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Subbotina A, Skjølsvik E, Solbu MD, Miroslawska A, Steigen T. Echocardiographic findings following renal sympathetic denervation for treatment resistant hypertension, the ReShape CV-risk study. Blood Press 2024; 33:2326298. [PMID: 38469724 DOI: 10.1080/08037051.2024.2326298] [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: 12/01/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE The aim of this study was to describe and compare echocardiographic findings before renal sympathetic denervation (RDN) and 6 and 24 months after the procedure. MATERIALS AND METHODS Patients with treatment resistant hypertension (TRH) were included in this non-randomised intervention study. RDN was performed by a single experienced operator using the Symplicity Catheter System. Echocardiographic measurements were performed at baseline, and after 6 and 24 months. RESULTS The cohort consisted of 21 patients with TRH, with a mean systolic office blood pressure (BP) of 163 mmHg and mean diastolic BP 109 mmHg. Mixed model analysis showed no significant change in left ventricular (LV) mass index (LVMI) or left atrium volume index (LAVI) after the RDN procedure. Higher LVMI at baseline was significantly associated with greater reduction in LVMI (p < 0.001). Relative wall thickness (RWT) increased over time (0.48 mm after two years) regardless of change in BP. There was a small but significant reduction in LV end-diastolic (LVIDd) and end-systolic (LVIDs) diameters after RDN, with a mean reduction of 2.6 and 2.4 mm, respectively, after two years. Progression to concentric hypertrophy was observed only in in patients who did not achieve normal BP values, despite BP reduction after RDN. CONCLUSION There was no reduction of LV mass after RDN. We found a small statistically significant reduction in LVIDd and LVIDs, which together with increase in RWT can indicate progression towards concentric hypertrophy. BP reduction after RDN on its own does not reverse concentric remodelling if target BP is not achieved.
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Affiliation(s)
- Anna Subbotina
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
- Clinical Cardiovascular Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Eystein Skjølsvik
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marit Dahl Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Atena Miroslawska
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Terje Steigen
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
- Clinical Cardiovascular Research Group, UiT The Arctic University of Norway, Tromsø, Norway
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Brahmandam A, Alves R, Liu H, Gonzalez L, Aoyagi Y, Ohashi Y, Langford JT, Thaxton C, Taniguchi R, Zhang W, Bai H, Yatsula B, Dardik A. A central arteriovenous fistula reduces systemic hypertension in a mouse model. JVS Vasc Sci 2024; 5:100191. [PMID: 38510938 PMCID: PMC10951512 DOI: 10.1016/j.jvssci.2024.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/11/2024] [Indexed: 03/22/2024] Open
Abstract
Objective A central arteriovenous fistula (AVF) has been proposed as a potential novel solution to treat patients with refractory hypertension. We hypothesized that venous remodeling after AVF creation in the hypertensive environment reduces systemic blood pressure but results in increased AVF wall thickness compared with remodeling in the normotensive environment. Methods A central AVF was performed in C57BL6/J mice previously made hypertensive with angiotensin II (Ang II); mice were sacrificed on postoperative day 7 or 21. Results In mice treated with Ang II alone, the mean systolic blood pressure increased from 90 ± 5 mmHg to 160 ± 5 mmHg at day 21; however, in mice treated with both Ang II and an AVF, the blood pressure decreased with creation of an AVF. There were significantly more PCNA-positive cells, SM22α/PCNA-positive cells, collagen I deposition, and increased Krüppel-like Factor 2 immunoreactivity in hypertensive mice with an AVF compared with normotensive mice with an AVF. Conclusions These data show that a central AVF decreases systemic hypertension as well as induces local alterations in venous remodeling.
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Affiliation(s)
- Anand Brahmandam
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Rafael Alves
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
| | - Hao Liu
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
- Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Luis Gonzalez
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
| | - Yukihiko Aoyagi
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichi Ohashi
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, Tokyo, Japan
| | - John T. Langford
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
| | - Carly Thaxton
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
| | - Ryosuke Taniguchi
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, Tokyo, Japan
| | - Weichang Zhang
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
| | - Hualong Bai
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
| | - Bogdan Yatsula
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
| | - Alan Dardik
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT
- Surgical Service, VA Connecticut Healthcare System, West Haven, CT
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Goyal A, Jain H, Verma A, Jain J, Shamim U, Kanagala SG, Motwani J, Dey RC, Chunawala Z, Sohail AH, Belur AD. The role of renal denervation in cardiology and beyond: An updated comprehensive review and future directives. Curr Probl Cardiol 2024; 49:102196. [PMID: 37952794 DOI: 10.1016/j.cpcardiol.2023.102196] [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: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
Renal denervation (RDN) is a minimally invasive intervention performed by denervation of the nervous fibers in the renal plexus, which decreases sympathetic activity. These sympathetic nerves influence various physiological functions that regulate blood pressure (BP), including intravascular volume, electrolyte composition, and vascular tone. Although proven effective in some trials, controversial trials, such as the Controlled Trial of Renal Denervation for Resistant Hypertension (SYMPLICITY-HTN3), have demonstrated contradictory results for the effectiveness of RDN in resistant hypertension (HTN). In the treatment of HTN, individuals with primary HTN are expected to experience greater benefits compared to those with secondary HTN due to the diverse underlying causes of secondary HTN. Beyond its application for HTN, RDN has also found utility in addressing cardiac arrhythmias, such as atrial fibrillation, and managing cases of heart failure. Non-cardiogenic applications of RDN include reducing the intensity of obstructive sleep apnea (OSA), overcoming insulin resistance, and in chronic kidney disease (CKD) patients. This article aims to provide a comprehensive review of RDN and its uses in cardiology and beyond, along with providing future directions and perspectives.
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Affiliation(s)
- Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Amogh Verma
- Department of Medicine and Surgery, Rama Medical College Hospital and Research Centre, Hapur, India
| | - Jyoti Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Urooj Shamim
- Department of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Sai Gautham Kanagala
- Department of Internal Medicine, Metropolitan Hospital Center, NY, New York, United States
| | - Jatin Motwani
- Department of Internal Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Rohit Chandra Dey
- Department of Internal Medicine, Altai State Medical University, Barnaul, Altai Krai, Russia
| | - Zainali Chunawala
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, United States
| | - Amir H Sohail
- Department of Surgery, University of New Mexico Health Sciences, Albuquerque, NM, United States
| | - Agastya D Belur
- Department of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States.
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Verdecchia P, Cavallini C, Sclafani R, Santucci A, Notaristefano F, Zingarini G, Colombo GA, Angeli F. Catheter-based renal artery denervation: facts and expectations. Eur J Intern Med 2023; 117:66-77. [PMID: 37544846 DOI: 10.1016/j.ejim.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
Catheter-based renal artery denervation (RAD) is entering a new era. After the disappointing results of SYMPLICITY-HTN 3 trial in year 2014, several technical and methodological advancements led to execution of important SHAM-controlled randomized trials with promising results. Now, the 2023 ESH Guidelines give RAD a class of recommendation II with a Level of Evidence B. Currently, catheter-based RAD has two main areas of application: (a) Hypertensive patients who are still untreated, in whom RAD is a sort of a first-line treatment; (b) Difficult-to-control or true resistant hypertensive patients. Notably, randomized SHAM-controlled trials met their primary end-point in both these conditions. So far, we do not dispose of established predictors of the antihypertensive response to RAD. Some data suggest that younger patients with systo-diastolic hypertension, absence of diffuse atherosclerosis and evidence of sympathetic nervous system overactivity experience a better BP response to the procedure. We reviewed the available data on catheter-based RAD and included an updated meta-analysis of the results of the available SHAM-controlled trials. Overall, the reduction in 24-h systolic blood pressure (BP) after RAD exceeded that after SHAM by 4.58 mmHg (95% CI 3.07-6.10) in untreated patients, and by 3.82 mmHg (95% CI 2.46-5.18) in treated patients, without significant heterogeneity across trials, patient phenotype (untreated versus treated patients) and technique (radiofrequency versus ultrasound). There were no important safety signals related to the procedure. Notably, some data suggest that RAD could be an effective additional approach in patients with atrial fibrillation and other conditions characterized by sympathetic nervous system overactivity.
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Affiliation(s)
- Paolo Verdecchia
- Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy.
| | - Claudio Cavallini
- Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Rocco Sclafani
- Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Andrea Santucci
- Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | | | - Gianluca Zingarini
- Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Giovanni Andrea Colombo
- Department of Medicine and Technological Innovation (DiMIT), University of Insubria, Varese and Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS, Tradate, Italy
| | - Fabio Angeli
- Department of Medicine and Technological Innovation (DiMIT), University of Insubria, Varese and Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS, Tradate, Italy
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Filippone EJ, Naccarelli GV, Foy AJ. Controversies in Hypertension IV: Renal Denervation. Am J Med 2023; 136:857-868. [PMID: 37230403 DOI: 10.1016/j.amjmed.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Abstract
Renal denervation is not a cure for hypertension. Although more recent sham-controlled trials were positive, a significant minority of patients in each trial were unresponsive. The optimal patient or patients need to be defined. Combined systolic/diastolic hypertension appears more responsive than isolated systolic hypertension. It remains uncertain whether patients with comorbidities associated with higher adrenergic tone should be targeted, including obesity, diabetes, sleep apnea, and chronic kidney disease. No biomarker can adequately predict response. A key to a successful response is the adequacy of denervation, which currently cannot be assessed in real time. It is uncertain what is the optimal denervation methodology: radiofrequency, ultrasound, or ethanol injection. Radiofrequency requires targeting the distal main renal artery plus major branches and accessory arteries. Although denervation appears to be safe, conclusive data on quality of life, improved target organ damage, and reduced cardiovascular events/mortality are required before denervation can be generally recommended.
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Affiliation(s)
- Edward J Filippone
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pa.
| | - Gerald V Naccarelli
- Department of Medicine, Penn State University Heart and Vascular Institute; Penn State M.S Hershey Medical Center and College of Medicine, Hershey, Pa
| | - Andrew J Foy
- Department of Medicine, Penn State University Heart and Vascular Institute; Penn State M.S Hershey Medical Center and College of Medicine, Hershey, Pa
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Manukyan M, Falkovskaya A, Mordovin V, Pekarskiy S, Zyubanova I, Solonskaya E, Ryabova T, Khunkhinova S, Vtorushina A, Popov S. Favorable effect of renal denervation on elevated renal vascular resistance in patients with resistant hypertension and type 2 diabetes mellitus. Front Cardiovasc Med 2022; 9:1010546. [PMID: 36601066 PMCID: PMC9806766 DOI: 10.3389/fcvm.2022.1010546] [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: 08/03/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To assess the effect of renal denervation (RDN) on renal vascular resistance and renal function in patients with drug-resistant hypertension (HTN) and type 2 diabetes mellitus (T2DM). Materials and methods Fifty-nine patients (mean age 60.3 ± 7.9 years, 25 men) with resistant HTN [mean 24-h ambulatory blood pressure (BP) 158.0 ± 16.3/82.5 ± 12.7 mmHg, systolic/diastolic] and T2DM (mean HbA1c 7.5 ± 1.5%) were included in the single-arm prospective study and underwent RDN. Renal resistive index (RRI) derived from ultrasound Doppler; estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration formula), office and 24-h ambulatory BP were measured at baseline, 6, and 12 months after RDN to evaluate the respective changes in renal vascular resistance, renal function, and BP during treatment. Results Forty-three patients completed 12 months follow-up. The RRI changed depending on the baseline value. Specifically, the RRI decreased significantly in patients with elevated baseline RRI values ≥ 0.7 {n = 23; -0.024 [95% confidence interval (CI): -0.046, -0.002], p = 0.035} and did not change in those with baseline RRI < 0.7 [n = 36; 0.024 (95% CI: -0.002, 0.050), p = 0.069]. No significant change was observed in eGFR whereas BP was significantly reduced at 12 months after RDN by -10.9 (95% CI: -16.7, -5.0)/-5.5 (95% CI: -8.7, -2.4) mmHg, systolic/diastolic. No relationship was found between the changes in RRI and BP. Conclusion Our study shows that RDN can decrease elevated renal vascular resistance (RRI > 0.7) and stabilize kidney function in patients with RHTN and T2DM independently of its BP-lowering effect.
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7
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Li S, Phillips JK. Patient Selection for Renal Denervation in Hypertensive Patients: What Makes a Good Candidate? Vasc Health Risk Manag 2022; 18:375-386. [PMID: 35592729 PMCID: PMC9113553 DOI: 10.2147/vhrm.s270182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/22/2022] [Indexed: 01/03/2023] Open
Affiliation(s)
- Sheran Li
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Correspondence: Sheran Li, Department of Emergency Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West Yanjiang Road, Yuexiu District, Guangzhou, Guangdong Province, 510120, People’s Republic of China, Tel +86 20 81332723, Fax +86 20 8133 2650, Email
| | - Jacqueline K Phillips
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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8
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Milošević M, Otašević P. Treatment-resistant hypertension. ARHIV ZA FARMACIJU 2022. [DOI: 10.5937/arhfarm72-34248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Treatment-resistant hypertension is one of the most significant causes of poor blood pressure regulation. Patients with resistant hypertension are at a higher risk of developing comorbidities compared to the general hypertensive population. As a result, these patients have an increased incidence of disability and premature death, as well as increased treatment costs. Due to the above-mentioned, in the last decade, there has been an increase in researchers' interest in elucidating the pathogenesis, diagnosis, and treatment of resistant hypertension. However, recent data indicate that 20% of female and 24% of male patients with arterial hypertension still have uncontrolled blood pressure, despite maximum doses of three antihypertensive drugs (including a diuretic) and appropriate lifestyle measures. New treatment modalities (i.e. devicebased interventions - catheter-based renal denervation and baroreceptor stimulation) offer hope for achieving adequate blood pressure regulation in these patients. In this paper, we have summarized previous knowledge about the mechanisms underlying the pathogenesis of resistant hypertension, as well as optimal diagnostic methods to differentiate true from pseudo-resistant hypertension. We have also given an overview of the current therapeutic approach, including optimal medical therapy and new treatment modalities (i.e. device-based interventions) and their role in the treatment of resistant hypertension.
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Kiuchi MG, Carnagarin R, Nolde JM, Lugo-Gavidia LM, Ward NC, Schlaich MP. Renal denervation as a management strategy for hypertension: current evidence and recommendations. Expert Rev Cardiovasc Ther 2021; 19:825-835. [PMID: 34353197 DOI: 10.1080/14779072.2021.1965878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The concept of targeting the renal sympathetic nerves therapeutically to lower blood pressure (BP) is based on their crucial role in regulating both renal and cardiovascular control. These effects are mainly mediated via three major mechanisms including alteration of renal blood flow, renin-release, and Na+ retention. Initial surgical approaches applying crude and unselected sympathectomy, while rendering significant BP lowering and cardiovascular event reducing properties, where plagued by side effects. More modern selective catheter-based denervation approaches selectively targeting the renal nerves have been shown to be safe and effective in reducing BP in various forms of hypertension and multiple comorbidities. AREAS COVERED This article covers the background relevant for the concept of renal denervation (RDN), the evidence obtained from relevant randomized controlled trials to substantiate the safety and efficacy of RDN, and recently published clinical recommendations. EXPERT OPINION Catheter-based RDN is safe and has now been shown in sham-controlled randomized clinical trials to result in clinically meaningful BP lowering in both drug naïve hypertensive patients and those on concomitant antihypertensive therapy. Real world data from a large global registry further supports the clinical utility of RDN. It now seems time to embed renal denervation into routine clinical care.
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Affiliation(s)
- Márcio Galindo Kiuchi
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit and RPH Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, the University of Western Australia, Perth, Western Australia, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit and RPH Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, the University of Western Australia, Perth, Western Australia, Australia
| | - Janis M Nolde
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit and RPH Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, the University of Western Australia, Perth, Western Australia, Australia
| | - Leslie Marisol Lugo-Gavidia
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit and RPH Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, the University of Western Australia, Perth, Western Australia, Australia
| | - Natalie C Ward
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit and RPH Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, the University of Western Australia, Perth, Western Australia, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit and RPH Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, the University of Western Australia, Perth, Western Australia, Australia.,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia
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10
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Chepurnoĭ AG, Shugushev ZK, Maksimkin DA. [Second chance for renal artery denervation]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:32-40. [PMID: 34166342 DOI: 10.33529/angio2021219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The article is a review of contemporary randomized studies on radiofrequency denervation of renal arteries, followed by critical assessment of their advantages and disadvantages for possible optimization of endovascular treatment of resistant arterial hypertension.
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Affiliation(s)
- A G Chepurnoĭ
- Cardiovascular Surgery Department, People's Friendship University of Russia, Moscow, Russia
| | - Z Kh Shugushev
- Cardiovascular Surgery Department, People's Friendship University of Russia, Moscow, Russia
| | - D A Maksimkin
- Cardiovascular Surgery Department, People's Friendship University of Russia, Moscow, Russia
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Abstract
In the past decade, efforts to improve blood pressure control have looked beyond conventional approaches of lifestyle modification and drug therapy to embrace interventional therapies. Based upon animal and human studies clearly demonstrating a key role for the sympathetic nervous system in the etiology of hypertension, the newer technologies that have emerged are predominantly aimed at neuromodulation of peripheral nervous system targets. These include renal denervation, baroreflex activation therapy, endovascular baroreflex amplification therapy, carotid body ablation, and pacemaker-mediated programmable hypertension control. Of these, renal denervation is the most mature, and with a recent series of proof-of-concept trials demonstrating the safety and efficacy of radiofrequency and more recently ultrasound-based renal denervation, this technology is poised to become available as a viable treatment option for hypertension in the foreseeable future. With regard to baroreflex activation therapy, endovascular baroreflex amplification, carotid body ablation, and programmable hypertension control, these are developing technologies for which more human data are required. Importantly, central nervous system control of the circulation remains a poorly understood yet vital component of the hypertension pathway and mandates further investigation. Technology to improve blood pressure control through deep brain stimulation of key cardiovascular control territories is, therefore, of interest. Furthermore, alternative nonsympathomodulatory intervention targeting the hemodynamics of the circulation may also be worth exploring for patients in whom sympathetic drive is less relevant to hypertension perpetuation. Herein, we review the aforementioned technologies with an emphasis on the preclinical data that underpin their rationale and the human evidence that supports their use.
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Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany (F.M.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology (MIT), Cambridge, MA (F.M.)
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, The University of Western Australia, Australia (M.S.)
- Departments of Cardiology (M.S.), Royal Perth Hospital, Australia
- Nephrology (M.S.), Royal Perth Hospital, Australia
- Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (M.S.)
| | - Melvin D Lobo
- William Harvey Research Institute and Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.D.L.)
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (M.D.L.)
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12
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Lee DP. Renal Denervation: History and Current Status. Interv Cardiol Clin 2020; 9:483-488. [PMID: 32921372 DOI: 10.1016/j.iccl.2020.07.004] [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] [Indexed: 06/11/2023]
Abstract
This review examines the early roots of renal denervation from its conceptualization and the creation of a percutaneous catheter system from a start-up company. As excitement began to grow with early animal experiments and human trials, renal denervation began to focus on the treatment of hypertension, culminating in a disappointing pivotal trial. Lessons learned from this trial are pushed forward, and renal denervation begins to gain clinical momentum as a new set of successful clinical trials emerge. The future for renal denervation eventually may extend beyond hypertension.
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Affiliation(s)
- David P Lee
- Stanford University Interventional Cardiology, Room H-2103, 300 Pasteur Drive, Stanford, CA 94305, USA.
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13
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Kandzari DE, Mahfoud F, Bhatt DL, Böhm M, Weber MA, Townsend RR, Hettrick DA, Schmieder RE, Tsioufis K, Kario K. Confounding Factors in Renal Denervation Trials: Revisiting Old and Identifying New Challenges in Trial Design of Device Therapies for Hypertension. Hypertension 2020; 76:1410-1417. [PMID: 32981360 DOI: 10.1161/hypertensionaha.120.15745] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent randomized sham-controlled trials have demonstrated significant blood pressure reductions following renal denervation (RDN) in patients with hypertension, both in the presence and absence of antihypertensive therapy. These new data encouraged us to revisit previously published insights into potential clinical trial confounding factors that informed the design and conduct of forthcoming trials. Initially identified confounders related to procedural technique, medication variability, and selected patient subgroups have been addressed in contemporary trial design. Regarding procedural method and technology, blood pressure reductions may be improved by ensuring circumferential lesion creation in the distal renal arteries and branch vessels. Safety of the RDN procedure has been demonstrated in multiple independent meta-analyses including thousands of treated patients with low reported rates of renal vessel complications and maintenance of renal function. However, a newer generation of RDN trials has also introduced insights related to medication adherence, patient selection, and the definition of treatment response. Evolving evidence indicates that RDN therapy may be considered in higher risk populations of uncontrolled hypertension regardless of ethnicity and in patients expressing a strong preference for a nondrug therapy option. Despite advances in procedural technique and clinical trial conduct, inconsistent antihypertensive-drug adherence behavior remains perhaps the most critical clinical trial design issue for device-based hypertension therapies. As the balance in clinical equipoise increasingly favors RDN, justification of sham-controlled trial designs will be revisited, and novel study designs may be required to evaluate the safety and efficacy of novel devices and procedures intended to address the escalating prevalence of poorly controlled hypertension.
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Affiliation(s)
- David E Kandzari
- From the Piedmont Heart Institute, Atlanta, GA (D.E.K.).,Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School (D.L.B.)
| | - Felix Mahfoud
- University Hospital of Saarland, Saarland University, Homburg, Germany (F.M., M.B.)
| | | | - Michael Böhm
- University Hospital of Saarland, Saarland University, Homburg, Germany (F.M., M.B.)
| | - Michael A Weber
- SUNY Downstate College of Medicine, Brooklyn, New York (M.A.W.)
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.)
| | | | | | - Konstantinos Tsioufis
- National and Kapodistrian University of Athens, Hippocration Hospital, Athens Medical Center, Greece (K.T.)
| | - Kazuomi Kario
- Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
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14
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Zaldivia MTK, Hering D, Marusic P, Sata Y, Lee R, Esler MD, Htun NM, Duval J, Hammond L, Flierl U, Wang X, Drummond GR, Walton A, Gardiner EE, Andrews RK, Schlaich MP, Peter K. Successful renal denervation decreases the platelet activation status in hypertensive patients. Cardiovasc Res 2020; 116:202-210. [PMID: 30715163 DOI: 10.1093/cvr/cvz033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/18/2018] [Accepted: 01/31/2019] [Indexed: 12/23/2022] Open
Abstract
AIMS To determine whether renal denervation (RDN) in hypertensive patients affects the platelet activation status. METHODS AND RESULTS We investigated the effect of RDN on the platelet activation status in 41 hypertensive patients undergoing RDN. Ambulatory blood pressure (BP), plasma sympathetic neurotransmitter Neuropeptide Y, and platelet activation markers were measured at baseline, at 3 months, and 6 months after RDN. RDN significantly decreased BP at 3 months (150.6 ± 11.3/80.9 ± 11.4 mmHg to 144.7 ± 12.0/77.1 ± 11.1 mmHg; P < 0.01) and at 6 months (144.3 ± 13.8/78.3 ± 11.1 mmHg; P < 0.01). Plasma levels of the sympathetic neurotransmitter Neuropeptide Y, an indicator of sympathetic nerve activity, were significantly decreased at 3 months (0.29 ± 0.11 ng/mL to 0.23 ± 0.11 ng/mL; P < 0.0001) and at 6 months (0.22 ± 0.12 ng/mL; P < 0.001) after RDN. This was associated with a reduction in platelet membrane P-selectin expression (3 months, P < 0.05; 6 months, P < 0.05), soluble P-selectin (6 months, P < 0.05), circulating numbers of platelet-derived extracellular vesicles (EVs) (3 months, P < 0.001; 6 months, P < 0.01), and phosphatidylserine expressing EVs (3 months, P < 0.001; 6 months, P < 0.0001), indicative of a reduction in platelet activation status and procoagulant activity. Only patients who responded to RDN with a BP reduction showed inhibition of P-selectin expression at 3 months (P < 0.05) and 6 months (P < 0.05) as well as reduction of glycoprotein IIb/IIIa activation at 3 months (P < 0.05). Notably, 13 patients who took aspirin did not show significant reduction in platelet P-selectin expression following RDN. CONCLUSION Our results imply a connection between the sympathetic nervous system and the platelet activation status and provide a potential mechanistic explanation by which RDN can have favourable effects towards reducing cardiovascular complications.
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Affiliation(s)
- Maria T K Zaldivia
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Dagmara Hering
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Petra Marusic
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Yusuke Sata
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Rebecca Lee
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Murray D Esler
- Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Nay M Htun
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Jacqueline Duval
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Louise Hammond
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Ulrike Flierl
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Xiaowei Wang
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Grant R Drummond
- Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Bundoora, Australia
| | - Antony Walton
- Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Elizabeth E Gardiner
- ACRF Department of Cancer Biology and Therapeutics, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Robert K Andrews
- Department of Medicine, Monash University, Melbourne, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Markus P Schlaich
- Department of Medicine, Monash University, Melbourne, Australia.,Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
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15
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Textor SC. Renal Denervation and International Registry Data: Where Are We Now? J Am Coll Cardiol 2020; 75:2889-2891. [PMID: 32527397 DOI: 10.1016/j.jacc.2020.04.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Stephen C Textor
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.
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16
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Sardar P, Bhatt DL, Kirtane AJ, Kennedy KF, Chatterjee S, Giri J, Soukas PA, White WB, Parikh SA, Aronow HD. Sham-Controlled Randomized Trials of Catheter-Based Renal Denervation in Patients With Hypertension. J Am Coll Cardiol 2020; 73:1633-1642. [PMID: 30947915 DOI: 10.1016/j.jacc.2018.12.082] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are conflicting data regarding the relative effectiveness of renal sympathetic denervation (RSD) in patients with hypertension. OBJECTIVES The purpose of this study was to evaluate the blood pressure (BP) response after RSD in sham-controlled randomized trials. METHODS Databases were searched through June 30, 2018. Randomized trials (RCTs) with ≥50 patients comparing catheter-based RSD with a sham control were included. The authors calculated summary treatment estimates as weighted mean differences (WMD) with 95% confidence intervals (CIs) using random-effects meta-analysis. RESULTS The analysis included 977 patients from 6 trials. The reduction in 24-h ambulatory systolic blood pressure (ASBP) was significantly greater for patients treated with RSD than sham procedure (WMD -3.65 mm Hg, 95% CI: -5.33 to -1.98; p < 0.001). Compared with sham, RSD was also associated with a significant decrease in daytime ASBP (WMD -4.07 mm Hg, 95% CI: -6.46 to -1.68; p < 0.001), office systolic BP (WMD -5.53 mm Hg, 95% CI: -8.18 to -2.87; p < 0.001), 24-h ambulatory diastolic BP (WMD -1.71 mm Hg, 95% CI: -3.06 to -0.35; p = 0.01), daytime ambulatory diastolic BP (WMD -1.57 mm Hg, 95% CI: -2.73 to -0.42; p = 0.008), and office diastolic BP (WMD -3.37 mm Hg, 95% CI: -4.86 to -1.88; p < 0.001). Compared with first-generation trials, a significantly greater reduction in daytime ASBP was observed with RSD in second-generation trials (6.12 mm Hg vs. 2.14 mm Hg; p interaction = 0.04); however, this interaction was not significant for 24-h ASBP (4.85 mm Hg vs. 2.23 mm Hg; p interaction = 0.13). CONCLUSIONS RSD significantly reduced blood pressure compared with sham control. Results of this meta-analysis should inform the design of larger, pivotal trials to evaluate the long-term efficacy and safety of RSD in patients with hypertension.
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Affiliation(s)
- Partha Sardar
- Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
| | - Kevin F Kennedy
- Mid America Heart and Vascular Institute, St. Luke's Hospital, Kansas City, Missouri
| | - Saurav Chatterjee
- Department of Cardiology, Saint Francis Hospital, Teaching Affiliate, University of Connecticut School of Medicine, Hartford, Connecticut
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter A Soukas
- Division of Cardiology, The Miriam Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - William B White
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Sahil A Parikh
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
| | - Herbert D Aronow
- Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island.
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17
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Kiuchi MG, Ho JK, Lugo Gavidia LM, Schlaich MP. Shaping the future of renal denervation-the relevance of sham-controlled randomized trials and recent meta-analyses. Cardiovasc Diagn Ther 2020; 9:601-606. [PMID: 32038950 DOI: 10.21037/cdt.2019.07.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Márcio G Kiuchi
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, Australia
| | - Jan K Ho
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, Australia
| | - Leslie Marisol Lugo Gavidia
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia.,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
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18
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Renal Artery Denervation in Resistant Hypertension: The Good, The Bad and The Future. Heart Lung Circ 2020; 29:94-101. [DOI: 10.1016/j.hlc.2019.06.723] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/04/2019] [Accepted: 06/24/2019] [Indexed: 02/05/2023]
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19
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Abstract
ZusammenfassungErhöhter Blutdruck bleibt eine Hauptursache von kardiovaskulären Erkrankungen, Behinderung und frühzeitiger Sterblichkeit in Österreich, wobei die Raten an Diagnose, Behandlung und Kontrolle auch in rezenten Studien suboptimal sind. Das Management von Bluthochdruck ist eine häufige Herausforderung für Ärztinnen und Ärzte vieler Fachrichtungen. In einem Versuch, diagnostische und therapeutische Strategien zu standardisieren und letztendlich die Rate an gut kontrollierten Hypertoniker/innen zu erhöhen und dadurch kardiovaskuläre Erkrankungen zu verhindern, haben 13 österreichische medizinische Fachgesellschaften die vorhandene Evidenz zur Prävention, Diagnose, Abklärung, Therapie und Konsequenzen erhöhten Blutdrucks gesichtet. Das hier vorgestellte Ergebnis ist der erste Österreichische Blutdruckkonsens. Die Autoren und die beteiligten Fachgesellschaften sind davon überzeugt, daß es einer gemeinsamen nationalen Anstrengung bedarf, die Blutdruck-assoziierte Morbidität und Mortalität in unserem Land zu verringern.
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20
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Procedural and anatomical predictors of renal denervation efficacy using two radiofrequency renal denervation catheters in a porcine model. J Hypertens 2019; 36:2453-2459. [PMID: 30005030 PMCID: PMC6221386 DOI: 10.1097/hjh.0000000000001840] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Several renal denervation (RDN) systems are currently under investigation for treatment of hypertension by ablation of renal sympathetic nerves. The procedural efficacy of devices, however, is variable and incompletely understood. This study aimed at investigating procedural and anatomical predictors of RDN efficacy by comparing two radiofrequency catheter systems in a porcine model. Methods: Domestic swine were assigned into two treatment groups (n = 10) and one sham group (n = 3). Bilateral RDN in main and in branch segments of renal arteries was performed using two different multielectrode catheter systems [Symplicity Spyral (SPY) and IberisBloom (IBB)]. After 7 days, measurement of norepinephrine (NEPI) tissue concentrations and histological analyses have been performed. Results: Renal NEPI tissue concentration following RDN was significantly reduced when compared with Sham (SPY: −95 ± 3% vs. Sham, P < 0.001; IBB: −88 ± 11% vs. Sham, P < 0.001). Histological evaluation showed comparable lesion depth and lesion area (lesion depth: SPY-main 6.26 ± 1.62 mm vs. SPY-branch 3.49 ± 1.11 mm; IBB-main 5.93 ± 1.88 mm vs. IBB-branch: 3.26 ± 1.26 mm, P < 0.001; lesion area: SPY-main 43.5 ± 29.5 mm2 vs. SYP-branch 45.0 ± 38.0 mm2; IBB-main 52.3 ± 34.8 mm2 vs. IBB-branch 44.0 ± 42.6 mm2, P = 0.77; intergroup SPY vs. IBB, P = 0.73). Histological investigations documented a significant correlation between number of ablations per millimeter length of renal artery and reduction in NEPI tissue concentration. Conclusion: The two devices under investigation demonstrated similar histopathological lesion characteristics and similar reduction of renal NEPI levels. An increase in number of ablations per millmeter length of renal artery resulted in improved efficacy and reduced variability in treatment effects.
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21
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Ambulatory arterial stiffness index as a predictor of blood pressure response to renal denervation. J Hypertens 2019; 36:1414-1422. [PMID: 29465712 DOI: 10.1097/hjh.0000000000001682] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Renal denervation (RDN) can reduce blood pressure (BP) in patients with resistant hypertension, but less so in patients with isolated systolic hypertension. A possible explanation is that patients with stiffer arteries may have lesser neural contribution to their hypertension. METHOD We hypothesized that arterial stiffness predicts the response to RDN. From ambulatory BP monitoring (ABPM), ambulatory arterial stiffness index (AASI) was calculated as 1 - the regression slope of DBP versus SBP. RESULTS In 111 patients with resistant hypertension, RDN reduced office and 24-h SBP after 3, 6, and 12 months (by -11 ± 22, -11 ± 25, -14 ± 21 mmHg for office, and -4 ± 11, -5 ± 12, -5 ± 15 mmHg for 24-h SBP, respectively, P < 0.01). Patients with baseline AASI above the median (>0.51) showed no change in 24-h SBP at 6 months after RDN (-0.4 ± 12.3 mmHg, P > 0.05), whereas an AASI below 0.51was associated with a marked reduction (-9.3 ± 11.0 mmHg, P < 0.01). Across AASI quartiles, patients in the highest quartile (AASI ≥ 0.60) had lower muscle sympathetic nerve activity than the other three quartiles (39 ± 13 versus 49 ± 13 bursts/min, P = 0.035). The responder rate, defined as a 24-h SBP reduction of at least 5% was 58% in the lowest AASI quartile (<0.45) and 16% in the highest quartile (≥0.60). After adjustment for age, sex, BMI, office and 24-h SBP, an AASI less than 0.51predicted those who respond to RDN (odds ratio 3.46, P = 0.04). CONCLUSION We conclude that in patients with resistant hypertension, a lower AASI is an independent predictor of the BP response to RDN, possibly explained by a more pronounced neurogenic rather than biomechanical contribution to their BP elevation.
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22
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Long-term effects of baroreflex activation therapy: 2-year follow-up data of the BAT Neo system. Clin Res Cardiol 2019; 109:513-522. [DOI: 10.1007/s00392-019-01536-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/01/2019] [Indexed: 12/24/2022]
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23
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Doumas M, Papademetriou V, Tsioufis C. Renal Sympathetic Denervation in Isolated Systolic Hypertension. Hypertension 2019; 74:255-256. [DOI: 10.1161/hypertensionaha.119.13168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Doumas
- From the Second Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece (M.D.)
| | | | - Costas Tsioufis
- First Cardiology Department, National and Kapodestrian University of Athens, Greece (C.T.)
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24
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Fengler K, Rommel KP, Lapusca R, Blazek S, Besler C, Hartung P, von Roeder M, Kresoja KP, Desch S, Thiele H, Lurz P. Renal Denervation in Isolated Systolic Hypertension Using Different Catheter Techniques and Technologies. Hypertension 2019; 74:341-348. [PMID: 31203726 DOI: 10.1161/hypertensionaha.119.13019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with isolated systolic hypertension (ISH) are thought to show a diminished blood pressure (BP)-lowering effect after renal sympathetic denervation (RDN). This conclusion is mostly derived from unipolar radiofrequency catheter ablation studies. Limited data for newer RDN technologies exist. We used data from the RADIOSOUND-HTN (Three-Arm Randomized Trial of Different Renal Denervation Devices and Techniques in Patients With Resistant Hypertension) comparing 3 different RDN approaches to investigate a possible interaction between ISH and RDN response. One hundred twenty patients were stratified by having ISH or combined systolic-diastolic hypertension (CH). Of these, 39 underwent radiofrequency ablation of the renal main arteries, 39 combined radiofrequency ablation of the main and branch arteries, and 42 were treated with ultrasound-based ablation of the main renal artery. Patients with ISH (n=61) were older and had lower systolic and diastolic BP on ambulatory measurement (ambulatory BP measurement) at baseline in comparison to CH (n=59). At 3 months, patients with ISH showed a less pronounced BP-lowering effect of RDN as compared to patients with CH (daytime average -5.9±11.8 versus -13.3±11.7 mm Hg, P=0.001). This difference was significant for radiofrequency ablation of the renal main arteries and ultrasound-based ablation of the main renal artery treatment but did not reach significance in the radiofrequency ablation of the main and branch arteries group. After adjustment for baseline BP values and age, there was no significant difference in BP reduction between ISH and CH. Using unadjusted BP values, RDN seems to be more effective in CH than in ISH. However, adjusting for baseline BP values revealed similar BP reduction in ISH and CH patients, irrespective of the RDN treatment used. The value of ISH as predictor for successful RDN might have been overestimated in the past. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02920034.
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Affiliation(s)
- Karl Fengler
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Karl-Philipp Rommel
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Razvan Lapusca
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Stephan Blazek
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Christian Besler
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Philipp Hartung
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Maximilian von Roeder
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Karl-Patrik Kresoja
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Steffen Desch
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Holger Thiele
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Philipp Lurz
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
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25
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Phase II randomized sham-controlled study of renal denervation for individuals with uncontrolled hypertension - WAVE IV. J Hypertens 2019; 36:680-689. [PMID: 29035942 DOI: 10.1097/hjh.0000000000001584] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this double-blind, randomized, sham-controlled study was to verify the blood pressure (BP)-lowering efficacy of externally delivered focused ultrasound for renal denervation (RDN). BACKGROUND Nonrandomized, first proof-of-concept study and experimental evidence suggested that noninvasive techniques of RDN emerged as an alternative approach of RDN to invasive technologies. METHODS WAVE IV, an international, randomized (1 : 1) sham-controlled, double-blind prospective clinical study, was prematurely stopped. Patients were enrolled if office BP was at least 160 mmHg and 24-h ambulatory BP was at least 135 mmHg, while taking three or more antihypertensive medications. The treatment consisted of bilateral RDN using therapeutic levels of ultrasound energy and the sham consisted of bilateral application of diagnostic levels of ultrasound energy. RESULTS In the 81 treated patients neither changes in office BP at 12 and 24 weeks, nor changes in 24-h ambulatory BP at 24-week follow-up visit differed between the two groups significantly. Of note, no safety signal was observed. Adherence analysis disclosed full adherence in 77% at baseline and 82% at 6 months' follow-up visit. Post hoc analysis revealed that stricter criteria for stabilization of BP at baseline were associated with a numerically greater change in 24-h ambulatory BP in the RDN group than in the sham group. CONCLUSION Our data did not prove that antihypertensive efficacy of the externally delivered focused ultrasound for RDN was greater than the sham effect. Stabilization of BP at baseline was identified as an important determinant of BP changes.
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26
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Blood pressure response to renal denervation is correlated with baseline blood pressure variability: a patient-level meta-analysis. J Hypertens 2019; 36:221-229. [PMID: 29045339 DOI: 10.1097/hjh.0000000000001582] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sympathetic tone is one of the main determinants of blood pressure (BP) variability and treatment-resistant hypertension. The aim of our study was to assess changes in BP variability after renal denervation (RDN). In addition, on an exploratory basis, we investigated whether baseline BP variability predicted the BP changes after RDN. METHODS We analyzed 24-h BP recordings obtained at baseline and 6 months after RDN in 167 treatment-resistant hypertension patients (40% women; age, 56.7 years; mean 24-h BP, 152/90 mmHg) recruited at 11 expert centers. BP variability was assessed by weighted SD [SD over time weighted for the time interval between consecutive readings (SDiw)], average real variability (ARV), coefficient of variation, and variability independent of the mean (VIM). RESULTS Mean office and 24-h BP fell by 15.4/6.6 and 5.5/3.7 mmHg, respectively (P < 0.001). In multivariable-adjusted analyses, systolic/diastolic SDiw and VIM for 24-h SBP/DBP decreased by 1.18/0.63 mmHg (P ≤ 0.01) and 0.86/0.42 mmHg (P ≤ 0.05), respectively, whereas no significant changes in ARV or coefficient of variation occurred. Furthermore, baseline SDiw (P = 0.0006), ARV (P = 0.01), and VIM (P = 0.04) predicted the decrease in 24-h DBP but not 24-h SBP after RDN. CONCLUSION RDN was associated with a decrease in BP variability independent of the BP level, suggesting that responders may derive benefits from the reduction in BP variability as well. Furthermore, baseline DBP variability estimates significantly correlated with mean DBP decrease after RDN. If confirmed in younger patients with less arterial damage, in the absence of the confounding effect of drugs and drug adherence, baseline BP variability may prove a good predictor of BP response to RDN.
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27
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Esler M. Does increased 24-h ambulatory heart rate identify de facto neurogenic hypertension, and facilitate selection of hypertensive patients for renal denervation? Eur Heart J 2019; 40:752-754. [PMID: 30753399 DOI: 10.1093/eurheartj/ehz027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Murray Esler
- Baker Heart and Diabetes Institute, Melbourne, Australia
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28
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Effects of renal denervation on blood pressure in hypertensive patients with end-stage renal disease: a single centre experience. Clin Exp Nephrol 2019; 23:749-755. [DOI: 10.1007/s10157-019-01697-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/17/2019] [Indexed: 11/27/2022]
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29
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Heradien MJ, Bijl PVD, Brink PA. Renal Denervation in High-risk Patients with Hypertension. Heart Int 2019; 13:12-16. [DOI: 10.17925/hi.2019.13.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/23/2019] [Indexed: 11/24/2022] Open
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30
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Al Raisi SI, Pouliopoulos J, Qian P, King P, Byth K, Barry MT, Swinnen J, Thiagalingam A, Kovoor P. Comparison of two different radiofrequency ablation systems for renal artery denervation: Evaluation of short-term and long-term follow up. Catheter Cardiovasc Interv 2018; 93:E105-E111. [PMID: 30549404 PMCID: PMC6590350 DOI: 10.1002/ccd.28038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 11/06/2018] [Accepted: 12/02/2018] [Indexed: 12/05/2022]
Abstract
Objectives To assess the clinical efficacy of renal artery denervation (RAD) in our center and to compare the efficacy of two different radiofrequency (RF) systems. Background Several systems are available for RF renal denervation. Whether there is a difference in clinical efficacy among various systems remains unknown. Methods Renal artery denervation was performed on 43 patients with resistant hypertension using either the single electrode Symplicity Flex (n = 20) or the multi‐electrode EnligHTN system (n = 23). Median post‐procedural follow‐up was 32.93 months. The primary outcome was post‐procedural change in office blood pressure (BP) within 1 year (short‐term follow‐up). Secondary outcomes were change in office BP between 1 and 4 years (long‐term follow‐up) and the difference in office BP reduction between the two systems at each follow‐up period. Results For the total cohort, mean baseline office BP (systolic/diastolic) was 174/94 mmHg. At follow‐up, mean changes in office BP from baseline were −19.70/−11.86 mmHg (P < 0.001) and −21.90/−13.94 mmHg (P < 0.001) for short‐term and long‐term follow‐up, respectively. The differences in office BP reduction between Symplicity and EnligHTN groups were 8.96/1.23 mmHg (P = 0.42 for systolic BP, P = 0.83 for diastolic BP) and 9.56/7.68 mmHg (P = 0.14 for systolic BP, P = 0.07 for diastolic BP) for short‐term and long‐term follow‐up, respectively. Conclusions In our cohort, there was a clinically significant office BP reduction after RAD, which persisted up to 4 years. No significant difference in office BP reduction between the two systems was found.
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Affiliation(s)
- Sara I Al Raisi
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jim Pouliopoulos
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Pierre Qian
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Patricia King
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Karen Byth
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Research and Educational Network, Westmead Hospital, Sydney, New South Wales, Australia
| | - Michael T Barry
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - John Swinnen
- Department of Vascular Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Aravinda Thiagalingam
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Reshetnik A, Gohlisch C, Scheurig-Münkler C, De Bucourt M, Zidek W, Tölle M, van der Giet M. Predictors for success in renal denervation-a single centre retrospective analysis. Sci Rep 2018; 8:15505. [PMID: 30341333 PMCID: PMC6195578 DOI: 10.1038/s41598-018-33783-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/07/2018] [Indexed: 12/23/2022] Open
Abstract
Renal denervation (RDN) is one of the most frequently used invasive methods for the treatment of arterial hypertension. However, recent randomized sham-controlled studies raised concern about the efficacy and predictability of response. We retrospectively analyzed outcomes of patients, who underwent RDN in our hypertension center between November 2010 and April 2014 and report here outcomes twelve months after procedure based on 24-hours ambulatory blood pressure monitoring. We defined ten-mm Hg decrease in office systolic blood pressure (SBP) as a cut-off for response and looked for possible predictors of this response using binary multiple regression analysis. 42 patients were included. Their mean age was 59.6 ± 9.2 years and 24% were female. Baseline office SBP and diastolic blood pressure (DBP) were 164.1 ± 20.3 and 91.8 ± 12.4 mm Hg respectively. Mean 24 h-SBP significantly decreased from 149.8 ± 13.3 mm Hg to 141.2 ± 14.6 mm Hg. Mean 24 h-DBP significantly decreased from 83.3 ± 11.7 mm Hg to 78.8 ± 11.2 mm Hg. A higher level of mean 24 h-DBP and office DBP was shown to be predictive for response in office BP and a higher level of mean 24 h-DBP for response in 24 h-SBP and 24 h-DBP. Further properly designed randomized trials are warranted to confirm this finding as well as further investigate the role of diabetes mellitus and arterial stiffness in RDN.
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Affiliation(s)
- Alexander Reshetnik
- Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Department of Nephrology, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Christopher Gohlisch
- Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Department of Nephrology, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Scheurig-Münkler
- Department for Diagnostic and Interventional Radiology and Neuroradiology, Universitaetsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Maximilian De Bucourt
- Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Department of Radiology, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Walter Zidek
- Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Department of Nephrology, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Markus Tölle
- Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Department of Nephrology, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Markus van der Giet
- Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Department of Nephrology, Hindenburgdamm 30, 12203, Berlin, Germany
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2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36:1953-2041. [PMID: 30234752 DOI: 10.1097/hjh.0000000000001940] [Citation(s) in RCA: 1808] [Impact Index Per Article: 301.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Document reviewers: Guy De Backer (ESC Review Co-ordinator) (Belgium), Anthony M. Heagerty (ESH Review Co-ordinator) (UK), Stefan Agewall (Norway), Murielle Bochud (Switzerland), Claudio Borghi (Italy), Pierre Boutouyrie (France), Jana Brguljan (Slovenia), Héctor Bueno (Spain), Enrico G. Caiani (Italy), Bo Carlberg (Sweden), Neil Chapman (UK), Renata Cifkova (Czech Republic), John G. F. Cleland (UK), Jean-Philippe Collet (France), Ioan Mircea Coman (Romania), Peter W. de Leeuw (The Netherlands), Victoria Delgado (The Netherlands), Paul Dendale (Belgium), Hans-Christoph Diener (Germany), Maria Dorobantu (Romania), Robert Fagard (Belgium), Csaba Farsang (Hungary), Marc Ferrini (France), Ian M. Graham (Ireland), Guido Grassi (Italy), Hermann Haller (Germany), F. D. Richard Hobbs (UK), Bojan Jelakovic (Croatia), Catriona Jennings (UK), Hugo A. Katus (Germany), Abraham A. Kroon (The Netherlands), Christophe Leclercq (France), Dragan Lovic (Serbia), Empar Lurbe (Spain), Athanasios J. Manolis (Greece), Theresa A. McDonagh (UK), Franz Messerli (Switzerland), Maria Lorenza Muiesan (Italy), Uwe Nixdorff (Germany), Michael Hecht Olsen (Denmark), Gianfranco Parati (Italy), Joep Perk (Sweden), Massimo Francesco Piepoli (Italy), Jorge Polonia (Portugal), Piotr Ponikowski (Poland), Dimitrios J. Richter (Greece), Stefano F. Rimoldi (Switzerland), Marco Roffi (Switzerland), Naveed Sattar (UK), Petar M. Seferovic (Serbia), Iain A. Simpson (UK), Miguel Sousa-Uva (Portugal), Alice V. Stanton (Ireland), Philippe van de Borne (Belgium), Panos Vardas (Greece), Massimo Volpe (Italy), Sven Wassmann (Germany), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain).The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines.
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Voora R, Hinderliter AL. Modulation of Sympathetic Overactivity to Treat Resistant Hypertension. Curr Hypertens Rep 2018; 20:92. [PMID: 30194545 DOI: 10.1007/s11906-018-0893-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To review the role and evidence for sympathetic overactivity in resistant hypertension and review the therapies that have been studied to modulate the sympathetic nervous system to treat resistant hypertension, with a focus on non-pharmacologic therapies such as renal denervation, baroreflex activation therapy, and carotid body ablation. RECENT FINDINGS Based on the two best current techniques available for assessing sympathetic nerve activity, resistant hypertension is characterized by increased sympathetic nerve activity. Several device therapies, including renal denervation baroreflex activation therapy and carotid body ablation, have been developed as non-pharmacologic means of reducing blood pressure in resistant hypertension. With respect to renal denervation, the technologies for renal denervation have evolved since the unfavorable results from the HTN-3 study, and the revised technologies are being actively studied. Data from the first phase of the SPYRAL HTN Clinical Trial Program have been published. Results from the SPYRAL HTN-OFF MED trial suggest that ablating renal nerves can reduce blood pressure in patients with untreated mild-to-moderate hypertension. The SPYRAL HTN-ON MED trial demonstrated the safety and efficacy of catheter-based renal denervation in patients with uncontrolled hypertension on antihypertensive treatment. Interestingly, there was a high rate of medication non-adherence among patients with hypertension in this study. One attractive alternative to radiofrequency ablation is the use of ultrasound for renal denervation. Proof of concept data for the Paradise endovascular ultrasound renal denervation system was recently published in the RADIANCE-HTN SOLO trial. The results of this trial indicate that, among patients with mild to moderate hypertension on no medications, renal denervation with the Paradise system results in a greater reduction in both SBP and DBP at 2months compared with a sham procedure. Overall reductions were similar in magnitude to those noted in the SPYRAL HTN-OFF MED study. With respect to carotid body ablation, there is an ongoing proof of concept study that is investigating the safety and feasibility of ultrasound-based endovascular carotid body ablation in 30 subjects with treatment-resistant hypertension outside of the USA. The sympathetic nervous system is an important contributor to resistant hypertension. Modulation of sympathetic overactivity should be an important goal of treatment. Innovative therapies using non-pharmacologic means to suppress the sympathetic nervous system are actively being studied to treat resistant hypertension.
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Affiliation(s)
- Raven Voora
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Alan L Hinderliter
- Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, NC, 27599, USA
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Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021-3104. [PMID: 30165516 DOI: 10.1093/eurheartj/ehy339] [Citation(s) in RCA: 5640] [Impact Index Per Article: 940.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Selejan SR, Linz D, Tatu AM, Hohl M, Speer T, Ewen S, Mahfoud F, Kindermann I, Zamyatkin O, Kazakov A, Laufs U, Böhm M. Sympathoadrenergic suppression improves heart function by upregulating the ratio of sRAGE/RAGE in hypertension with metabolic syndrome. J Mol Cell Cardiol 2018; 122:34-46. [PMID: 30096408 DOI: 10.1016/j.yjmcc.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 07/16/2018] [Accepted: 08/05/2018] [Indexed: 11/16/2022]
Abstract
Receptors-for-Advanced-Glycation-End-products (RAGE) activate pro-inflammatory programs mediated by carboxymethyllysine (CML) and high-mobility-group-box1 protein (HMGB1). The soluble isoform sRAGE neutralizes RAGE-ligands preventing cardiovascular complications in conditions associated with increased sympathetic activation like hypertension and diabetes. The effects of sympathetic modulation on RAGE/sRAGE-balance and end-organ damage in metabolic syndrome on top of hypertension remains unknown. We hypothesized that increased sympathoadrenergic activity might lead to an unfavourable RAGE/sRAGE regulation. Renal denervation (RDN) was used to modulate sympathetic activation in obese spontaneously hypertensive rats (SHRobRDN) versus sham-operated obese spontaneously hypertensive rats (SHRob), their hypertensive lean controls (SHR) and non-hypertensive controls. Cardiac fibrosis was assessed by histological analysis and sRAGE/RAGE and ligand levels by Western blotting. Levels of CML and HMGB1 were highest in SHRob and were significantly lowered by RDN in serum (-44% and -45%) and myocardium (-25% and -52%). Myocardial RAGE was increased in SHR (+72% versus controls) and in SHRob (+68% versus SHR) while sRAGE decreased (-50% in SHR versus controls and -51% in SHRob versus SHR). RDN reduced myocardial RAGE expression. (-20%) and increased sRAGE levels in heart (+80%) and serum (+180%) versus sham-operated SHRob. Myocardial fibrosis correlated inversely with myocardial sRAGE content (r = -0.79; p = .004; n = 10). Myocardial sRAGE shedding active A-Disintegrin-And-Metalloprotease-10 (ADAM-10) was decreased in SHR (-33% versus controls) and in SHRob (-54% versus SHR), and was restored after RDN (+129% versus SHRob). Serum ADAM-10 activity was also decreased in SHRob (-66% versus SHR) and restored after RDN (+150% versus SHRob). In vitro, isoproterenol induced a ß1-adrenergic receptor mediated increase of RAGE expression in splenocytes (+200%) and decreased sRAGE secretion of splenocytes and cardiac fibroblasts (-50% and -49%) by ß2-adrenergic receptor stimulation mediated suppression of ADAM-10 activity. In conclusion, sympathetic activity affects sRAGE/RAGE-balance, which can be suppressed through sympathetic modulation by RDN, preventing RAGE-induced cardiac damage in hypertension with metabolic syndrome.
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Affiliation(s)
- Simina-Ramona Selejan
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universität des Saarlandes, Homburg, Saar, Germany.
| | - Dominik Linz
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universität des Saarlandes, Homburg, Saar, Germany
| | - Anna-Maria Tatu
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universität des Saarlandes, Homburg, Saar, Germany
| | - Mathias Hohl
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universität des Saarlandes, Homburg, Saar, Germany
| | - Thimoteus Speer
- Klinik für Innere Medizin IV (Nieren- und Hochdruckkrankheiten), Universität des Saarlandes, Homburg, Saar, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universität des Saarlandes, Homburg, Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universität des Saarlandes, Homburg, Saar, Germany
| | - Ingrid Kindermann
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universität des Saarlandes, Homburg, Saar, Germany
| | - Olesja Zamyatkin
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universität des Saarlandes, Homburg, Saar, Germany
| | - Andrey Kazakov
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universität des Saarlandes, Homburg, Saar, Germany
| | - Ulrich Laufs
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universität des Saarlandes, Homburg, Saar, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universität des Saarlandes, Homburg, Saar, Germany
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Ewen S, Lauder L, Azizi M, Kandzari DE, Pathak A, Sharif F, Wijns W, Mahfoud F, Lüscher TF. Will SPYRAL HTN-ON MED change my practice? SPYRAL HTN-ON MED: a prospective, randomised, sham-controlled trial on renal denervation in the presence of antihypertensive medications. EUROINTERVENTION 2018; 14:e598-e602. [DOI: 10.4244/eijy18m07_1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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First-in-Man Experience with a Novel Catheter-Based Renal Denervation System of Ultrasonic Ablation in Patients with Resistant Hypertension. J Vasc Interv Radiol 2018; 29:1158-1166. [DOI: 10.1016/j.jvir.2018.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 11/21/2022] Open
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Hypertension: history and development of established and novel treatments. Clin Res Cardiol 2018; 107:16-29. [DOI: 10.1007/s00392-018-1299-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/11/2018] [Indexed: 01/08/2023]
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Mahfoud F, Bakris G, Bhatt DL, Esler M, Ewen S, Fahy M, Kandzari D, Kario K, Mancia G, Weber M, Böhm M. Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry. Eur Heart J 2018; 38:93-100. [PMID: 28158510 PMCID: PMC5381589 DOI: 10.1093/eurheartj/ehw325] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/27/2016] [Accepted: 06/29/2016] [Indexed: 12/26/2022] Open
Abstract
Aims Catheter-based renal artery denervation (RDN) has been shown to lower blood pressure (BP) in certain patients with uncontrolled hypertension. Isolated systolic hypertension (ISH) (systolic BP [SBP] ≥140 mmHg and diastolic BP <90 mmHg), characterized by increased vascular stiffness, is the predominant hypertensive phenotype in elderly patients. This study compared baseline characteristics and SBP change at 6 months between patients with ISH and combined systolic–diastolic hypertension (CH). Methods and results This study pooled data from 1103 patients from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry. A total of 429 patients had ISH, and 674 had CH. Patients with ISH were significantly older than those with CH (66 vs. 55 years), had more type 2 diabetes mellitus (52.9 vs. 34.6%), and a lower estimated glomerular filtration rate (71.8 vs. 78.6 mL/min/1.73 m2); all P < 0.001. At 6 months, the SBP drop for CH patients was −18.7 ± 23.7 mmHg compared with a reduction of −10.9 ± 21.7 mmHg for ISH patients −7.8 mmHg, 95% confidence interval, CI, −10.5, −5.1, P < 0.001). The change in 24-h SBP at 6 months was −8.8 ± 16.2 mmHg in patients with CH vs. −5.8 ± 15.4 mmHg in ISH (−3.0 mmHg, 95% CI −5.4, −0.6, P = 0.015). Presence of ISH at baseline but not age was associated with less pronounced BP changes following the procedure. The strongest predictor of office SBP reduction at 6 months was CH, followed by aldosterone antagonist use and non-use of vasodilators. Conclusion The reduction in BP among patients with ISH following RDN was less pronounced than the reduction in patients with CH. Clinical.Trials.gov identifiers NCT01534299 and NCT01418261.
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Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Kirrberger Str., Geb. 40, Homburg/Saar 66421, Germany
- Corresponding author. Tel: +49 6841 16 15911, Fax: +49 6841 16 15910,
| | | | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Murray Esler
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Kirrberger Str., Geb. 40, Homburg/Saar 66421, Germany
| | | | | | - Kazuomi Kario
- Jichi Medical University School of Medicine, Tochigi, Japan
| | - Giuseppe Mancia
- University of Milano-Bicocca and Istituto Auxologico Italiano, Milan, Italy
| | | | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Kirrberger Str., Geb. 40, Homburg/Saar 66421, Germany
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Sata Y, Head GA, Esler MD, Schlaich MP. Reply. J Hypertens 2018; 36:1606-1607. [PMID: 29847455 DOI: 10.1097/hjh.0000000000001765] [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]
Affiliation(s)
- Yusuke Sata
- Neurovascular Hypertension and Kidney Disease Laboratory.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria
| | - Geoffrey A Head
- Neuropharmacology Laboratory, Baker Heart and Diabetes Institute
| | - Murray D Esler
- Neurovascular Hypertension and Kidney Disease Laboratory.,Department of Cardiovascular Medicine, Alfred Hospital
| | - Markus P Schlaich
- Neurovascular Hypertension and Kidney Disease Laboratory.,Department of Cardiovascular Medicine, Alfred Hospital.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria.,Royal Perth Hospital Unit, Dobney Hypertension Centre, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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41
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Ambulatory arterial stiffness index: a (too) easy predictor for renal denervation success? J Hypertens 2018; 36:1604-1605. [PMID: 29847454 DOI: 10.1097/hjh.0000000000001764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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Cardiac magnetic resonance assessment of central and peripheral vascular function in patients undergoing renal sympathetic denervation as predictor for blood pressure response. Clin Res Cardiol 2018; 107:945-955. [DOI: 10.1007/s00392-018-1267-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
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43
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Ambulatory arterial stiffness index and blood pressure response to renal denervation. J Hypertens 2018; 36:1272-1275. [PMID: 29697480 DOI: 10.1097/hjh.0000000000001714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morganti A, Mancia G. Resistant hypertension: Renal denervation or intensified medical treatment? Eur J Intern Med 2018; 50:6-11. [PMID: 29287767 DOI: 10.1016/j.ejim.2017.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 12/27/2022]
Abstract
Resistant hypertension (RH) can be diagnosed if blood pressure (BP) is not controlled with the combination of three antihypertensive drugs, including a diuretic, all at effective doses. Patients affected by this condition exhibit a marked increase in the risk of cardiovascular and renal morbid and fatal events. They also exhibit an increased activity of the sympathetic nervous system which is likely to importantly contribute at the renal and other vascular levels to the hypertensive state. Almost 10years ago renal denervation (RDN) by radiofrequency thermal energy delivery to the walls of the renal arteries was proposed for the treatment of RH. Several uncontrolled studies initially reported that this procedure substantially reduced the elevated BP values but this conclusion has not been supported by a recent randomized control trial, which has almost marginalized this therapeutic approach. A revival, however, is under way because of recent positive findings and technical improvement that hold promise to make renal denervation more complete. The antihypertensive efficacy and overall validity of RDN will have to be tested against drug treatment of RH. Several studies indicate that an excess of aldosterone production contributes to RH and recent evidence documents indisputably that anti-aldosterone agents such as spironolactone can effectively control BP in many RH patients, although with some side effects that require close patients' monitoring. At present, it is advisable to treat RH with the addition of an anti-aldosterone agent. If BP control is not achieved or serious side effects become manifest RDN may then be considered.
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Affiliation(s)
- Alberto Morganti
- Centro Fisiologia Clinica e Ipertensione, Ospedale Policlinico, Università Milano, Milan, Italy
| | - Giuseppe Mancia
- Università degli Studi di Milano-Bicocca, Milano, Italy; Policlinico di Monza, Istituto di Ricovero e Cura ad Alta Specializzazione, Monza, Italy.
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Vonend O, Martin O, Rump LC, Kroepil P, Stegbauer J. Erythrocyte Salt Sedimentation Assay Does Not Predict Response to Renal Denervation. Front Med (Lausanne) 2018; 5:51. [PMID: 29594117 PMCID: PMC5854684 DOI: 10.3389/fmed.2018.00051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/13/2018] [Indexed: 12/23/2022] Open
Abstract
Renal denervation (RDN) has recently been shown to be effective in patients without antihypertensive medication. However, about 30% of patients do not respond to RDN, and therefore, there exists a need to find predictors of response. Individuals are either salt-sensitive (SS) or non-salt-sensitive (NSS) in terms of their blood pressure (BP) regulation. The sympathetic nervous system can influence water and salt handling. RDN reduces sympathetic drive and has an impact on salt excretion. The present study was conducted to test the influence of salt sensitivity in terms of the BP reducing effect after RDN procedure. Salt sensitivity was estimated using the in vitro Erythrocyte Salt Sedimentation Assay (ESS). In 88 patients with resistant hypertension, RDN was performed. Office BP and lab testing were performed at baseline and at month 1, 3, 6, 12, 18, and 24 after RDN. A responder rate of 64.7% has been observed. Salt sensitivity measurements (ESS-Test) were completed in a subgroup of 37 patients with resistant hypertension. In this group, 15 were SS and 17 were salt-resistant according to the in vitro assay, respectively. The responder rate was 60% in SS patients and 59.1% in NSS patients, respectively. Electrolytes as well as aldosterone and renin levels did not differ between the two groups at baseline and in the follow-up measurements. The present study showed that salt sensitivity, estimated using the ESS in vitro test, did not affect the outcome of RDN and, therefore, does not help to identify patients suitable for RDN.
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Affiliation(s)
- Oliver Vonend
- Nierenzentrum, DKD Helios Klinik Wiesbaden, Wiesbaden, Germany.,Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Ole Martin
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Lars C Rump
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Patrick Kroepil
- Departement of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Johannes Stegbauer
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Percutaneous Creation of a Central Iliac Arteriovenous Anastomosis for the Treatment of Arterial Hypertension. Curr Hypertens Rep 2018; 20:18. [DOI: 10.1007/s11906-018-0816-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ott C, Franzen KF, Graf T, Weil J, Schmieder RE, Reppel M, Mortensen K. Renal denervation improves 24-hour central and peripheral blood pressures, arterial stiffness, and peripheral resistance. J Clin Hypertens (Greenwich) 2018; 20:366-372. [DOI: 10.1111/jch.13193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/23/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Christian Ott
- Department of Nephrology and Hypertension; Friedrich-Alexander Universität Erlangen-Nürnberg; Erlangen Germany
| | - Klaas F. Franzen
- Campus Lübeck Medizinische Klinik III; Universitätsklinikum Schleswig-Holstein; Lübeck Germany
| | - Tobias Graf
- Campus Lübeck Medizinische Klinik II; Universitätsklinikum Schleswig-Holstein; Lübeck Germany
| | | | - Roland E. Schmieder
- Department of Nephrology and Hypertension; Friedrich-Alexander Universität Erlangen-Nürnberg; Erlangen Germany
| | - Michael Reppel
- Campus Lübeck Medizinische Klinik II; Universitätsklinikum Schleswig-Holstein; Lübeck Germany
- Cardiology Landsberg; Landsberg Germany
| | - Kai Mortensen
- Campus Lübeck Medizinische Klinik II; Universitätsklinikum Schleswig-Holstein; Lübeck Germany
- Cardiology Practice; Kiel Germany
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Mauri L, Kario K, Basile J, Daemen J, Davies J, Kirtane AJ, Mahfoud F, Schmieder RE, Weber M, Nanto S, Azizi M. A multinational clinical approach to assessing the effectiveness of catheter-based ultrasound renal denervation: The RADIANCE-HTN and REQUIRE clinical study designs. Am Heart J 2018; 195:115-129. [PMID: 29224639 DOI: 10.1016/j.ahj.2017.09.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 09/06/2017] [Indexed: 01/24/2023]
Abstract
Catheter-based renal denervation is a new approach to treat hypertension via modulation of the renal sympathetic nerves. Although nonrandomized and small, open-label randomized studies resulted in significant reductions in office blood pressure 6months after renal denervation with monopolar radiofrequency catheters, the first prospective, randomized, sham-controlled study (Symplicity HTN-3) failed to meet its blood pressure efficacy end point. New clinical trials with new catheters have since been designed to address the limitations of earlier studies. Accordingly, the RADIANCE-HTN and REQUIRE studies are multicenter, blinded, randomized, sham-controlled trials designed to assess the blood pressure-lowering efficacy of the ultrasound-based renal denervation system (Paradise) in patients with established hypertension either on or off antihypertensive medications, is designed to evaluate patients in 2 cohorts-SOLO and TRIO, in the United States and Europe. The SOLO cohort includes patients with essential hypertension, at low cardiovascular risk, and either controlled on 1 to 2 antihypertensive medications or uncontrolled on 0 to 2 antihypertensive medications. Patients undergo a 4-week medication washout period before randomization to renal denervation (treatment) or renal angiogram (sham). The TRIO cohort includes patients with hypertension resistant to at least 3 antihypertensive drugs including a diuretic. Patients will be stabilized on a single-pill, triple-antihypertensive-drug combination for 4weeks before randomization to treatment or sham. Reduction in daytime ambulatory systolic blood pressure (primary end point) will be assessed at 2months in both cohorts. A predefined medication escalation protocol, as needed for blood pressure control, is implemented between 2 and 6months in both cohorts by a study staff member blinded to the randomization process. At 6months, daytime ambulatory blood pressure and antihypertensive treatment score will be assessed. REQUIRE is designed to evaluate patients with resistant hypertension on standard of care medication in Japan and Korea. Reduction in 24-hour ambulatory systolic blood pressure will be assessed at 3months (primary end point). Both studies are enrolling patients, and their results are expected in 2018.
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Affiliation(s)
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, School of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Jan Basile
- Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H Johnson VA Medical Center, Charleston, SC
| | - Joost Daemen
- Erasmus MC Thoraxcenter, 'S Gravendijkwal 230, Rotterdam, NL, the Netherlands
| | - Justin Davies
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Ajay J Kirtane
- Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Michael Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York, NY
| | - Shinsuke Nanto
- Nishinomiya Hospital Affairs, Nishinomiya Municipal Central Hospital, Nishinomiya, Hyogo, Japan
| | - Michel Azizi
- Université Paris-Descartes, Paris, France; AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DHU PARC, Paris, France; INSERM, CIC1418, Paris, France
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Padmanabhan D, Isath A, Gersh B. Renal Denervation: Paradise Lost? Paradise Regained? US CARDIOLOGY REVIEW 2018. [DOI: 10.15420/usc.2018.1.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Renal denervation is a relatively recent concept whose initial promising results suffered a setback following the SYMPLICITY 3 trial, which did not show a significant blood pressure-lowering effect in comparison to sham. In this review article, we begin with the history including the physiological basis behind the concept of renal denervation. Furthermore, we review the literature in support of renal denervation, including the recently published SPYRAL HTN-OFF MED, which demonstrated significant blood pressure reduction in the absence of antihypertensive medication. We further touch upon the potential pitfalls and possible future directions of renal denervation.
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