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Sesa-Ashton G, Nolde JM, Muente I, Carnagarin R, Macefield VG, Dawood T, Lambert EA, Lambert GW, Walton A, Esler MD, Schlaich MP. Long-Term Blood Pressure Reductions Following Catheter-Based Renal Denervation: A Systematic Review and Meta-Analysis. Hypertension 2024; 81:e63-e70. [PMID: 38506059 DOI: 10.1161/hypertensionaha.123.22314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Renal denervation is a recognized adjunct therapy for hypertension with clinically significant blood pressure (BP)-lowering effects. Long-term follow-up data are critical to ascertain durability of the effect and safety. Aside from the 36-month follow-up data available from randomized control trials, recent cohort analyses extended follow-up out to 10 years. We sought to analyze study-level data and quantify the ambulatory BP reduction of renal denervation across contemporary randomized sham-controlled trials and available long-term follow-up data up to 10 years from observational studies. METHODS A systematic review was performed with data from 4 observational studies with follow-up out to 10 years and 2 randomized controlled trials meeting search and inclusion criteria with follow-up data out to 36 months. Study-level data were extracted and compared statistically. RESULTS In 2 contemporary randomized controlled trials with 36-month follow-up, an average sham-adjusted ambulatory systolic BP reduction of -12.7±4.5 mm Hg from baseline was observed (P=0.05). Likewise, a -14.8±3.4 mm Hg ambulatory systolic BP reduction was found across observational studies with a mean long-term follow-up of 7.7±2.8 years (range, 3.5-9.4 years; P=0.0051). The observed reduction in estimated glomerular filtration rate across the long-term follow-up was in line with the predicted age-related decline. Antihypertensive drug burden was similar at baseline and follow-up. CONCLUSIONS Renal denervation is associated with a significant and clinically meaningful reduction in ambulatory systolic BP in both contemporary randomized sham-controlled trials up to 36 months and observational cohort studies up to 10 years without adverse consequences on renal function.
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Affiliation(s)
- Gianni Sesa-Ashton
- Human Neurotransmitter and Neurovascular Hypertension & Kidney Diseases Laboratories (G.S.-A., E.A.L., G.W.L., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne Australia
- Human Autonomic Neurophysiology Laboratory (G.S.-A., V.G.M., T.D.), Baker Heart and Diabetes Institute, Melbourne Australia
- Department of Neuroscience, Monash University, Melbourne Australia (G.S.-A., V.G.M., T.D.)
| | - Janis M Nolde
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Australia (J.M.N., I.M., R.C., M.P.S.)
| | - Ida Muente
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Australia (J.M.N., I.M., R.C., M.P.S.)
| | - Revathy Carnagarin
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Australia (J.M.N., I.M., R.C., M.P.S.)
| | - Vaughan G Macefield
- Human Autonomic Neurophysiology Laboratory (G.S.-A., V.G.M., T.D.), Baker Heart and Diabetes Institute, Melbourne Australia
- Department of Neuroscience, Monash University, Melbourne Australia (G.S.-A., V.G.M., T.D.)
| | - Tye Dawood
- Human Autonomic Neurophysiology Laboratory (G.S.-A., V.G.M., T.D.), Baker Heart and Diabetes Institute, Melbourne Australia
- Department of Neuroscience, Monash University, Melbourne Australia (G.S.-A., V.G.M., T.D.)
| | - Elisabeth A Lambert
- Human Neurotransmitter and Neurovascular Hypertension & Kidney Diseases Laboratories (G.S.-A., E.A.L., G.W.L., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne Australia
- Iverson Health Innovation Research Institute & School of Health Sciences, Swinburne University of Technology, Melbourne, Australia (E.A.L., G.W.L.)
| | - Gavin W Lambert
- Human Neurotransmitter and Neurovascular Hypertension & Kidney Diseases Laboratories (G.S.-A., E.A.L., G.W.L., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne Australia
- Iverson Health Innovation Research Institute & School of Health Sciences, Swinburne University of Technology, Melbourne, Australia (E.A.L., G.W.L.)
| | - Antony Walton
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia (A.W., M.D.E.)
| | - Murray D Esler
- Human Neurotransmitter and Neurovascular Hypertension & Kidney Diseases Laboratories (G.S.-A., E.A.L., G.W.L., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne Australia
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia (A.W., M.D.E.)
| | - Markus P Schlaich
- Human Neurotransmitter and Neurovascular Hypertension & Kidney Diseases Laboratories (G.S.-A., E.A.L., G.W.L., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne Australia
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Australia (J.M.N., I.M., R.C., M.P.S.)
- Department of Cardiology and Department of Nephrology, Royal Perth Hospital, WA, Australia (M.P.S.)
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Lai X, Wen H, Yang T, Qin F, Zhong X, Pan Y, Yu J, Huang J, Li J. Effects of renal denervation on endogenous ouabain in spontaneously hypertensive rats. Acta Cir Bras 2023; 37:e371102. [PMID: 36629529 PMCID: PMC9829196 DOI: 10.1590/acb371102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/12/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To investigate the role of renal denervation (RDN) on endogenous ouabain (EO) secretion in spontaneously hypertensive rats (SHR). METHODS Sixteen 12-week-old male SHR were randomly separated into the renal denervation group (RDNX group) and sham operation group (sham group), and eight age-matched Wistar Kyoto rats (WKY) were served as control group. EO concentrations, the Na+- K+-ATPaseactivity, and the expression of Na+-K+-ATPase were assessed. RESULTS EO levels in serum, kidneys and hypothalamus of sham group were higher than in RDNX group (p < 0.05). Renal Na+-K+-ATPase activity subjected to denervation surgery showed significantly reduction when compared with the sham groups (p < 0.05). A positive correlation existed between norepinephrine (NE) content and Na+-K+-ATPase activity in the kidney (r2 = 0.579). Renal Na+-K+-ATPase α1 subunit mRNA expression was down-regulated in the RDNX group compared with the sham group (P < 0.05), while renal Na+-K+-ATPase α1 subunit mRNA expression was no statistical significance between the groups (P = 0.63). Immunohistochemical analysis showed that there were significant differences in the renal expression of Na+-K+-ATPasebetween the three groups (P < 0.05). CONCLUSIONS These experiments demonstrate that RDN exerted an anti-hypertensive effect with reduction of EO levels and Na+-K+-ATPase activity and Na+-K+-ATPase α1 subunit expression of kidney in SHR.
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Affiliation(s)
- Xiaomei Lai
- Postgraduate. Guangxi Medical University – First Affiliated Hospital – Department of Cardiology – Nanning, China
| | - Hong Wen
- PhD. Guangxi Medical University – First Affiliated Hospital – Department of Cardiology – Nanning, China
| | - Tingting Yang
- Postgraduate. Guangxi Medical University – First Affiliated Hospital – Department of Cardiology – Nanning, China
| | - Fei Qin
- Postgraduate. Guangxi Medical University – First Affiliated Hospital – Department of Cardiology – Nanning, China
| | - Xiaoge Zhong
- Postgraduate. Guangxi Medical University – First Affiliated Hospital – Department of Cardiology – Nanning, China
| | - Yajin Pan
- Postgraduate. Guangxi Medical University – First Affiliated Hospital – Department of Cardiology – Nanning, China
| | - Jie Yu
- Postgraduate. Guangxi Medical University – First Affiliated Hospital – Department of Cardiology – Nanning, China
| | - Jing Huang
- Postgraduate. Guangxi Medical University – First Affiliated Hospital – Department of Cardiology – Nanning, China
| | - Jianling Li
- PhD, and Postdoctoral Mobile Station. Guangxi Medical University – First Affiliated Hospital – Department of Cardiology – Nanning, China.,Corresponding author:
- 13407710624
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Renal Denervation Influences Angiotensin II Types 1 and 2 Receptors. Int J Nephrol 2022; 2022:8731357. [PMID: 36262553 PMCID: PMC9576444 DOI: 10.1155/2022/8731357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
The sympathetic and renin-angiotensin systems (RAS) are two critical regulatory systems in the kidney which affect renal hemodynamics and function. These two systems interact with each other so that angiotensin II (Ang II) has the presynaptic effect on the norepinephrine secretion. Another aspect of this interaction is that the sympathetic nervous system affects the function and expression of local RAS receptors, mainly Ang II receptors. Therefore, in many pathological conditions associated with an increased renal sympathetic tone, these receptors' expression changes and renal denervation can normalize these changes and improve the diseases. It seems that the renal sympathectomy can alter Ang II receptors expression and the distribution of RAS receptors in the kidneys, which influence renal functions.
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Perrotta M, Carnevale D. Brain Areas Involved in Modulating the Immune Response Participating in Hypertension and Its Target Organ Damage. Antioxid Redox Signal 2021; 35:1515-1530. [PMID: 34269604 DOI: 10.1089/ars.2021.0142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Significance: Hypertension is a multifactorial disease ensuing from the continuous challenge imposed by several risk factors on the cardiovascular system. Classically known pathophysiological alterations associated with hypertension comprise neurogenic mechanisms dysregulating the autonomic nervous system (ANS), vascular dysfunction, and excessive activation of the renin angiotensin system. During the past few years, a considerable number of studies indicated that immune activation and inflammation also have an important role in the onset and maintenance of hypertension. Critical Issues: On these premises, it has been necessary to reconsider the pathophysiological mechanisms underlying hypertension development, taking into account the potential interactions established between classically known determinants of high blood pressure and the immune system. Recent Advances: Interestingly, central nervous system areas controlling cardiovascular functions are enriched with Angiotensin II receptors. Observations showing that these brain areas are crucial for mediating peripheral ANS and immune responses were suggestive of a critical role of neuroimmune interactions in hypertension. In fact, the ANS, characterized by an intricate network of afferent and efferent fibers, represents an intermediate between the brain and peripheral responses that are essential for blood pressure regulation. Future Directions: In this review, we will summarize studies showing how specific brain areas can modulate immune responses that are involved in hypertension. Antioxid. Redox Signal. 35, 1515-1530.
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Affiliation(s)
- Marialuisa Perrotta
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Daniela Carnevale
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Research Unit of Neuro and Cardiovascular Pathophysiology, IRCCS Neuromed, Pozzilli, Italy
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5
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Travin MI. Expanding the clinical potential of cardiac radionuclide adrenergic imaging. J Nucl Cardiol 2020; 27:2210-2215. [PMID: 30761479 DOI: 10.1007/s12350-019-01629-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Mark I Travin
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center and the Albert Einstein College of Medicine, 111 E. 210th Street, Bronx, NY, 10467-2490, USA.
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Lateef N, Virk HU, Khan MS, Lakhter V, Haseeb A, Ahsan MJ, Mirza M, Rangaswami J, Zidar DA, Holmberg M, Janzer S. Role of renal sympathetic denervation in hypertension. Future Cardiol 2020; 16:211-216. [PMID: 32166965 DOI: 10.2217/fca-2019-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Noman Lateef
- Department of Medicine, Creighton University Medical Center, Omaha, NE 68124, USA
| | - Hafeez Uh Virk
- Department of Cardiology, Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL 60612, USA
| | - Vladimir Lakhter
- Department of Cardiovascular Disease, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Abdul Haseeb
- Department of Medicine, Wright Center of Graduate Medical Education, Scranton, PA 18505, USA
| | | | - Mohsin Mirza
- Department of Medicine, Creighton University Medical Center, Omaha, NE 68124, USA
| | - Janani Rangaswami
- Department of Nephrology, Einstein Medical Center, Philadelphia, PA 19141, USA
| | - David A Zidar
- Division of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Mark Holmberg
- Division of Cardiovascular Medicine, Creighton University Medical Center, Omaha, NE 68124, USA
| | - Sean Janzer
- Department of Cardiology, Einstein Medical Center, Philadelphia, PA 19141 USA
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7
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Soto-Piña AE, Franklin C, Rani CSS, Fernandez E, Cardoso-Peña E, Benítez-Arciniega AD, Gottlieb H, Hinojosa-Laborde C, Strong R. Dexamethasone Causes Hypertension in Rats Even Under Chemical Blockade of Peripheral Sympathetic Nerves. Front Neurosci 2019; 13:1305. [PMID: 31866814 PMCID: PMC6909820 DOI: 10.3389/fnins.2019.01305] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/21/2019] [Indexed: 11/19/2022] Open
Abstract
Synthetic glucocorticoids (GCs) are widely used to treat inflammatory conditions. However, chronic use of GCs can lead to hypertension. The cause of this undesired side effect remains unclear. Previously, we developed an in vivo rat model to study the mechanisms underlying hypertension induced by the chronic administration of the potent synthetic GC, dexamethasone (DEX) and found that the catecholamine biosynthetic pathway plays an important role. In the current study, we used this model to investigate the role of the adrenal medulla, renal nerves, and other peripheral sympathetic nerves in DEX-induced hypertension. After 5 days of baseline telemetric recording of mean arterial pressure (MAP) and heart rate (HR), rats were subjected to one of the following treatments: renal denervation (RDNX), adrenal medullectomy (ADMX), 6-hydroxydopamine (6-OHDA, 20 mg/kg, i.p.) to induce chemical sympathectomy, or a combination of ADMX and 6-OHDA. On day 11, the animals received vehicle (VEH) or DEX in drinking water for 7 days, with the latter causing an increase in MAP in control animals. ADMX and RDNX by themselves exacerbated the pressor effect of DEX. In the chemical sympathectomy group, DEX still caused a rise in MAP but the response was lower (ΔMAP of 6-OHDA/DEX < VEH/DEX, p = 0.039). However, when ΔMAP was normalized to day 10, 6-OHDA + DEX did not show any difference from VEH + DEX, certainly not an increase as observed in DEX + ADMX or RDNX groups. This indicates that sympathetic nerves do not modulate the pressor effect of DEX. TH mRNA levels increased in the adrenal medulla in both VEH/DEX (p = 0.009) and 6-OHDA/DEX (p = 0.031) groups. In the 6-OHDA group, DEX also increased plasma levels of norepinephrine (NE) (p = 0.016). Our results suggest that the activation of catecholamine synthetic pathway could be involved in the pressor response to DEX in animals even under chemical sympathectomy with 6-OHDA.
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Affiliation(s)
| | - Cynthia Franklin
- Feik School of Pharmacy, University of the Incarnate Word, San Antonio, TX, United States
| | - C S Sheela Rani
- Department of Pharmacology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States.,Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX, United States
| | - Elizabeth Fernandez
- Department of Pharmacology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States.,Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX, United States
| | - Elías Cardoso-Peña
- Unidad de Medicina Familiar 220, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Helmut Gottlieb
- Feik School of Pharmacy, University of the Incarnate Word, San Antonio, TX, United States
| | - Carmen Hinojosa-Laborde
- Department of Pharmacology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Randy Strong
- Department of Pharmacology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States.,Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX, United States
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8
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Takemoto Y, Hasegawa Y, Hayashi K, Cao C, Hamasaki T, Kawano T, Mukasa A, Kim-Mitsuyama S. The Stabilization of Central Sympathetic Nerve Activation by Renal Denervation Prevents Cerebral Vasospasm after Subarachnoid Hemorrhage in Rats. Transl Stroke Res 2019; 11:528-540. [DOI: 10.1007/s12975-019-00740-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/22/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023]
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9
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Avataneo V, De Nicolò A, Rabbia F, Perlo E, Burrello J, Berra E, Pappaccogli M, Cusato J, D'Avolio A, Di Perri G, Veglio F. Therapeutic drug monitoring-guided definition of adherence profiles in resistant hypertension and identification of predictors of poor adherence. Br J Clin Pharmacol 2018; 84:2535-2543. [PMID: 29971815 DOI: 10.1111/bcp.13706] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/01/2018] [Accepted: 06/23/2018] [Indexed: 12/11/2022] Open
Abstract
AIMS Arterial hypertension is an important cardiovascular risk factor. A substantial proportion of patients show resistance to antihypertensive treatment but poor adherence to medication regimens is also a significant cause of treatment failure. In this context, therapeutic drug monitoring (TDM) could be useful. The objective of this study was to assess adherence to treatment in patients with resistant hypertension by TDM and to identify parameters that predict nonadherence. METHODS Liquid chromatography tandem mass spectrometry was used to quantify a wide panel of antihypertensive drugs in human plasma to assess treatment compliance. Associations between TDM-determined adherence profiles, self-reported adherence and other patient-related clinical, anthropometric or demographic features were evaluated as potentially useful pre-TDM predictors of poor adherence. RESULTS TDM was performed on 50 patients with suspected resistant hypertension: 24% of patients partially complied to treatment and 18% were nonadherent. No concordance was observed with questionnaire results, while nonadherence was associated with high diastolic blood pressure, high heart rate, previous onset of stroke and previous use of invasive treatments, including renal denervation or baroreceptor stimulation. CONCLUSIONS This evidence highlights the high prevalence of poor adherence in patients with resistant hypertension and the need for caution in using invasive approaches. These preliminary data require validation in a larger cohort, to confirm the need for TDM in routine clinical practice.
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Affiliation(s)
- Valeria Avataneo
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Amedeo De Nicolò
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Franco Rabbia
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Elisa Perlo
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Jacopo Burrello
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Elena Berra
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Marco Pappaccogli
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Antonio D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Giovanni Di Perri
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
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Effect of renal sympathetic denervation on hepatic glucose metabolism and blood pressure in a rat model of insulin resistance. J Hypertens 2017; 34:2465-2474. [PMID: 27512967 DOI: 10.1097/hjh.0000000000001087] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Hypertension and diabetes are associated with impaired glucose metabolism and insulin resistance. Chronic activation of the sympathetic nervous system may contribute to either condition. The purpose of this study was to investigate the effect of renal denervation on glucose kinetics and insulin signal pathways in high-fat diet (HFD)-fed rats. METHODS We examined the effects of renal denervation on glucose kinetics and insulin sensitivity in HFD-fed rats with a hyperinsulinemic-euglycemic clamp technique combined with [3-H] glucose and [U-C]-lactate as a tracer. We also analyzed in vivo the flux through glucose-6-phosphatase and the relative contribution of gluconeogenesis and glycogenolysis in renal denervation rats. In addition, western blotting was used to identify the activities of insulin signaling proteins. RESULTS Renal denervation in HFD-fed rats markedly decreased blood pressure and hepatic glucose production. Hepatic glucose production reduction in renal-denervation-treated rats includes decrease in glycogenolysis by 18.2% for left renal denervation or 31.9% for bilateral renal denervation and decrease in gluconeogenesis by 16.3% for left renal denervation or 42.8% for bilateral renal denervation. These changes were accompanied by decreased hepatic expression of glucose-6-phosphatase and phosphoenolpyruvate carboxykinase. Importantly, renal denervation increased phosphorylation of insulin receptors, insulin receptor substrate-1 and Akt kinase in HFD-fed rats. CONCLUSION These data corroborate the notion that renal denervation potentiates hepatic insulin sensitivity.
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11
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van der Bel R, Çalişkan M, van Hulst RA, van Lieshout JJ, Stroes ESG, Krediet CTP. Blood Pressure Increase during Oxygen Supplementation in Chronic Kidney Disease Patients Is Mediated by Vasoconstriction Independent of Baroreflex Function. Front Physiol 2017; 8:186. [PMID: 28424627 PMCID: PMC5371675 DOI: 10.3389/fphys.2017.00186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/13/2017] [Indexed: 01/07/2023] Open
Abstract
Renal hypoxia is thought to be an important pathophysiological factor in the progression of chronic kidney disease (CKD) and the associated hypertension. In a previous study among CKD patients, supplementation with 100% oxygen reduced sympathetic nerve activity (SNA) and lowered blood pressure (BP). We aimed to assess the underlying haemodynamic modulation and hypothesized a decreased systemic vascular resistance (SVR). To that end, 19 CKD patients were studied during 15-min intervals of increasing partial oxygen pressure (ppO2) from room air (0.21 ATA) to 1.0 ATA and further up to 2.4 ATA, while continuously measuring finger arterial blood pressure (Finapres). Off-line, we derived indexes of SVR, cardiac output (CO) and baroreflex sensitivity from the continuous BP recordings (Modelflow). During oxygen supplementation, systolic, and diastolic BP both increased dose-dependently from 128 ± 24 and 72 ± 19 mmHg respectively at baseline to 141 ± 23 (p < 0.001) and 80 ± 21 mmHg (p < 0.001) at 1.0 ATA oxygen. Comparing baseline and 1.0 ATA oxygen, SVR increased from 1440 ± 546 to 1745 ± 710 dyn·s/cm5 (p = 0.009), heart rate decreased from 60 ± 8 to 58 ± 6 bpm (p < 0.001) and CO from 5.0 ± 1.3 to 4.6 ± 1.1 L/min (p = 0.02). Baroreflex sensitivity remained unchanged (13 ± 13 to 15 ± 12 ms/mmHg). These blood pressure effects were absent in a negative control group of eight young healthy subjects. We conclude that oxygen supplementation in CKD patients causes a non-baroreflex mediated increased in SVR and blood pressure.
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Affiliation(s)
- René van der Bel
- Department of Internal Medicine, Academic Medical Center at the University of AmsterdamAmsterdam, Netherlands
| | - Müşerref Çalişkan
- Department of Internal Medicine, Academic Medical Center at the University of AmsterdamAmsterdam, Netherlands
| | - Robert A van Hulst
- Department of Hyperbaric Medicine, Academic Medical Center at the University of AmsterdamAmsterdam, Netherlands
| | - Johannes J van Lieshout
- Department of Internal Medicine, Academic Medical Center at the University of AmsterdamAmsterdam, Netherlands.,MRC-Arthritis Research UK Centre of Musculoskeletal Ageing Research, School of Life Sciences, Medical School, University of Nottingham, Queen's Medical CentreNottingham, UK
| | - Erik S G Stroes
- Department of Internal Medicine, Academic Medical Center at the University of AmsterdamAmsterdam, Netherlands
| | - C T Paul Krediet
- Department of Internal Medicine, Academic Medical Center at the University of AmsterdamAmsterdam, Netherlands
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Fischell TA, Ebner A, Gallo S, Ikeno F, Minarsch L, Vega F, Haratani N, Ghazarossian VE. Transcatheter Alcohol-Mediated Perivascular Renal Denervation With the Peregrine System. JACC Cardiovasc Interv 2016; 9:589-98. [DOI: 10.1016/j.jcin.2015.11.041] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 02/07/2023]
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13
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Han SY, Bouwer GT, Seymour AJ, Korpal AK, Schwenke DO, Brown CH. Induction of hypertension blunts baroreflex inhibition of vasopressin neurons in the rat. Eur J Neurosci 2015; 42:2690-8. [PMID: 26342194 DOI: 10.1111/ejn.13062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/12/2015] [Accepted: 08/27/2015] [Indexed: 01/21/2023]
Abstract
Vasopressin secretion from the posterior pituitary gland is determined by action potential discharge of hypothalamic magnocellular neurosecretory cells. Vasopressin is a potent vasoconstrictor, but vasopressin levels are paradoxically elevated in some patients with established hypertension. To determine whether vasopressin neurons are excited in hypertension, extracellular single-unit recordings of vasopressin neurons from urethane-anaesthetized Cyp1a1-Ren2 rats with inducible angiotensin-dependent hypertension were made. The basal firing rate of vasopressin neurons was higher in hypertensive Cyp1a1-Ren2 rats than in non-hypertensive Cyp1a1-Ren2 rats. The increase in firing rate was specific to vasopressin neurons because oxytocin neuron firing rate was unaffected by the induction of hypertension. Intravenous injection of the α1-adrenoreceptor agonist, phenylephrine (2.5 μg/kg), transiently increased mean arterial blood pressure to cause a baroreflex-induced inhibition of heart rate and vasopressin neuron firing rate (by 52 ± 9%) in non-hypertensive rats. By contrast, intravenous phenylephrine did not inhibit vasopressin neurons in hypertensive rats, despite a similar increase in mean arterial blood pressure and inhibition of heart rate. Circulating angiotensin II can excite vasopressin neurons via activation of afferent inputs from the subfornical organ. However, the increase in vasopressin neuron firing rate and the loss of inhibition by intravenous phenylephrine were not blocked by intra-subfornical organ infusion of the angiotensin AT1 receptor antagonist, losartan. It can be concluded that increased vasopressin neuron activity at the onset of hypertension is driven, at least in part, by reduced baroreflex inhibition of vasopressin neurons and that this might exacerbate the increase in blood pressure at the onset of hypertension.
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Affiliation(s)
- Su Young Han
- Centre for Neuroendocrinology, University of Otago, Dunedin, 9054, New Zealand.,Department of Physiology, University of Otago, Dunedin, 9054, New Zealand
| | - Gregory T Bouwer
- Centre for Neuroendocrinology, University of Otago, Dunedin, 9054, New Zealand.,Department of Physiology, University of Otago, Dunedin, 9054, New Zealand
| | - Alexander J Seymour
- Centre for Neuroendocrinology, University of Otago, Dunedin, 9054, New Zealand.,Department of Physiology, University of Otago, Dunedin, 9054, New Zealand
| | - Aaron K Korpal
- Centre for Neuroendocrinology, University of Otago, Dunedin, 9054, New Zealand.,Department of Physiology, University of Otago, Dunedin, 9054, New Zealand
| | - Daryl O Schwenke
- Department of Physiology, University of Otago, Dunedin, 9054, New Zealand
| | - Colin H Brown
- Centre for Neuroendocrinology, University of Otago, Dunedin, 9054, New Zealand.,Department of Physiology, University of Otago, Dunedin, 9054, New Zealand
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Yalagudri S, Raju N, Das B, Daware A, Maiya S, Jothiraj K, Ravikishore AG. Renal sympathetic denervation using an externally irrigated radiofrequency ablation catheter for treatment of resistant hypertension - Acute safety and short term efficacy. Indian Heart J 2015; 67:207-13. [PMID: 26138176 DOI: 10.1016/j.ihj.2015.02.020] [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: 04/11/2014] [Accepted: 02/13/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study was conducted to assess the acute safety and short term efficacy of renal sympathetic denervation (RSDN) using solid tip radiofrequency ablation (RFA) catheter and saline irrigation through the renal guiding catheter to achieve effective denervation. BACKGROUND RSDN using a specialized solid-tip RFA catheter has recently been demonstrated to safely reduce systemic blood pressure in patients with refractory hypertension, the limitation being inadequate power delivery in renal arteries. So, we used solid-tip RFA catheter along with saline irrigation for RSDN. METHODS Nine patients with resistant hypertension underwent CT and conventional renal angiography, followed by bilateral or unilateral RSDN using 5F RFA catheter with saline irrigation through renal guiding catheter. Repeat renal angiography was performed at the end of the procedure. In all patients, pre- and post-procedure serum creatinine was measured. RESULTS Over 1-month period: 1) the systolic/diastolic blood pressure decreased by -57 ± 20/-25 ± 7.5 mm Hg; 2) all patients experienced a decrease in systolic blood pressure of at least -36 mm Hg (range 36-98 mm Hg); 3) there was no evidence of renal artery injury immediate post-procedure. There was no significant change in serum creatinine level. CONCLUSIONS This data shows the acute procedural safety and short term efficacy of RSDN using modified externally irrigated solid tip RFA catheter.
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Affiliation(s)
- Sachin Yalagudri
- Fellow in Cardiac Electrophysiology, Narayana Hrudayalaya, Bangalore, India.
| | - Narayana Raju
- Senior Resident, Dept of Cardiology, Narayana Hrudayalaya, Bangalore, India
| | - Bharati Das
- Fellow in Cardiac Electrophysiology, Narayana Hrudayalaya, Bangalore, India
| | - Ashwin Daware
- Consultant Cardiologist, Narayana Hrudayalaya, Bangalore, India
| | - Shreesha Maiya
- Consultant Paediatric Cardiologist and Electrophysiologist, Narayana Hrudayalaya, Bangalore, India
| | - Kannan Jothiraj
- Senior Consultant Cardiologist and Electrophysiologist, Narayana Hrudayalaya, Bangalore, India
| | - A G Ravikishore
- Head of Electrophysiology and Arrhythmia Services, Narayana Hrudayalaya, Bangalore, India
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15
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Desch S, Okon T, Heinemann D, Kulle K, Röhnert K, Sonnabend M, Petzold M, Müller U, Schuler G, Eitel I, Thiele H, Lurz P. Randomized sham-controlled trial of renal sympathetic denervation in mild resistant hypertension. Hypertension 2015; 65:1202-8. [PMID: 25824248 DOI: 10.1161/hypertensionaha.115.05283] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 03/04/2015] [Indexed: 02/05/2023]
Abstract
UNLABELLED Few data are available with regard to the effectiveness of renal sympathetic denervation in patients with resistant hypertension yet only mildly elevated blood pressure (BP). Patients with resistant hypertension and slightly elevated BP (day-time systolic pressure, 135-149 and diastolic pressure, 90-94 mm Hg on 24-hour ambulatory measurement) were randomized in a 1:1 ratio to renal sympathetic denervation with the Symplicity Flex Catheter (Medtronic) or an invasive sham procedure. The primary efficacy end point was the change in 24-hour systolic BP at 6 months between groups in the intention to treat population. A total of 71 patients underwent randomization. Baseline day-time systolic BP was 144.4±4.8 mm Hg in patients assigned to denervation and 143.0±4.7 mm Hg in patients randomized to the sham procedure. The mean change in 24-hour systolic BP in the intention to treat cohort at 6 months was -7.0 mm Hg (95% confidence interval, -10.8 to -3.2) for patients undergoing denervation and -3.5 mm Hg (95% confidence interval, -6.7 to -0.2) in the sham group (P=0.15). In the per protocol population, the change in 24-hour systolic BP at 6 months was -8.3 mm Hg (95% confidence interval, -11.7 to -5.0) for patients undergoing denervation and -3.5 mm Hg (95% confidence interval, -6.8 to -0.2) in the sham group (P=0.042). In patients with mild resistant hypertension, renal sympathetic denervation failed to show a significant reduction in the primary end point of 24-hour systolic BP at 6 months between groups in the intention to treat analysis. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01656096.
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Affiliation(s)
- Steffen Desch
- From the Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany (S.D., I.E., H.T.); and Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany (S.D., T.O., D.H., K.K., K.R., M.S., M.P., U.M., G.S., I.E., H.T., P.L.).
| | - Thomas Okon
- From the Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany (S.D., I.E., H.T.); and Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany (S.D., T.O., D.H., K.K., K.R., M.S., M.P., U.M., G.S., I.E., H.T., P.L.)
| | - Diana Heinemann
- From the Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany (S.D., I.E., H.T.); and Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany (S.D., T.O., D.H., K.K., K.R., M.S., M.P., U.M., G.S., I.E., H.T., P.L.)
| | - Konrad Kulle
- From the Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany (S.D., I.E., H.T.); and Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany (S.D., T.O., D.H., K.K., K.R., M.S., M.P., U.M., G.S., I.E., H.T., P.L.)
| | - Karoline Röhnert
- From the Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany (S.D., I.E., H.T.); and Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany (S.D., T.O., D.H., K.K., K.R., M.S., M.P., U.M., G.S., I.E., H.T., P.L.)
| | - Melanie Sonnabend
- From the Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany (S.D., I.E., H.T.); and Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany (S.D., T.O., D.H., K.K., K.R., M.S., M.P., U.M., G.S., I.E., H.T., P.L.)
| | - Martin Petzold
- From the Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany (S.D., I.E., H.T.); and Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany (S.D., T.O., D.H., K.K., K.R., M.S., M.P., U.M., G.S., I.E., H.T., P.L.)
| | - Ulrike Müller
- From the Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany (S.D., I.E., H.T.); and Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany (S.D., T.O., D.H., K.K., K.R., M.S., M.P., U.M., G.S., I.E., H.T., P.L.)
| | - Gerhard Schuler
- From the Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany (S.D., I.E., H.T.); and Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany (S.D., T.O., D.H., K.K., K.R., M.S., M.P., U.M., G.S., I.E., H.T., P.L.)
| | - Ingo Eitel
- From the Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany (S.D., I.E., H.T.); and Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany (S.D., T.O., D.H., K.K., K.R., M.S., M.P., U.M., G.S., I.E., H.T., P.L.)
| | - Holger Thiele
- From the Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany (S.D., I.E., H.T.); and Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany (S.D., T.O., D.H., K.K., K.R., M.S., M.P., U.M., G.S., I.E., H.T., P.L.)
| | - Philipp Lurz
- From the Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany (S.D., I.E., H.T.); and Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany (S.D., T.O., D.H., K.K., K.R., M.S., M.P., U.M., G.S., I.E., H.T., P.L.)
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Leong KTG, Walton A, Krum H. Renal sympathetic denervation for the treatment of refractory hypertension. Annu Rev Med 2014; 65:349-65. [PMID: 24422574 DOI: 10.1146/annurev-med-051812-145353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Resistant hypertension poses significant health concerns. There are strong demands for new and safe therapies to control resistant hypertension while addressing its common causes, specifically poor compliance to lifelong polypharmacy, lifestyle modifications, and physician inertia. The sympathetic nervous system plays a significant pathophysiological role in hypertension. Surgical sympathectomy for blood pressure reduction is an old but extremely efficacious therapeutic concept, now abandoned with the dawn of a safer contemporary pharmacology era. Recently, clinical studies have revealed promising results for safe and sustained blood pressure reduction with percutaneous renal sympathetic denervation. This is a novel, minimally invasive, device-based therapy, specifically targeting and ablating the renal artery nerves with radiofrequency waves without permanent implantation. There are also reported additional benefits in related comorbidities, such as impaired glucose metabolism, renal impairment, left ventricular hypertrophy, heart failure, and others. This review focuses on how selective renal sympathetic denervation works, its present and potential therapeutic indications, and its future directions.
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17
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Milouk FZ, El Bakkali M, Coghlan L, Lachhab A, Aboudrar S, Benjelloun H. Kinetics of orthostatic blood pressure in primary hypertension. Int Cardiovasc Res J 2014; 8:83-8. [PMID: 25177669 PMCID: PMC4109041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 04/29/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Primary Hypertension (HT) is the most prevalent cardiovascular disorder worldwide and is accompanied by significant morbidity and mortality. OBJECTIVES The present study aimed to investigate the kinetics of orthostatic Blood Pressure (BP) in primary hypertensive patients during the change from supine position to standing position as well as during the standing position using the Orthostatic Test (OT). PATIENTS AND METHODS This prospective study included a group of 107 primary hypertensive patients (mean age: 55.82 ± 11.35 years, ranging from 39 to 80 years). Orthostatic systolic BP (Ortho SBP) was recorded for 10 minutes at the rhythm of 3 measurements per minute and was compared to the values of supine systolic preorthostatic (Preortho SBP). According to the changes in Ortho SBP, three subgroups of primary hypertensive patients were selected as follows: Subgroup A: Ortho SBP was higher than mean Preortho SBP by 10 mmHg or more. Subgroup B: Ortho SBP was lower than mean Preortho SBP by 20 mmHg or more. Subgroup C: -20 mmHg < (Ortho SBP - Preortho SBP) < + 10 mmHg. The kinetics of each group was then recorded. RESULTS In this study, the prevalence of subgroups A, B, and C was 27.1%, 15.9%, and 57.0%, respectively. In subgroup A, the adrenergic peripheral sympathetic alpha response was 20% during the OT. CONCLUSIONS Hypertensives with very similar supine SBP behavior could exhibit widely different Ortho SBP. Thus, careful and effective treatment of hypertensives requires careful consideration and assessment of orthostatic BP.
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Affiliation(s)
| | - Mustapha El Bakkali
- Autonomic Nervous System Team (ERSNA), Faculty of Medicine and Pharmacy, University Mohammed V Souissi, Rabat 6203, Morocco,Physiology of Exercise Team (LPE), Faculty of Medicine and Pharmacy, University Mohammed V Souissi, Rabat 6203, Morocco,Corresponding author: Mustapha El Bakkali, Faculty of Medicine and Pharmacy, Laboratory of Physiology, Av Med Belarbi Elalaoui, BP 6203, Rabat-Institutes, Morocco. Tel: + 212-662323278, E-mail: elbakkali@hotmail
| | - Leslie Coghlan
- School of Science and Engineering, AL Akhawayn University, Ifrane, Morocco
| | - Amal Lachhab
- Autonomic Nervous System Team (ERSNA), Faculty of Medicine and Pharmacy, University Mohammed V Souissi, Rabat 6203, Morocco
| | - Souad Aboudrar
- Autonomic Nervous System Team (ERSNA), Faculty of Medicine and Pharmacy, University Mohammed V Souissi, Rabat 6203, Morocco,Physiology of Exercise Team (LPE), Faculty of Medicine and Pharmacy, University Mohammed V Souissi, Rabat 6203, Morocco,Research Center for Clinical Epidemiology and Therapeutic Trials (CRECET), Faculty of Medicine and Pharmacy, University Mohammed V Souissi, Rabat 6203, Morocco
| | - Halima Benjelloun
- Unit of Cardiology A, Ibn Sina University Hospital, Rabat 10000, Morocco,Autonomic Nervous System Team (ERSNA), Faculty of Medicine and Pharmacy, University Mohammed V Souissi, Rabat 6203, Morocco,Research Center for Clinical Epidemiology and Therapeutic Trials (CRECET), Faculty of Medicine and Pharmacy, University Mohammed V Souissi, Rabat 6203, Morocco
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18
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Alexander VV, Shi Z, Iftekher F, Welsh MJ, Gurm HS, Rising G, Yanovich A, Walacavage K, Islam MN. Renal denervation using focused infrared fiber lasers: A potential treatment for hypertension. Lasers Surg Med 2014; 46:689-702. [DOI: 10.1002/lsm.22290] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Vinay V. Alexander
- Electrical and Computer Engineering Department; University of Michigan; Ann Arbor Michigan 48109
| | - Zhennan Shi
- Electrical and Computer Engineering Department; University of Michigan; Ann Arbor Michigan 48109
| | - Fariha Iftekher
- Electrical and Computer Engineering Department; University of Michigan; Ann Arbor Michigan 48109
| | - Michael J. Welsh
- Department of Cell and Developmental Biology; University of Michigan; Ann Arbor Michigan 48109
| | - Hitinder S. Gurm
- Department of Internal Medicine; University of Michigan Medical School; Ann Arbor Michigan 48109
| | - Gail Rising
- Unit for Laboratory and Animal Medicine; University of Michigan Medical School; Ann Arbor Michigan 48109
| | - Amber Yanovich
- Unit for Laboratory and Animal Medicine; University of Michigan Medical School; Ann Arbor Michigan 48109
| | - Kim Walacavage
- Unit for Laboratory and Animal Medicine; University of Michigan Medical School; Ann Arbor Michigan 48109
| | - Mohammed N. Islam
- Electrical and Computer Engineering Department; University of Michigan; Ann Arbor Michigan 48109
- Department of Internal Medicine; University of Michigan Medical School; Ann Arbor Michigan 48109
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Kannan A, Medina RI, Nagajothi N, Balamuthusamy S. Renal sympathetic nervous system and the effects of denervation on renal arteries. World J Cardiol 2014; 6:814-823. [PMID: 25228960 PMCID: PMC4163710 DOI: 10.4330/wjc.v6.i8.814] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/18/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
Resistant hypertension is associated with chronic activation of the sympathetic nervous system resulting in various comorbidities. The prevalence of resistant hypertension is often under estimated due to various reasons. Activation of sympathetic nervous system at the renal- as well as systemic- level contributes to the increased level of catecholamines and resulting increase in the blood pressure. This increased activity was demonstrated by increased muscle sympathetic nerve activity and renal and total body noradrenaline spillover. Apart from the hypertension, it is hypothesized to be associated with insulin resistance, congestive heart failure and obstructive sleep apnea. Renal denervation is a novel procedure where the sympathetic afferent and efferent activity is reduced by various techniques and has been used successfully to treat drug-resistant hypertension improvement of various metabolic derangements. Renal denervation has the unique advantage of offering the denervation at the renal level, thus mitigating the systemic side effects. Renal denervation can be done by various techniques including radiofrequency ablation, ultrasound guided ablation and chemical ablation. Various trials evaluated the role of renal denervation in the management of resistant hypertension and have found promising results. More studies are underway to evaluate the role of renal denervation in patients presenting with resistant hypertension in different scenarios. Appropriate patient selection might be the key in determining the effectiveness of the procedure.
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Reddi AS. Resistant hypertension: is renal denervation the current treatment of choice? Clin Exp Hypertens 2014; 36:525-30. [PMID: 24678737 DOI: 10.3109/10641963.2014.881846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Resistant hypertension is simply defined as failure to control blood pressure <140/90 mmHg in an adherent non-diabetic patient with normal kidney function despite the use of optimal doses of three antihypertensive agents, including a diuretic. Also, control of blood pressure in any adherent patient with more than four antihypertensive agents defines resistant hypertension. In a patient with diabetes or chronic kidney disease, the goal blood pressure is <130/80 mmHg. One of the most important pathophysiological mechanisms of resistant hypertension is overactivity of the sympathetic nervous system (SNS). In selected patients with resistant hypertension, renal denervation has been shown to control blood pressure by suppressing SNS overactivity. SUMMARY This review summarizes the results of the studies of renal denervation for resistant hypertension and suggests the use of this procedure in several other conditions that are associated with SNS overactivity. KEY MESSAGE Renal denervation seems to control blood pressure in patients with resistant hypertension.
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Affiliation(s)
- Alluru S Reddi
- Department of Medicine, Division of Nephrology and Hypertension, Rutgers, New Jersey Medical School , Newark, NJ , USA
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Hering D, Esler MD, Krum H, Mahfoud F, Böhm M, Sobotka PA, Schlaich MP. Recent advances in the treatment of hypertension. Expert Rev Cardiovasc Ther 2014; 9:729-44. [DOI: 10.1586/erc.11.71] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Fischell TA, Vega F, Raju N, Johnson ET, Kent DJ, Ragland RR, Fischell DR, Almany SL, Ghazarossian VE. Ethanol-mediated perivascular renal sympathetic denervation: preclinical validation of safety and efficacy in a porcine model. EUROINTERVENTION 2013; 9:140-7. [PMID: 23685302 DOI: 10.4244/eijv9i1a20] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS We report the use of a novel endovascular approach using chemical neurolysis, via periadventitial injection of dehydrated ethanol (EtOH) to perform renal artery denervation. METHODS AND RESULTS A novel, three-needle delivery device was introduced into the renal arteries of adult swine using fluoroscopic guidance. EtOH was injected bilaterally with one injection per artery, via the three needles into the adventitial and periadventitial space, using EtOH doses 0.15 ml/artery; n=3, 0.30 ml/artery; n=3, and 0.60 ml/artery; n=3, with saline injection as a sham control (0.4 ml/artery; n=3), and naive subjects (n=7) as a true negative control. The renal parenchymal norepinephrine (NE) concentration at two-week follow-up was the primary efficacy endpoint. The mean renal NE reduction was 54%, 78% and 88% at doses of 0.15 ml, 0.30 ml and 0.60 ml, respectively (p<0.0001 vs. controls). Histological examination revealed marked, and deep, circumferential renal nerve injury at depths of 2-8 mm from the intimal surface. There was no evidence of device-related or EtOH-induced injury to the intimal layers. In some samples at the higher EtOH doses, there was focal loss of smooth muscle cells in the outer media. Angiography at 45 days demonstrated normal appearing renal arteries with no detectable stenoses (n=8). CONCLUSIONS Circumferential adventitial delivery of very low doses of EtOH may be a promising alternative to energy-based systems to achieve dose-dependent, and predictable renal denervation. Further study is warranted.
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Affiliation(s)
- Tim A Fischell
- Michigan State University, Borgess Heart Institute, Kalamazoo, MI 49048, USA.
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Renal denervation. Cardiovasc Endocrinol 2013. [DOI: 10.1097/xce.0000000000000012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lambert GW, Dhar AK, Schlaich MP. Cognitive performance in patients with resistant hypertension following renal sympathetic denervation. EUROINTERVENTION 2013; 9:665-7. [DOI: 10.4244/eijv9i6a108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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How Does Renal Denervation Lower Blood Pressure and When Should This Technique Be Considered for the Treatment of Hypertension? Curr Cardiol Rep 2013; 15:414. [DOI: 10.1007/s11886-013-0414-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Katayama T, Sueta D, Kataoka K, Hasegawa Y, Koibuchi N, Toyama K, Uekawa K, Mingjie M, Nakagawa T, Maeda M, Ogawa H, Kim-Mitsuyama S. Long-term renal denervation normalizes disrupted blood pressure circadian rhythm and ameliorates cardiovascular injury in a rat model of metabolic syndrome. J Am Heart Assoc 2013; 2:e000197. [PMID: 23974905 PMCID: PMC3828797 DOI: 10.1161/jaha.113.000197] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Although renal denervation significantly reduces blood pressure in patients with resistant hypertension, the role of the renal nerve in hypertension with metabolic syndrome is unknown. We investigated the impact of long‐term renal denervation on SHR/NDmcr‐cp(+/+) (SHRcp) rats, a useful rat model of metabolic syndrome, to determine the role of the renal nerve in hypertension with metabolic syndrome. Methods and Results SHRcp rats were divided into (1) a renal denervation (RD) group and (2) a sham operation group (control) to examine the effects of long‐term RD on blood pressure circadian rhythm, renal sodium retention‐related molecules, the renin‐angiotensin‐aldosterone system, metabolic disorders, and organ injury. RD in SHRcp rats not only significantly reduced blood pressure but also normalized blood pressure circadian rhythm from the nondipper to the dipper type, and this improvement was associated with an increase in urinary sodium excretion and the suppression of renal Na+‐Cl− cotransporter upregulation. RD significantly reduced plasma renin activity. RD significantly prevented cardiovascular remodeling and impairment of vascular endothelial function and attenuated cardiovascular oxidative stress. However, RD failed to ameliorate obesity, metabolic disorders, and renal injury and failed to reduce systemic sympathetic activity in SHRcp rats. Conclusions By including the upregulation of the Na+‐Cl− cotransporter, the renal sympathetic nerve is involved in the disruption of blood pressure circadian rhythm as well as hypertension in metabolic syndrome. Thus, RD seems to be a useful therapeutic strategy for hypertension with metabolic syndrome.
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Affiliation(s)
- Tetsuji Katayama
- Department of Pharmacology and Molecular Therapeutics, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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Loria AS, Brands MW, Pollock DM, Pollock JS. Early life stress sensitizes the renal and systemic sympathetic system in rats. Am J Physiol Renal Physiol 2013; 305:F390-5. [PMID: 23678041 PMCID: PMC3742864 DOI: 10.1152/ajprenal.00008.2013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 05/09/2013] [Indexed: 01/16/2023] Open
Abstract
We hypothesized that maternal separation (MS), an early life stress model, induces a sensitization of the sympathetic system. To test this hypothesis, we evaluated the renal and systemic sympathetic system in 12- to 14-wk-old male control or MS rats with the following parameters: 1) effect of renal denervation on conscious renal filtration capacity, 2) norepinephrine (NE) content in key organs involved in blood pressure control, and 3) acute systemic pressor responses to adrenergic stimulation or ganglion blockade. MS was performed by separating pups from their mothers for 3 h/day from day 2 to 14; controls were nonhandled littermates. Glomerular filtration rate (GFR) was examined in renal denervated (DnX; within 2 wk) or sham rats using I¹²⁵-iothalamate plasma clearance. MS-DnX rats showed significantly increased GFR compared with MS-SHAM rats (3.8 ± 0.4 vs. 2.4 ± 0.2 ml/min, respectively, P < 0.05), whereas DnX had no effect in controls, indicating that renal nerves regulate GFR in MS rats. NE content was significantly increased in organ tissues from MS rats (P < 0.05, n = 6-8), suggesting a sensitization of the renal and systemic sympathetic system. Conscious MS rats displayed a significantly greater increase in mean arterial pressure (MAP) in response to NE (2 μg/kg ip) and a greater reduction in MAP in response to mecamylamine (2 mg/kg ip, P < 0.05, n = 4) monitored by telemetry, indicating that MS rats exhibit exaggerated responses to sympathetic stimulation. In conclusion, these data indicate that MS sensitizes the renal and systemic sympathetic system ultimately impairing blood pressure regulation.
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Affiliation(s)
- Analia S Loria
- Section of Experimental Medicine, CB 2200, 1459 Laney Walker Blvd., Dept. of Medicine, Georgia Regents University, Augusta, GA 30912, USA.
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Hart EC, McBryde FD, Burchell AE, Ratcliffe LEK, Stewart LQ, Baumbach A, Nightingale A, Paton JFR. Translational examination of changes in baroreflex function after renal denervation in hypertensive rats and humans. Hypertension 2013; 62:533-41. [PMID: 23817496 DOI: 10.1161/hypertensionaha.113.01261] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal denervation has shown promise in the treatment of resistant hypertension, although the mechanisms underlying the blood pressure (BP) reduction remain unclear. In a translational study of spontaneously hypertensive rats (n=7, surgical denervation) and resistant hypertensive human patients (n=8; 5 men, 33-71 years), we examined the relationship among changes in BP, sympathetic nerve activity, and cardiac and sympathetic baroreflex function after renal denervation. In humans, mean systolic BP (SBP; sphygmomanometry) and muscle sympathetic nerve activity (microneurography) were unchanged at 1 and 6 months after renal denervation (P<0.05). Interestingly, 4 of 8 patients showed a 10% decrease in SBP at 6 months, but sympathetic activity did not necessarily change in parallel with SBP. In contrast, all rats showed significant and immediate decreases in telemetric SBP and lumbar sympathetic activity (P<0.05), 7 days after denervation. Despite no change in SBP, human cardiac and sympathetic baroreflex function (sequence and threshold techniques) showed improvements at 1 and 6 months after denervation, particularly through increased sympathetic baroreflex sensitivity to falling BP. This was mirrored in spontaneously hypertensive rats; cardiac and sympathetic baroreflex sensitivity (spontaneous sequence and the Oxford technique) improved 7 days after denervation. The more consistent results in rats may be because of a more complete (>90% reduction in renal norepinephrine content) denervation. We conclude that (1) renal denervation improves BP in some patients, but sympathetic activity does not always change in parallel, and (2) baroreflex sensitivity is consistently improved in animals and humans, even when SBP has not decreased. Determining procedural success will be crucial in advancing this treatment modality.
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Affiliation(s)
- Emma C Hart
- School of Physiology and Pharmacology, Bristol Heart Institute, Medical Science Bldg, University of Bristol, Bristol, United Kingdom
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Santiapillai GR, Ferro A. Renal denervation as an option for the management of hypertension. J Biomed Res 2013; 28:18-24. [PMID: 24474960 PMCID: PMC3904171 DOI: 10.7555/jbr.27.20130036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 04/16/2013] [Accepted: 05/02/2013] [Indexed: 01/17/2023] Open
Abstract
Hypertension is a multifactorial condition which makes the development of treatment approaches difficult. The vast majority of patients are treated with lifestyle measures either alone or in combination with antihypertensive drugs, and this approach is largely successful in controlling blood pressure. However, for a subgroup of patients, control of blood pressure remains resistant to this approach and therefore the development of new strategies is imperative. The sympathetic nervous system has been known to be implicated in hypertension for many decades, and evidence from studies in the past has revealed the benefit of reducing sympathetic nerve activity in the control of blood pressure albeit with severe side effects. Recent technological advances have allowed for specific targeting of the renal sympathetic nerves by catheter ablation. The Symplicity HTN-1 and HTN-2 trials have provided strong evidence for renal denervation giving rise to considerable blood pressure reductions in treatment-resistant hypertensives and, due to the high incidence of hypertension worldwide, this carries the promise of further reducing the global burden of hypertension and its attendant complications. Here we review the evidence for renal denervation in the management of hypertension.
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Affiliation(s)
- Georgina Radhini Santiapillai
- Department of Clinical Pharmacology, Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
| | - Albert Ferro
- Department of Clinical Pharmacology, Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
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Esler MD, Krum H, Schlaich M, Schmieder RE, Böhm M, Sobotka PA. Renal sympathetic denervation for treatment of drug-resistant hypertension: one-year results from the Symplicity HTN-2 randomized, controlled trial. Circulation 2013; 126:2976-82. [PMID: 23248063 DOI: 10.1161/circulationaha.112.130880] [Citation(s) in RCA: 324] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Renal sympathetic nerve activation contributes to the pathogenesis of hypertension. Symplicity HTN-2, a multicenter, randomized trial, demonstrated that catheter-based renal denervation produced significant blood pressure lowering in treatment-resistant patients at 6 months after the procedure compared with control, medication-only patients. Longer-term follow-up, including 6-month crossover results, is now presented. METHODS AND RESULTS Eligible patients were on ≥3 antihypertensive drugs and had a baseline systolic blood pressure ≥160 mm Hg (≥150 mm Hg for type 2 diabetics). After the 6-month primary end point was met, renal denervation in control patients was permitted. One-year results on patients randomized to immediate renal denervation (n=47) and 6-month postprocedure results for crossover patients are presented. At 12 months after the procedure, the mean fall in office systolic blood pressure in the initial renal denervation group (-28.1 mm Hg; 95% confidence interval, -35.4 to -20.7; P<0.001) was similar to the 6-month fall (-31.7 mm Hg; 95% confidence interval, -38.3 to -25.0; P=0.16 versus 6-month change). The mean systolic blood pressure of the crossover group 6 months after the procedure was significantly lowered (from 190.0±19.6 to 166.3±24.7 mm Hg; change, -23.7±27.5; P<0.001). In the crossover group, there was 1 renal artery dissection during guide catheter insertion, before denervation, corrected by renal artery stenting, and 1 hypotensive episode, which resolved with medication adjustment. CONCLUSIONS Control patients who crossed over to renal denervation with the Symplicity system had a significant drop in blood pressure similar to that observed in patients receiving immediate denervation. Renal denervation provides safe and sustained reduction of blood pressure to 1 year.
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Affiliation(s)
- Murray D Esler
- Baker IDI Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia.
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31
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Schlaich MP, Bart B, Hering D, Walton A, Marusic P, Mahfoud F, Böhm M, Lambert EA, Krum H, Sobotka PA, Schmieder RE, Ika-Sari C, Eikelis N, Straznicky N, Lambert GW, Esler MD. Feasibility of catheter-based renal nerve ablation and effects on sympathetic nerve activity and blood pressure in patients with end-stage renal disease. Int J Cardiol 2013; 168:2214-20. [PMID: 23453868 DOI: 10.1016/j.ijcard.2013.01.218] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/03/2012] [Accepted: 01/18/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Sympathetic activation is a hallmark of ESRD and adversely affects cardiovascular prognosis. Efferent sympathetic outflow and afferent neural signalling from the failing native kidneys are key mediators and can be targeted by renal denervation (RDN). Whether this is feasible and effective in ESRD is not known. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS In an initial safety and proof-of-concept study we attempted to perform RDN in 12 patients with ESRD and uncontrolled blood pressure (BP). Standardized BP measurements were obtained in all patients on dialysis free days at baseline and follow up. Measures of renal noradrenaline spillover and muscle sympathetic nerve activity were available from 5 patients at baseline and from 2 patients at 12 month follow up and beyond. RESULTS Average office BP was 170.8 ± 16.9/89.2 ± 12.1 mmHg despite the use of 3.8 ± 1.4 antihypertensive drugs. All 5 patients in whom muscle sympathetic nerve activity and noradrenaline spillover was assessed at baseline displayed substantially elevated levels. Three out of 12 patients could not undergo RDN due to atrophic renal arteries. Compared to baseline, office systolic BP was significantly reduced at 3, 6, and 12 months after RDN (from 166 ± 16.0 to 148 ± 11, 150 ± 14, and 138 ± 17 mmHg, respectively), whereas no change was evident in the 3 non-treated patients. Sympathetic nerve activity was substantially reduced in 2 patients who underwent repeat assessment. CONCLUSIONS RDN is feasible in patients with ESRD and associated with a sustained reduction in systolic office BP. Atrophic renal arteries may pose a problem for application of this technology in some patients with ESRD.
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Affiliation(s)
- Markus P Schlaich
- Neurovascular Hypertension & Kidney Disease and Human Neurotransmitters Laboratories Baker IDI Heart & Diabetes Institute, Alfred Hospital, Melbourne, Australia; Heart Centre, Alfred Hospital, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences and Department of Physiology, Monash University, Melbourne, Victoria, Australia.
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Avanzas P, Bayes-Genis A, Pérez de Isla L, Sanchis J, Heras M. Innovation in cardiology: introduction. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2013; 66:133. [PMID: 24775389 DOI: 10.1016/j.rec.2012.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 09/24/2012] [Indexed: 06/03/2023]
Affiliation(s)
| | | | | | - Juan Sanchis
- Asociate Editor, Revista Española de Cardiología
| | - Magda Heras
- Editor-in-Chief, Revista Española de Cardiología
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Volpe M, Rosei EA, Ambrosioni E, Cottone S, Cuspidi C, Borghi C, De Luca N, Fallo F, Ferri C, Mancia G, Morganti A, Muiesan ML, Sarzani R, Sechi L, Tocci G, Virdis A. Renal Artery Denervation for Treating Resistant Hypertension. High Blood Press Cardiovasc Prev 2012; 19:237-44. [DOI: 10.1007/bf03297636] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022] Open
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Morphological assessment of renal arteries after radiofrequency catheter-based sympathetic denervation in a porcine model. J Hypertens 2012; 30:2230-9. [DOI: 10.1097/hjh.0b013e32835821e5] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zucker IH, Patel KP, Schultz HD. Be sympathetic to your nervous system. J Appl Physiol (1985) 2012; 113:1292-3. [DOI: 10.1152/japplphysiol.00911.2012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Irving H. Zucker
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kaushik P. Patel
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Harold D. Schultz
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska
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Kandzari DE, Bhatt DL, Sobotka PA, O'Neill WW, Esler M, Flack JM, Katzen BT, Leon MB, Massaro JM, Negoita M, Oparil S, Rocha-Singh K, Straley C, Townsend RR, Bakris G. Catheter-based renal denervation for resistant hypertension: rationale and design of the SYMPLICITY HTN-3 Trial. Clin Cardiol 2012; 35:528-35. [PMID: 22573363 PMCID: PMC6652693 DOI: 10.1002/clc.22008] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 04/11/2012] [Indexed: 12/11/2022] Open
Abstract
Hypertension represents a significant global public health concern, contributing to vascular and renal morbidity, cardiovascular mortality, and economic burden. The opportunity to influence clinical outcomes through hypertension management is therefore paramount. Despite adherence to multiple available medical therapies, a significant proportion of patients have persistent blood pressure elevation, a condition termed resistant hypertension. Recent recognition of the importance of the renal sympathetic and somatic nerves in modulating blood pressure and the development of a novel procedure that selectively removes these contributors to resistant hypertension represents an opportunity to provide clinically meaningful benefit across wide and varied patient populations. Early clinical evaluation with catheter-based, selective renal sympathetic denervation in patients with resistant hypertension has mechanistically correlated sympathetic efferent denervation with decreased renal norepinephrine spillover and renin activity, increased renal plasma flow, and has demonstrated clinically significant, sustained reductions in blood pressure. The SYMPLICITY HTN-3 Trial is a pivotal study designed as a prospective, randomized, masked procedure, single-blind trial evaluating the safety and effectiveness of catheter-based bilateral renal denervation for the treatment of uncontrolled hypertension despite compliance with at least 3 antihypertensive medications of different classes (at least one of which is a diuretic) at maximal tolerable doses. The primary effectiveness endpoint is measured as the change in office-based systolic blood pressure from baseline to 6 months. This manuscript describes the design and methodology of a regulatory trial of selective renal denervation for the treatment of hypertension among patients who have failed pharmacologic therapy.
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Radjab Y, Aboudrar S, Milouk FZ, Rkain H, El Bakkali M, Dakka T, Coghlan L, Benjelloun H. Cardiovascular autonomic response to amlodipine in primary hypertension. ISRN CARDIOLOGY 2012; 2012:832183. [PMID: 22919515 PMCID: PMC3418654 DOI: 10.5402/2012/832183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/07/2012] [Indexed: 12/02/2022]
Abstract
Sympathetic hyperactivity may be involved in primary hypertension. The purpose of this study was to evaluate both sympathetic and vagal activity responses in patients receiving amlodipine as antihypertensive agent. Patients and Methods. This prospective study included a group of primary hypertensive patients (N = 32, mean age 54.6 ± 7.6 years). The cardiovascular autonomic tests performed in this group, before and after 3 months of daily oral administration of amlodipine, included deep breathing, hand-grip, and mental stress tests. Statistical analysis was done using the Student's t-test. Results. Cardiovascular autonomic reflexes responses before and after 3 months of amlodipine oral administration were as follows: the mental stress test stimulation method produced a central alpha adrenergic response of 23.9 ± 8.7% versus 11.2 ± 2.0% (P < 0.05), a central beta sympathetic response of 16.7 ± 9.2% versus 10.4 ± 1.3% (P < 0.05), a blood pressure increase in response to hand grip test of 20.5 ± 7.3% versus 10.7 ± 2.4% (P < 0.05), vagal response to deep breathing test was 21.2 ± 6.5% versus 30.8 ± 2.9%, (P < 0.05). Conclusion. The results attest that amlodipine may have an anti-sympathetic effect.
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Affiliation(s)
- Youssouf Radjab
- Physiology Laboratory, School of Medicine and Pharmacy, University Mohammed V Souissi, Rabat 6203, Morocco
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Bernard S, Maurer MS. Heart Failure With a Normal Ejection Fraction: Treatments for a Complex Syndrome? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:305-18. [DOI: 10.1007/s11936-012-0187-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Hypothesis: Catheter-based renal sympathetic denervation should be the initial therapy for essential hypertension. Med Hypotheses 2012; 78:482-4. [DOI: 10.1016/j.mehy.2012.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 01/06/2012] [Indexed: 11/19/2022]
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Renal sympathetic activation from long-term low-dose angiotensin II infusion in rabbits. J Hypertens 2012; 30:551-60. [DOI: 10.1097/hjh.0b013e328350133a] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Pimenta E, Oparil S. Renal Sympathetic Denervation for Treatment of Hypertension. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:127-135. [PMID: 22294071 DOI: 10.1007/s11936-012-0166-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OPINION STATEMENT: Sympathetic nervous system activation of the heart, kidney and peripheral vasculature increases cardiac output, fluid retention and vascular resistance and plays an important role in acute and chronic BP elevation. Renal sympathetic denervation via a percutaneous radiofrequency catheter based approach is a safe and effective procedure that lowers BP in patients with resistant hypertension. Exploratory studies in patients with resistant hypertension and a variety of comorbidities, including insulin resistance/metabolic syndrome, obstructive sleep apnea and the polycystic ovary syndrome, have shown benefit of renal denervation in attenuating the severity of the comorbid conditions, as well as reducing BP. However, more studies are needed to further address the long term effects of renal denervation and its safety and effectiveness in other disease states such as congestive heart failure.
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Affiliation(s)
- Eduardo Pimenta
- University of Queensland, Hypertension Unit, Princess Alexandra Hospital, 5th Floor, Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia,
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Abstract
Pharmacological therapy of systolic left ventricular dysfunction has evolved over the past 3 decades. Current therapy is focused primarily on the regulation of the renin-angiotensin-aldosterone axis and sympathetic nervous system. Additional targets of pharmacotherapy include vasoconstriction, impaired nitric oxide metabolism, inflammation and improving myocardial function. As therapies in chronic systolic heart failure have evolved beyond diuretics and digoxin, so too has mortality improved. Future directions in the management of heart failure include cell-based and genetic therapy, and further refinement of current therapy through genetics.
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Affiliation(s)
- Ajith P Nair
- Cardiovascular Institute, Mount Sinai Medical Center, New York, NY 10029, USA.
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