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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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Patel HC, Hayward C, Vassiliou V, Patel K, Howard JP, Di Mario C. Renal denervation for the management of resistant hypertension. Integr Blood Press Control 2015; 8:57-69. [PMID: 26672761 PMCID: PMC4675644 DOI: 10.2147/ibpc.s65632] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Renal sympathetic denervation (RSD) as a therapy for patients with resistant hypertension has attracted great interest. The majority of studies in this field have demonstrated impressive reductions in blood pressure (BP). However, these trials were not randomized or sham-controlled and hence, the findings may have been overinflated due to trial biases. SYMPLICITY HTN-3 was the first randomized controlled trial to use a blinded sham-control and ambulatory BP monitoring. A surprise to many was that this study was neutral. Possible reasons for this neutrality include the fact that RSD may not be effective at lowering BP in man, RSD was not performed adequately due to limited operator experience, patients’ adherence with their anti-hypertensive drugs may have changed during the trial period, and perhaps the intervention only works in certain subgroups that are yet to be identified. Future studies seeking to demonstrate efficacy of RSD should be designed as randomized blinded sham-controlled trials. The efficacy of RSD is in doubt, but many feel that its safety has been established through the thousands of patients in whom the procedure has been performed. Over 90% of these data, however, are for the Symplicity™ system and rarely extend beyond 12 months of follow-up. Long-term safety cannot be assumed with RSD and nor should it be assumed that if one catheter system is safe then all are. We hope that in the near future, with the benefit of well-designed clinical trials, the role of renal denervation in the management of hypertension will be established.
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Affiliation(s)
- Hitesh C Patel
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Carl Hayward
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Vassilis Vassiliou
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Ketna Patel
- Department of Cardiology, Royal Free Hospital, London, UK
| | - James P Howard
- National Heart and Lung Institute, Imperial College, London, UK
| | - Carlo Di Mario
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
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Thaung HPA, Yao Y, Bussey CT, Hughes G, Jones PP, Bahn A, Sammut IA, Lamberts RR. Chronic bilateral renal denervation reduces cardiac hypertrophic remodelling but not β-adrenergic responsiveness in hypertensive type 1 diabetic rats. Exp Physiol 2015; 100:628-39. [DOI: 10.1113/ep085021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/13/2015] [Indexed: 11/08/2022]
Affiliation(s)
- H. P. Aye Thaung
- Department of Physiology - HeartOtago, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
| | - Yimin Yao
- Department of Pharmacology and Toxicology, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
| | - Carol T. Bussey
- Department of Physiology - HeartOtago, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
| | - Gillian Hughes
- Department of Physiology - HeartOtago, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
| | - Peter P. Jones
- Department of Physiology - HeartOtago, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
| | - Andrew Bahn
- Department of Physiology - HeartOtago, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
| | - Ivan A. Sammut
- Department of Pharmacology and Toxicology, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
| | - Regis R. Lamberts
- Department of Physiology - HeartOtago, Otago School of Medical Sciences; University of Otago; Dunedin New Zealand
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Hubens LEG, Verloop WL, Joles JA, Blankestijn PJ, Voskuil M. Ischemia and reactive oxygen species in sympathetic hyperactivity states: a vicious cycle that can be interrupted by renal denervation? Curr Hypertens Rep 2014; 15:313-20. [PMID: 23754326 DOI: 10.1007/s11906-013-0367-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Renal denervation has developed as a new treatment strategy for patients suffering from resistant hypertension. The success of this therapy is due to the fact that sympathetic hyperactivity is involved in the pathogenesis of elevated blood pressure. However, not only the sympathetic nervous system (SNS), but also the renin angiotensin system (RAS) is known to be involved in hypertension. In addition, RAS is involved in other sympathetic hyperactivity states, such as heart failure, chronic kidney disease, insulin resistance and obstructive sleep apnea. Moreover, renal denervation has a beneficial effect on patients suffering from these disease states. Recent research suggested that the production of reactive oxygen species (ROS) is elevated in sympathetic hyperactivity states, and that ROS are able to activate the SNS and local tissue renin angiotensin system. Therefore, this review discusses the possibility of ROS as a common trigger of SNS and RAS activity in sympathetic hyperactivity states, and the effect of renal denervation on this ROS production.
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Affiliation(s)
- Lisette E G Hubens
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
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Renal denervation in human hypertension: mechanisms, current findings, and future prospects. Curr Hypertens Rep 2012; 14:247-53. [PMID: 22457244 DOI: 10.1007/s11906-012-0264-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Denervating the human kidney to improve blood pressure control is an old therapeutic concept first applied on a larger scale by surgeons in the 1920s. With the advent of modern pharmacology and the development of powerful drugs to lower blood pressure, approaches to directly target the sympathetic nerves were more or less abandoned. Over the past 2-3 years, however, we have witnessed enormous renewed interest in novel and minimally invasive device-based approaches to specifically target the renal nerves. The enthusiasm is fueled by promising results from proof-of-concept studies and clinical trials demonstrating convincing blood pressure-lowering effects in the majority of treated patients, and perhaps even more so by observations indicating potential additional benefits relating to common comorbidities of hypertension, such as impaired glucose metabolism, renal impairment, left ventricular hypertrophy, and others. Herein we review the current findings and assess whether these high hopes are justified.
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Schlaich MP, Sobotka PA, Krum H, Whitbourn R, Walton A, Esler MD. Renal Denervation as a Therapeutic Approach for Hypertension. Hypertension 2009; 54:1195-201. [DOI: 10.1161/hypertensionaha.109.138610] [Citation(s) in RCA: 188] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Markus P. Schlaich
- From the Neurovascular Hypertension and Kidney Disease Laboratory/Human Neurotransmitters Laboratory (M.P.S., M.D.E.), Baker IDI Heart and Diabetes Institute and Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology (P.A.S.), Hennepin County Medical Center, Minneapolis, Minn; Ardian, Inc (P.A.S.), Palo Alto, Calif; Monash Centre of Cardiovascular Research and Education in Therapeutics (H.K.), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne,
| | - Paul A. Sobotka
- From the Neurovascular Hypertension and Kidney Disease Laboratory/Human Neurotransmitters Laboratory (M.P.S., M.D.E.), Baker IDI Heart and Diabetes Institute and Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology (P.A.S.), Hennepin County Medical Center, Minneapolis, Minn; Ardian, Inc (P.A.S.), Palo Alto, Calif; Monash Centre of Cardiovascular Research and Education in Therapeutics (H.K.), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne,
| | - Henry Krum
- From the Neurovascular Hypertension and Kidney Disease Laboratory/Human Neurotransmitters Laboratory (M.P.S., M.D.E.), Baker IDI Heart and Diabetes Institute and Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology (P.A.S.), Hennepin County Medical Center, Minneapolis, Minn; Ardian, Inc (P.A.S.), Palo Alto, Calif; Monash Centre of Cardiovascular Research and Education in Therapeutics (H.K.), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne,
| | - Robert Whitbourn
- From the Neurovascular Hypertension and Kidney Disease Laboratory/Human Neurotransmitters Laboratory (M.P.S., M.D.E.), Baker IDI Heart and Diabetes Institute and Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology (P.A.S.), Hennepin County Medical Center, Minneapolis, Minn; Ardian, Inc (P.A.S.), Palo Alto, Calif; Monash Centre of Cardiovascular Research and Education in Therapeutics (H.K.), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne,
| | - Anthony Walton
- From the Neurovascular Hypertension and Kidney Disease Laboratory/Human Neurotransmitters Laboratory (M.P.S., M.D.E.), Baker IDI Heart and Diabetes Institute and Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology (P.A.S.), Hennepin County Medical Center, Minneapolis, Minn; Ardian, Inc (P.A.S.), Palo Alto, Calif; Monash Centre of Cardiovascular Research and Education in Therapeutics (H.K.), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne,
| | - Murray D. Esler
- From the Neurovascular Hypertension and Kidney Disease Laboratory/Human Neurotransmitters Laboratory (M.P.S., M.D.E.), Baker IDI Heart and Diabetes Institute and Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology (P.A.S.), Hennepin County Medical Center, Minneapolis, Minn; Ardian, Inc (P.A.S.), Palo Alto, Calif; Monash Centre of Cardiovascular Research and Education in Therapeutics (H.K.), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne,
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