renal sympathetic denervation (RDN) has been and is still proposed as a new treatment modality in patients with apparently treatment resistant hypertension (TRH), a condition defined as persistent blood pressure elevation despite prescription of at least 3 antihypertensive drugs including a diuretic. However, the large fall in blood pressure after RDN reported in the first randomized study, Symplicity HTN-2 and multiple observational studies has not been confirmed in five subsequent prospective randomized studies and may be largely explained by non-specific effects such as improvement of drug adherence in initially poorly adherent patients (the Hawthorne effect), placebo effect and regression to the mean. The overall blood-pressure lowering effect of RDN seems rather limited and the characteristics of true responders are largely unknown. Accordingly, RDN is not ready for clinical practice. In most patients with apparently TRH, drug monitoring and improvement of drug adherence may prove more effective and cost-beneficial to achieve blood pressure control. In the meantime, research should aim at identifying characteristics of those patients with truly TRH who may respond to RDN.
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Affiliation(s)
- Fadl Elmula M Fadl Elmula
- Departments of Cardiology and Internal Medicine, Oslo University Hospital Ullevaal, Norway ; Faculty of Medicine, University of Oslo Oslo, Norway
| | - Anne C Larstorp
- Departments of Cardiology and Internal Medicine, Oslo University Hospital Ullevaal, Norway ; Faculty of Medicine, University of Oslo Oslo, Norway
| | - Sverre E Kjeldsen
- Departments of Cardiology and Internal Medicine, Oslo University Hospital Ullevaal, Norway ; Faculty of Medicine, University of Oslo Oslo, Norway
| | - Alexandre Persu
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain Brussels, Belgium ; Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain Brussels, Belgium
| | - Yu Jin
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven Leuven, Belgium
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven Leuven, Belgium ; VitaK Development and Research, Maastricht University Maastricht, Netherlands
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Kjeldsen SE, Fadl Elmula FEM, Os I, Persu A, Jin Y, Staessen JA. Renal sympathetic denervation after Symplicity HTN-3 and therapeutic drug monitoring in patients with resistant hypertension to improve patients' adherence. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:48-56. [DOI: 10.1093/ehjcvp/pvu009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/27/2014] [Indexed: 12/26/2022]
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Affiliation(s)
- Felix Mahfoud
- Cardiology, Angiology, Intensive Care Medicine, Saarland University, Homburg/Saar, Germany
| | - Thomas Felix Lüscher
- University Heart Center, Cardiology, University Hospital Zurich and Center for Molecular Cardiology, Campus Schlieren, University of Zurich, and Department of Medicine, Switzerland
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Mariampillai JE, Fadl Elmula FEM, Hoffmann P, Sørensen H, Høieggen A, Kjeldsen SE. [Questionable efficacy of renal denervation]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:1643-4. [PMID: 25223668 DOI: 10.4045/tidsskr.14.0900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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27
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Kjeldsen SE, Fadl Elmula FEM, Persu A, Jin Y, Staessen JA. Renal sympathetic denervation in the aftermath of Symplicity HTN-3. Blood Press 2014; 23:256-61. [DOI: 10.3109/08037051.2014.953861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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