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Evans LC, Dailey-Krempel B, Lauar MR, Dayton A, Vulchanova L, Osborn JW. Renal interoception in health and disease. Auton Neurosci 2024; 255:103208. [PMID: 39128142 DOI: 10.1016/j.autneu.2024.103208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/19/2024] [Accepted: 07/26/2024] [Indexed: 08/13/2024]
Abstract
Catheter based renal denervation has recently been FDA approved for the treatment of hypertension. Traditionally, the anti-hypertensive effects of renal denervation have been attributed to the ablation of the efferent sympathetic renal nerves. In recent years the role of the afferent sensory renal nerves in the regulation of blood pressure has received increased attention. In addition, afferent renal denervation is associated with reductions in sympathetic nervous system activity. This suggests that reductions in sympathetic drive to organs other than the kidney may contribute to the non-renal beneficial effects observed in clinical trials of catheter based renal denervation. In this review we will provide an overview of the role of the afferent renal nerves in the regulation of renal function and the development of pathophysiologies, both renal and non-renal. We will also describe the central projections of the afferent renal nerves, to give context to the responses seen following their ablation and activation. Finally, we will discuss the emerging role of the kidney as an interoceptive organ. We will describe the potential role of the kidney in the regulation of interoceptive sensitivity and in this context, speculate on the possible pathological consequences of altered renal function.
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Affiliation(s)
- Louise C Evans
- Department of Surgery, University of Minnesota Medical School, Minneapolis 55455, United States of America
| | - Brianna Dailey-Krempel
- Department of Neuroscience, University of Minnesota, Minneapolis 55455, United States of America
| | - Mariana R Lauar
- Department of Surgery, University of Minnesota Medical School, Minneapolis 55455, United States of America
| | - Alex Dayton
- Division of Nephrology and Hypertension, University of Minnesota Medical School, Minneapolis 55455, United States of America
| | - Lucy Vulchanova
- Department of Neuroscience, University of Minnesota, Minneapolis 55455, United States of America
| | - John W Osborn
- Department of Surgery, University of Minnesota Medical School, Minneapolis 55455, United States of America.
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2
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Esler MD, Osborn JW, Schlaich MP. Sympathetic Pathophysiology in Hypertension Origins: The Path to Renal Denervation. Hypertension 2024; 81:1194-1205. [PMID: 38557153 DOI: 10.1161/hypertensionaha.123.21715] [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: 04/04/2024]
Abstract
The importance of the sympathetic nervous system in essential hypertension has been recognized in 2 eras. The first was in early decades of the 20th century, through to the 1960s. Here, the sympathetic nervous system was identified as a target for the treatment of hypertension, and an extensive range of antiadrenergic therapies were developed. Then, after a period of lapsed interest, in a second era from 1985 on, the development of precise measures of human sympathetic nerve firing and transmitter release allowed demonstration of the importance of neural mechanisms in the initiation and maintenance of the arterial blood pressure elevation in hypertension. This led to the development of a device treatment of hypertension, catheter-based renal denervation, which we will discuss.
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Affiliation(s)
- Murray D Esler
- Human Neurotransmitter Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (M.D.E., M.P.S.)
| | - John W Osborn
- Department of Surgery, Medical School, University of Minnesota, Minneapolis (J.W.O.)
| | - Markus P Schlaich
- Human Neurotransmitter Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (M.D.E., M.P.S.)
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia (M.P.S.)
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3
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Koutra E, Dimitriadis K, Pyrpyris N, Iliakis P, Fragkoulis C, Beneki E, Kasiakogias A, Tsioufis P, Tatakis F, Kordalis A, Tsiachris D, Aggeli K, Tsioufis K. Unravelling the effect of renal denervation on glucose homeostasis: more questions than answers? Acta Diabetol 2024; 61:267-280. [PMID: 38066299 PMCID: PMC10948574 DOI: 10.1007/s00592-023-02208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/07/2023] [Indexed: 03/20/2024]
Abstract
Renal Denervation (RDN) is an interventional, endovascular procedure used for the management of hypertension. The procedure itself aims to ablate the renal sympathetic nerves and to interrupt the renal sympathetic nervous system overactivation, thus decreasing blood pressure (BP) levels and total sympathetic drive in the body. Recent favorable evidence for RDN resulted in the procedure being included in the recent European Guidelines for the management of Hypertension, while RDN is considered the third pillar, along with pharmacotherapy, for managing hypertension. Sympathetic overactivation, however, is associated with numerous other pathologies, including diabetes, metabolic syndrome and glycemic control, which are linked to adverse cardiovascular health and outcomes. Therefore, RDN, via ameliorating sympathetic response, could be also proven beneficial for maintaining an euglycemic status in patients with cardiovascular disease, alongside its BP-lowering effects. Several studies have aimed, over the years, to provide evidence regarding the pathophysiological effects of RDN in glucose homeostasis as well as investigate the potential clinical benefits of the procedure in glucose and insulin homeostasis. The purpose of this review is, thus, to analyze the pathophysiological links between the autonomous nervous system and glycemic control, as well as provide an overview of the available preclinical and clinical data regarding the effect of RDN in glycemic control.
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Affiliation(s)
- Evaggelia Koutra
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Kyriakos Dimitriadis
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 115 27, Athens, Greece.
- , Dardanellion 146-148, 17123, Athens, Greece.
| | - Nikolaos Pyrpyris
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Panagiotis Iliakis
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Christos Fragkoulis
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Eirini Beneki
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Alexandros Kasiakogias
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Panagiotis Tsioufis
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Fotis Tatakis
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Athanasios Kordalis
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Dimitrios Tsiachris
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Konstantina Aggeli
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 115 27, Athens, Greece
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4
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Guenes-Altan M, Schmid A, Kannenkeril D, Linz P, Ott C, Bosch A, Schiffer M, Uder M, Schmieder RE. Skin sodium content as a predictor of blood pressure response to renal denervation. Hypertens Res 2024; 47:361-371. [PMID: 37880499 PMCID: PMC10838764 DOI: 10.1038/s41440-023-01450-4] [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: 07/17/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 10/27/2023]
Abstract
Patients with treatment resistant hypertension (TRH) are known to have elevated sodium (Na) content in muscle and skin. Renal denervation (RDN) emerged as an adjacent therapeutic option in this group of patients. This analysis aimed at evaluating whether tissue Na content predicts blood pressure (BP) response after RDN in patients with TRH. Radiofrequency-device based RDN was performed in 58 patients with uncontrolled TRH. Office and 24-h ambulatory BP were measured at baseline and after 6 months. To assess tissue Na content Na magnetic resonance imaging (Na-MRI) was performed at baseline prior to RDN. We splitted the study cohort into responders and non-responders based on the median of systolic 24-h ambulatory blood pressure (ABP) reduction after 6 months and evaluated the association between BP response to RDN and tissue Na content in skin and muscle. The study was registered at http://www.clinicaltrials.gov (NCT01687725). Six months after RDN 24-h ABP decreased by -8.6/-4.7 mmHg. BP-Responders were characterized by the following parameters: low tissue sodium content in the skin (p = 0.040), female gender (p = 0.027), intake of aldosterone antagonists (p = 0.032), high baseline 24-h night-time heart rate (p = 0.045) and high LDL cholesterol (p < 0.001). These results remained significant after adjustment for baseline 24-h systolic BP. Similar results were obtained when the median of day-time and night-time ABP reduction after 6 months were used as cut-off criteria for defining BP response to RDN. We conclude that in addition to clinical factors including baseline 24-h ABP Na-MRI may assist to select patients with uncontrolled TRH for RDN treatment.
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Affiliation(s)
- Merve Guenes-Altan
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Axel Schmid
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Dennis Kannenkeril
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Agnes Bosch
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Mario Schiffer
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany.
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Persu A, Stoenoiu MS, Maes F, Kreutz R, Mancia G, Kjeldsen SE. Late outcomes of renal denervation are more favourable than early ones: facts or fancies? Clin Kidney J 2023; 16:2357-2364. [PMID: 38046011 PMCID: PMC10689164 DOI: 10.1093/ckj/sfad231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Indexed: 12/05/2023] Open
Abstract
Following second-generation randomized trials, there is evidence that renal denervation (RDN) decreases blood pressure (BP), although to a lesser extent than suggested in the initial controlled and observational studies. The recent publication of the 36-month follow-up of the Symplicity HTN-3 trial has raised expectations, suggesting increasing, late benefits of the procedure, despite initially negative results. These findings come after those obtained at 36 months in the sham-controlled trial SPYRAL HTN-ON MED and in the Global Symplicity Registry. However, they are susceptible to biases inherent in observational studies (after unblinding for sham-control) and non-random, substantial attrition of treatment groups at 36 months, and used interpolation of missing BPs. More importantly, in SPYRAL HTN-ON MED and Symplicity HTN-3, long-term BP changes in patients from the initial RDN group were compared with those in a heterogeneous control group, including both control patients who did not benefit from RDN and patients who eventually crossed over to RDN. In crossover patients, the last BP before RDN was imputed to subsequent follow-up. In Symplicity HTN-3, this particular approach led to the claim of increasing long-term benefits of RDN. However, comparison of BP changes in patients from the RDN group and control patients who did not undergo RDN, without imputation of BPs from crossover patients, does not support this view. The good news is that despite the suggestion of sympathetic nerve regrowth after RDN in some animal models, there is no strong signal in favour of a decreasing effect of RDN over time, up to 24 or even 36 months. Still, current data do not support a long-term increase in the effect of RDN and the durability of RDN-related BP reduction remains to be formally demonstrated.
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Affiliation(s)
- Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc Université Catholique de Louvain, Brussels, Belgium
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Maria S Stoenoiu
- Department of Internal Medicine, Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Frédéric Maes
- Division of Cardiology, Cliniques Universitaires Saint-Luc Université Catholique de Louvain, Brussels, Belgium
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Reinhold Kreutz
- Charité – Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | | | - Sverre E Kjeldsen
- Institute of Clinical Medicine, University of Oslo, Departments of Cardiology and Nephrology, Ullevaal Hospital, Oslo, Norway
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Schmieder RE, Mahfoud F, Mancia G, Narkiewicz K, Ruilope L, Hutton DW, Cao KN, Hettrick DA, Fahy M, Schlaich MP, Böhm M, Pietzsch JB. Clinical event reductions in high-risk patients after renal denervation projected from the global SYMPLICITY registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:575-582. [PMID: 36057838 PMCID: PMC10495746 DOI: 10.1093/ehjqcco/qcac056] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/15/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
AIMS Renal denervation has been shown to lower blood pressure in sham-controlled trials and represents a device-based treatment option for hypertension. We sought to project clinical event reductions after radiofrequency renal denervation using a novel modelling approach. METHODS AND RESULTS The Global SYMPLICITY Registry is a global, prospective all-comer registry to evaluate safety and efficacy after renal denervation. For this analysis, change in office systolic blood pressure from baseline was calculated from reported follow-up in the Global SYMPLICITY Registry. Relative risks for death and other cardiovascular events as well as numbers needed to treat for event avoidance were obtained for the respective blood pressure reductions based on previously reported meta-regression analyses for the full cohort and high-risk subgroups including type 2 diabetes, chronic kidney disease, resistant hypertension, and high basal cardiovascular risk. Average baseline office systolic blood pressure and reduction estimates for the full cohort (N = 2651) were 166±25 and -14.8 ± 0.4 mmHg, respectively. Mean reductions in blood pressure ranged from -11.0--21.8 mmHg for the studied high-risk subgroups. Projected relative risks ranged from 0.57 for stroke in the resistant hypertension cohort to 0.92 for death in the diabetes cohort. Significant absolute reductions in major adverse cardiovascular events over 3 years compared with the projected control (8.6 ± 0.7% observed vs. 11.7 ± 0.9% for projected control; P < 0.01) were primarily due to reduced stroke incidence. The robustness of findings was confirmed in sensitivity and scenario analyses. CONCLUSION Model-based projections suggest radiofrequency renal denervation for patients with uncontrolled hypertension adds considerable clinical benefit across a spectrum of different cohort characteristics.
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Affiliation(s)
- Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Bavaria 91054, Germany
| | - Felix Mahfoud
- Internal Medicine and Cardiology, Saarland University Hospital, Homburg/Saar, Saarland 66421, Germany
| | - Giuseppe Mancia
- Department of Medicine, University of Milano-Bicocca, Monza, Lombardia 20126, Italy
| | - Krzysztof Narkiewicz
- Hypertension and Diabetology, Medical University of Gdansk, Gdansk 80-210, Poland
| | - Luis Ruilope
- Cardiorenal Investigation, Institute of Research, Hospital Universitario 12 de Octubre and CIBERCV and School of Doctoral Studies and Research, Universidad Europea de Madrid, Madrid 28041, Spain
| | - David W Hutton
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Khoa N Cao
- Wing Tech Inc., Menlo Park, CA 94025, USA
| | | | - Martin Fahy
- Coronary and Renal Denervation, Medtronic, Santa Rosa, CA 95403, USA
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine—Royal Perth Hospital Unit, The University of Western Australia, Perth, WA 6009, Australia
| | - Michael Böhm
- Internal Medicine and Cardiology, Saarland University Hospital, Homburg/Saar, Saarland 66421, Germany
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Rosch S, Rommel K, Blazek S, Kresoja K, Schöber A, von Roeder M, Desch S, Thiele H, Lurz P, Fengler K. Twenty-Four-Month Blood Pressure Results After Renal Denervation Using Endovascular Ultrasound. J Am Heart Assoc 2023; 12:e030767. [PMID: 37581398 PMCID: PMC10492948 DOI: 10.1161/jaha.123.030767] [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: 04/26/2023] [Accepted: 07/13/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Renal denervation has proven its efficacy to lower blood pressure in comparison to sham treatment in recent randomized clinical trials. Although there is a large body of evidence for the durability and safety of radiofrequency-based renal denervation, there are a paucity of data for endovascular ultrasound-based renal denervation (uRDN). We aimed to assess the long-term efficacy and safety of uRDN in a single-center cohort of patients. METHODS AND RESULTS Data from 2 previous studies on uRDN were pooled. Ambulatory 24-hour blood pressure measurements were taken before as well as 3, 6, 12, and 24 months after treatment with uRDN. A total of 130 patients (mean age 63±9 years, 24% women) underwent uRDN. After 3, 6, 12, and 24 months, systolic mean 24-hour ambulatory blood pressure values were reduced by 10±12, 10±14, 8±15, and 10±15 mm Hg, respectively, when compared with baseline (P<0.001). Corresponding diastolic values were reduced by 6±8, 6±8, 5±9, and 6±9 mm Hg, respectively (P<0.001). Periprocedural adverse events occurred in 16 patients, and all recovered without sequelae. CONCLUSIONS In this single-center study, uRDN effectively lowered blood pressure up to 24 months after treatment.
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Affiliation(s)
- Sebastian Rosch
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Karl‐Philipp Rommel
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Stephan Blazek
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Karl‐Patrik Kresoja
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Anne Schöber
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | | | - Steffen Desch
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Holger Thiele
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Philipp Lurz
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Karl Fengler
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
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8
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Mahfoud F, Mancia G, Schmieder RE, Ruilope L, Narkiewicz K, Schlaich M, Williams B, Ribichini F, Weil J, Kao HL, Rodriguez-Leor O, Noory E, Ong TK, Unterseeh T, de Araújo Gonçalves P, Zirlik A, Almerri K, Sharif F, Lauder L, Wanten M, Fahy M, Böhm M. Cardiovascular Risk Reduction After Renal Denervation According to Time in Therapeutic Systolic Blood Pressure Range. J Am Coll Cardiol 2022; 80:1871-1880. [DOI: 10.1016/j.jacc.2022.08.802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/12/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022]
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9
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Fengler K, Rommel KP, Kriese W, Kresoja KP, Blazek S, Obradovic D, Feistritzer HJ, Lücke C, Gutberlet M, Desch S, Thiele H, Lurz P. Assessment of arterial stiffness to predict blood pressure response to renal sympathetic denervation. EUROINTERVENTION 2022; 18:e686-e694. [PMID: 35244604 PMCID: PMC10241279 DOI: 10.4244/eij-d-21-01036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/02/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent trials support the efficacy of renal sympathetic denervation (RDN) to reduce blood pressure (BP). Nevertheless, about one third of patients are considered non-responders to RDN. Previous retrospective analyses suggest arterial stiffness could predict BP response to RDN. AIMS We prospectively assessed the potential of invasive pulse wave velocity (iPWV) to predict BP response to RDN. Additionally, we aimed to establish non-invasive models based on arterial stiffness to predict BP response to RDN. METHODS iPWV, magnetic resonance imaging-based markers of arterial stiffness and the carotid-femoral pulse wave velocity were recorded prior to RDN in patients with treatment resistant hypertension. Changes in daytime BP after 3 months were analysed according to the prespecified iPWV cut-off (14.4 m/s). Regression analyses were used to establish models for non-invasive prediction of BP response. Results were compared to iPWV as reference and were then validated in an external patient cohort. RESULTS Eighty patients underwent stiffness assessment before RDN. After 3 months, systolic 24h and daytime BP were reduced by 13.6±9.8 mmHg and 14.7±10.6 mmHg in patients with low iPWV, versus 6.2±13.3 mmHg and 6.3±12.8 mmHg in those with high iPWV (p<0.001 for both). Upon regression analysis, logarithmic ascending aortic distensibility and systolic baseline BP independently predicted BP change at follow-up. Both were confirmed in the validation cohort. CONCLUSIONS iPWV is an independent predictor for BP response after RDN. In addition, BP change prediction following RDN using non-invasive measures is feasible. This could facilitate patient selection for RDN treatment.
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Affiliation(s)
- Karl Fengler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Karl-Philipp Rommel
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Wenzel Kriese
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Karl-Patrik Kresoja
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Stephan Blazek
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Danilo Obradovic
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Hans-Josef Feistritzer
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Christian Lücke
- Leipzig Heart Institute, Leipzig, Germany
- Department of Interventional and Diagnostic Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Matthias Gutberlet
- Leipzig Heart Institute, Leipzig, Germany
- Department of Interventional and Diagnostic Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
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10
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Renal Denervation for Resistant Hypertension: A Concise Update on Treatment Options and the Latest Clinical Evidence. Cardiol Ther 2022; 11:385-392. [PMID: 35943714 PMCID: PMC9381663 DOI: 10.1007/s40119-022-00275-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/22/2022] [Indexed: 11/21/2022] Open
Abstract
Evidence from recent sham-controlled trials supports the use of endovascular renal denervation (RDN) to lower blood pressure in general as well as in treatment-resistant hypertension. According to recent studies, the effects of RDN are long lasting. Newer technologies using multipolar radiofrequency catheters and an additional ablation of the renal side branches as well as ultrasound with improved circumferential tissue penetration have made these advances possible. This has initiated a change of the perspective on RDN in clinical guidelines and has thereby set a cornerstone for a broader clinical application of RDN in the future.
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11
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Mogi M, Maruhashi T, Higashi Y, Masuda T, Nagata D, Nagai M, Bokuda K, Ichihara A, Nozato Y, Toba A, Narita K, Hoshide S, Tanaka A, Node K, Yoshida Y, Shibata H, Katsurada K, Kuwabara M, Kodama T, Shinohara K, Kario K. Update on Hypertension Research in 2021. Hypertens Res 2022; 45:1276-1297. [PMID: 35790879 PMCID: PMC9255494 DOI: 10.1038/s41440-022-00967-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 12/16/2022]
Abstract
In 2021, 217 excellent manuscripts were published in Hypertension Research. Editorial teams greatly appreciate the authors' contribution to hypertension research progress. Here, our editorial members have summarized twelve topics from published work and discussed current topics in depth. We hope you enjoy our special feature, "Update on Hypertension Research in 2021".
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Affiliation(s)
- Masaki Mogi
- Department of Pharmacology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Tohon, Ehime, 791-0295, Japan.
| | - Tatsuya Maruhashi
- Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Yukihito Higashi
- Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takahiro Masuda
- Division of Nephrology, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Michiaki Nagai
- Department of Cardiology, Hiroshima City Asa Hospital, 1-2-1 Kameyamaminami Asakita-ku, Hiroshima, 731-0293, Japan
| | - Kanako Bokuda
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Atsuhiro Ichihara
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yoichi Nozato
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ayumi Toba
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Keisuke Narita
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, 5-1-1, Nabeshima, Saga, 849-8501, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-1-1, Nabeshima, Saga, 849-8501, Japan
| | - Yuichi Yoshida
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, 1-1, 1-1 Idaigaoka, Hasama-machi, Yufu city, Oita, 879-5593, Japan
| | - Hirotaka Shibata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, 1-1, 1-1 Idaigaoka, Hasama-machi, Yufu city, Oita, 879-5593, Japan
| | - Kenichi Katsurada
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
- Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Masanari Kuwabara
- Department of Cardiology, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Takahide Kodama
- Department of Cardiology, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Keisuke Shinohara
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Selejan SR, Linz D, Mauz M, Hohl M, Huynh AKD, Speer T, Wintrich J, Kazakov A, Werner C, Mahfoud F, Böhm M. Renal denervation reduces atrial remodeling in hypertensive rats with metabolic syndrome. Basic Res Cardiol 2022; 117:36. [PMID: 35834066 PMCID: PMC9283368 DOI: 10.1007/s00395-022-00943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 01/31/2023]
Abstract
Atrial fibrillation (AF) is highly prevalent in hypertensive patients with metabolic syndrome and is related to inflammation and activation of the sympathoadrenergic system. The multi-ligand Receptor-for-Advanced-Glycation-End-products (RAGE) activates inflammation-associated tissue remodeling and is regulated by the sympathetic nervous system. Its counterpart, soluble RAGE (sRAGE), serves as anti-inflammatory decoy receptor with protective properties. We investigated the effect of sympathetic modulation by renal denervation (RDN) on atrial remodeling, RAGE/sRAGE and RAGE ligands in metabolic syndrome. RDN was performed in spontaneously hypertensive obese rats (SHRob) with metabolic syndrome compared with lean spontaneously hypertensive rats (SHR) and with normotensive non-obese control rats. Blood pressure and heart rate were measured by telemetry. The animals were killed 12 weeks after RDN. Left atrial (LA) and right atrial (RA) remodeling was assessed by histological analysis and collagen types. Sympathetic innervation was measured by tyrosine hydroxylase staining of atrial nerve fibers, RAGE/sRAGE, RAGE ligands, cytokine expressions and inflammatory infiltrates were analyzed by Western blot and immunofluorescence staining. LA sympathetic nerve fiber density was higher in SHRob (+44%) versus controls and reduced after RDN (-64% versus SHRob). RAGE was increased (+718%) and sRAGE decreased (- 62%) in SHRob as compared with controls. RDN reduced RAGE expression (- 61% versus SHRob), significantly increased sRAGE levels (+162%) and induced a significant decrease in RAGE ligand levels in SHRob (- 57% CML and - 51% HMGB1) with reduced pro-inflammatory NFkB activation (- 96%), IL-6 production (- 55%) and reduced inflammatory infiltrates. This led to a reduction in atrial fibrosis (- 33%), collagen type I content (- 72%), accompanied by reduced LA myocyte hypertrophy (- 21%). Transfection experiments on H9C2 cardiomyoblasts demonstrated that RAGE is directly involved in fibrosis formation by influencing cellular production of collagen type I. In conclusion, suppression of renal sympathetic nerve activity by RDN prevents atrial remodeling in metabolic syndrome by reducing atrial sympathetic innervation and by modulating RAGE/sRAGE balance and reducing pro-inflammatory and pro-fibrotic RAGE ligands, which provides a potential therapeutic mechanism to reduce the development of AF.
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Affiliation(s)
- Simina-Ramona Selejan
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Dominik Linz
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Muriel Mauz
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Mathias Hohl
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Anh Khoa Dennis Huynh
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Thimoteus Speer
- Klinik für Innere Medizin IV (Nephrologie und Hochdruckkrankheiten), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar, Germany
| | - Jan Wintrich
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Andrey Kazakov
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Christian Werner
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstr. 100, Geb. 41.1 (IMED), 66421 Homburg/Saar, Germany
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Lyu TJ, Li LY, Wang X, Ye J, Gao JQ, Liu ZJ. Main Renal Artery Plus Branch Ablation in the Treatment of Resistant Hypertension with Renal Denervation. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2021. [DOI: 10.15212/cvia.2021.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To study the safety and efficacy of denervation of renal artery branches in the treatment of resistant hypertension.Methods: Sixty patients with resistant hypertension were enrolled. The patients were randomly assigned to the main renal artery plus branch
ablation group or the main renal artery ablation group. The clinical data and operation-related parameters, including number of ablation points, temperature, and average energy, were recorded. Ambulatory blood pressure was taken for all patients at the baseline and at 6 months after treatment.
Office blood pressure was recorded before treatment and after treatment every 3 months for 2 years.Results: Sixty patients with resistant hypertension were enrolled in this study. There were 30 patients in each group. Angiography was performed after ablation. No renal artery complications,
such as stenosis and dissection, occurred in the two groups. There was no significant difference in age, sex, BMI, comorbid disease, and medication between the two groups (P>0.05). The number of ablation points for the main renal artery plus branch ablation group was greater than that for
the main renal artery ablation group. The office blood pressure and 24-hour blood pressure were significantly lower 6 months after treatment than before treatment in both groups (P<0.05). Office blood pressure in the main renal artery plus branch ablation group was lower than that in the
main renal artery ablation group during the 3‐12-month follow-up period, with a statistical difference. However, as the follow-up time increased, the difference disappeared.Conclusion: The results of this study show that main renal artery plus branch ablation is a safe interventional
method, but there was no obvious advantage on long-term follow-up compared with only main renal artery ablation.
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Affiliation(s)
- Tian-Jiao Lyu
- Department of Cardiology, Putuo Center Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 200062 Shanghai, People’s Republic of China
| | - Ling-Yan Li
- Department of Cardiology, Putuo Center Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 200062 Shanghai, People’s Republic of China
| | - Xu Wang
- Department of Cardiology, Putuo Center Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 200062 Shanghai, People’s Republic of China
| | - Jian Ye
- Department of Cardiology, Putuo Center Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 200062 Shanghai, People’s Republic of China
| | - Jun-Qing Gao
- Department of Cardiology, Putuo Center Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 200062 Shanghai, People’s Republic of China
| | - Zong-Jun Liu
- Department of Cardiology, Putuo Center Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 200062 Shanghai, People’s Republic of China
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Long-term outcomes after renal denervation in an Asian population: results from the Global SYMPLICITY Registry in South Korea (GSR Korea). Hypertens Res 2021; 44:1099-1104. [PMID: 34145423 DOI: 10.1038/s41440-021-00683-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/22/2021] [Accepted: 05/01/2021] [Indexed: 01/06/2023]
Abstract
The objective of this work was to investigate the long-term safety and efficacy of renal denervation in Korean patients from the Global SYMPLICITY Registry (GSR). GSR Korea is a substudy of GSR with additional inclusion and exclusion criteria compared to GSR, including inclusion criteria of office systolic blood pressure ≥160 mmHg, or ≥150 mmHg for type 2 diabetes patients, while receiving 3 or more antihypertensive medications without changes for 2 weeks prior to enrollment. Renal denervation was performed using a Symplicity Flex catheter for ablation in the main renal arteries. Changes in office systolic blood pressure and adverse events were collected for up to 36 months of follow-up for 102 patients in GSR Korea. In addition, adverse events and reductions in office systolic blood pressure were analyzed for patients with and without type II diabetes mellitus. Renal denervation led to mean (± standard deviation) reductions in office systolic blood pressure at 12, 24, and 36 months in GSR Korea (-26.7 ± 18.5, -30.1 ± 21.6 mmHg, and -32.5 ± 18.8, respectively). The proportion of patients with a ≥10 mmHg office systolic blood pressure reduction from baseline was 86.3% at 12 months, 86.5% at 24 months, and 89.7% at 36 months. Adverse events at 3 years were rare. In addition, reductions in office systolic blood pressure were similar for patients with vs. without diabetes mellitus (p > 0.05 at all timepoints). Office systolic blood pressure was safely reduced at up to 36 months post-renal denervation in GSR Korea, and adverse events were rare. In addition, patients with and without diabetes had similar office systolic blood pressure reductions.
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Bazoukis G, Thomopoulos C, Tse G, Vassiliou VS, Liu T, Dimitriadis K, Tatakis F, Konstantinou K, Doumas M, Tsioufis K. Impact of renal sympathetic denervation on cardiac magnetic resonance-derived cardiac indices in hypertensive patients - A meta-analysis. J Cardiol 2021; 78:314-321. [PMID: 34088560 DOI: 10.1016/j.jjcc.2021.05.002] [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] [Received: 02/19/2021] [Revised: 03/20/2021] [Accepted: 04/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Renal sympathetic denervation (RDN) is a safe device-based option for the treatment of hypertension although current guidelines do not recommend its use in routine clinical practice. In this meta-analysis, we investigated the effects of RDN in cardiac magnetic resonance (CMR)-derived cardiac indices. METHODS This meta-analysis was performed in accordance with the PRISMA statement. A comprehensive systematic search of MEDLINE database and Cochrane library through to January 2021 was performed. The inclusion criteria were studies that enrolled patients undergoing RDN in whom CMR data were provided for left ventricular end-diastolic volume indexed to body surface area (BSA) (LVEDVI), left ventricular end-systolic volume indexed (LVESVI), left ventricular mass indexed (LVMI), and left ventricular ejection fraction (LVEF) pre and post RDN. A random effects model was used for the analyses. RESULTS Our search strategy revealed 9 studies that were finally included in the meta-analysis (n=300 patients, mean age: 60 years old, males: 59%). Compared to control group, RDN patients showed significantly lower values in the attained volumes (LVEDVI: -6.70 ml/m2, p=0.01; LVESVI: -3.63 ml/m2, p=0.006). Moreover, RDN group achieved a statistically significant higher attained LVEF (3.49%, p=0.01). A non-significant difference was found in the attained LVMI between RDN and control groups (-2.59 g/m2, p=0.39). Compared to pre-RDN values, RDN reduces significantly the LVMI, the LVEDVI, and the LVESVI while a non-significant change of LVEF was found. CONCLUSIONS In conclusion, the current study demonstrates the potential beneficial role of RDN in CMR-derived cardiac indices that reflect adverse remodeling. However, large, randomized studies are needed to elucidate the role of RDN in cardiac remodeling in hypertension, heart failure, and other clinical settings.
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Affiliation(s)
- George Bazoukis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
| | | | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Vassilios S Vassiliou
- Norfolk and Norwich University Hospital, Norwich, UK; Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Kyriakos Dimitriadis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Fotios Tatakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Konstantinos Konstantinou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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Zhang Z, Liu K, Xiao S, Chen X. Effects of catheter-based renal denervation on glycemic control and lipid levels: a systematic review and meta-analysis. Acta Diabetol 2021; 58:603-614. [PMID: 33459896 DOI: 10.1007/s00592-020-01659-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/10/2020] [Indexed: 02/05/2023]
Abstract
AIMS As an emerging interventional technique to treat resistant hypertension, renal denervation (RDN) has also attracted considerable attention due to its potential beneficial effects on glucose and lipid metabolism. Given that inconsistent results were documented among studies, we aimed to perform a systematic review and meta-analysis to elaborate on this issue. METHODS The PubMed, EMBASE, Web of Science (SCI) and ClinicalTrials.gov databases were comprehensively searched from their inception date to June 18, 2020, for relevant clinical studies evaluating the efficacy of RDN on glucose and lipid levels. The outcomes of interest were changes in fasting glucose, insulin, C-peptide, hemoglobin A1C (HbA1C), homeostatic model assessment-insulin resistance (HOMA-IR), cholesterol and triglyceride (TG) levels before versus after RDN and also RDN versus the control group. The mean differences (MDs) of the outcomes measured before versus after RDN and RDN versus the control group were pooled by a randomized effects model. Heterogeneity was quantified with Chi-square (χ2) and inconsistency index (I2). Assessment of publication bias was performed by the funnel plot and Egger's test. RESULTS A total of 1600 studies were initially identified. Nineteen of the identified studies (six randomized controlled studies, one non-randomized controlled studies and 12 observational cohort studies) involving 2245 subjects were included in the final analysis. No significant change was observed after RDN in fasting glucose (weighted mean difference [WMD] - 0.19 mmol/L; 95% CI - 0.37, 0.00 mmol/L), insulin (standardized mean difference [SMD] - 0.01; 95% CI - 0.41, 0.39), C-peptide (SMD - 0.05; 95% CI - 0.30, 0.21), HbA1C (SMD - 0.05; 95% CI - 0.17, 0.07), HOMA-IR (SMD - 0.29; 95% CI - 0.72, 0.14), total cholesterol (TC) (WMD - 0.11 mmol/L; 95% CI - 0.37, 0.15 mmol/L), and low-density lipoprotein cholesterol (LDL-C) levels (WMD - 0.18 mmol/L; 95% CI - 0.59, 0.24 mmol/L) during follow-up. Changes in fasting glucose, insulin, HbA1C and TC levels in RDN groups were not significantly different from those in the control group. High-density lipoprotein cholesterol (HDL-C) and TG were slightly improved after RDN (WMD 0.07 mmol/L, 95% CI 0.01, 0.14 mmol/L; WMD - 0.26 mmol/l, 95% CI - 0.51, - 0.01 mmol/L, respectively). The funnel plot and Egger's test demonstrated the absence of potential publication bias. CONCLUSIONS Catheter-based RDN appeared to have no impact on glucose metabolism. There was a statistically significant but clinically negligible improvement in HDL-C and TG levels based on the current evidence. Future research with more rigorous designs is warranted to draw definitive conclusions. REGISTRATION DETAILS The protocol of this meta-analysis was registered on PROSPERO (CRD42020192805). ( https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=192805 ).
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Affiliation(s)
- Zhipeng Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Sichuan province, Chengdu, China
| | - Kai Liu
- Department of Cardiology, West China Hospital, Sichuan University, Sichuan province, Chengdu, China
| | - Shan Xiao
- Day Surgery Center, West China Hospital, Sichuan University, Sichuan province, Chengdu, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Sichuan province, Chengdu, China.
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Doumas M, Andreadis E, Andronoglou M, Davlouros P, Dimitriadis K, Gkaliagkousi E, Grassos H, Hatzitolios A, Iliakis P, Kalaitzidis R, Kallistratos E, Kasiakogias A, Konstantinidis D, Kotsis V, Makris T, Manolis A, Moulias A, Marketou M, Papadakis I, Papadopoulos D, Poulimenos L, Sanidas E, Sarafidis P, Savopoulos C, Stergiou G, Tatakis F, Thomopoulos K, Triantafyllidi H, Triantafyllou A, Vlachakos D, Zebekakis P, Ziakas A, Papademetriou V, Tsioufis C. Joint ESH excellence centers' national meeting on renal sympathetic denervation: A Greek experts' survey. Hellenic J Cardiol 2021; 62:355-358. [PMID: 33895312 DOI: 10.1016/j.hjc.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The efficacy of renal sympathetic denervation (RDN) has been affirmed by a number of recent clinical studies, despite controversies in this field over the last five years. Therefore, it is of paramount importance that hypertension experts debate the merits of RDN by revealing and expressing their personal beliefs and perspectives regarding this procedure. METHODS A cross-sectional survey was conducted among Greek leaders of the Hypertension Excellence Centers with the use of a closed-type questionnaire specifically designed to elicit information and evaluate the respondent's views and perspectives about RDN efficacy, safety and ideal target patient population. RESULTS A total of 36 participants completed the survey. Based on the results, RDN was considered efficient (91.7%) and safe (94.5%), while the overwhelming majority of the participants felt confident in the long-term efficacy (88.9%) of the intervention and that it lacks reliable predictors of blood pressure response (94.5%). Patients with resistant (91.7%), ultra-resistant (94.4%), and uncontrolled hypertension (80.6%) were suggested as ideal candidates for RDN. Establishing a close co-operation between interventionalists and hypertension experts was considered essential to ensure the efficacy (97.2%) as well as the safety (97.3%) of the procedure. CONCLUSION The vast majority of Greek hypertension experts surveyed were convinced of the efficacy and safety of RDN based on the preponderance of available scientific and clinical data. Identification of the ideal patient group remains controversial. Respondents generally agreed on the necessity of building close collaborative relationships between interventionalists and hypertension experts in order to improve RDN clinical outcome.
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Kim CJ, Chang K, Kim BK, Park CG, Jang Y. An Open-label, Single-arm, Multicenter Feasibility Study Evaluating the Safety of Catheter-based Renal Denervation with DENEX™ in Patients with Uncontrolled Hypertension on Standard Medical Therapy. Korean Circ J 2021; 51:43-55. [PMID: 33377328 PMCID: PMC7779817 DOI: 10.4070/kcj.2020.0391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background and Objectives DENEX™ is a novel renal sympathetic denervation (RDN) system that is equipped with 3 electrodes that deliver radiofrequency energy to the renal nerves along renal arteries. The purpose of this study was to evaluate the safety and efficacy of RDN with DENEX™ in resistant hypertension. Methods This was an open-label, single-arm, multicenter, first-in-man pilot study. Between November 2016 and May 2018, a total of 16 patients were enrolled at 4 centers in South Korea. The inclusion criteria were systolic blood pressure (SBP) ≥150 mmHg and use of 3 or more antihypertensive medications, including diuretics. The primary objective was the safety outcome of RDN with the DENEX™ system. The secondary objective was efficacy outcome based on changes of office, and 24-hour ambulatory SBP from baseline to 3 months. The patients underwent abdominal computed tomography (CT) or duplex ultrasonogram before and 6 months after RDN. Results No major adverse events occurred after RDN for 6 month of follow-up period. There was no vascular complication either by CT or duplex ultrasonogram. The office SBP was significantly reduced from 164.6±11.6 mmHg at baseline to 142.0±20.4 mmHg (−24.4±24.4 mmHg, p=0.003) at 3 months. The ambulatory SBP was reduced from 151.44±12.85 mmHg at baseline to 140.0±16.5 mmHg (−13.1±18.9 mmHg, p=0.056) at 3 months. Conclusion RDN with the DENEX™ system showed a favorable safety profile in resistant hypertension. A significant reduction in office SBP and a borderline reduction in ambulatory SBP were observed. Trial Registration ClinicalTrials.gov Identifier: NCT04248530
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Affiliation(s)
- Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Kiyuk Chang
- Department of Cardiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Byeong Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Shen Y, Zhang X, Li C, Wang X, Ye Y, Yuan J, Gong H, Zou Y, Ge J. Pressure overload promotes cystatin C secretion of cardiomyocytes to regulate the MAPK signaling pathway and mediate cardiac hypertrophy. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1514. [PMID: 33313259 PMCID: PMC7729345 DOI: 10.21037/atm-20-7041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/18/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study aimed to compare serum cystatin C (CysC) levels between hypertensive and non-hypertensive patients, and to explore the correlation between serum CysC and left ventricular hypertrophy (LVH). We also investigated the effects of pressure overload on cardiac expression and secretion of CysC, and explored the direct effect of CysC on the hypertrophy of primary cardiomyocytes. METHODS Serum CysC was compared in patients with hypertension (634 patients) and those without hypertension (411 patients), and the correlation between serum CysC levels and LVH was explored. A transverse aortic constriction (TAC) mouse model and a mechanical stretch model of primary cardiomyocytes and fibroblasts were developed to compare cardiac expression and secretion of CysC under pressure overload. After intervention with exogenous CysC, we compared the cross-sectional area of primary cardiomyocytes, cardiac hypertrophy-associated gene expression, and phosphorylation of the MAPK signaling pathway. RESULTS In chronic kidney disease (CKD) stage 1 patients, serum CysC was higher in hypertensive patients independent of renal function. Serum CysC elevation was an independent predictor of LVH after correction for endogenous creatinine clearance rate (eCCr), left ventricular ejection fraction (LVEF), and NT-proBNP. Cardiac levels of CysC in TAC mice were elevated. CST3 gene expression was upregulated, and both intracellular and culture supernatant CysC levels increased after mechanical stretch of primary cardiomyocytes. After intervention with exogenous CysC, the cross-sectional area of primary cardiomyocytes increased, as well as the gene expression of Nppa, Nppb, and Myh7, and the phosphorylation of ERK, p38, and TAK1. CONCLUSIONS Serum CysC levels were higher in hypertensive patients, and serum CysC elevation was an independent predictor of LVH after correction for eCCr. Pressure overload induced greater cardiomyocyte secretion of CysC. Exogenous CysC can enter cardiomyocytes, having a pro-hypertrophic effect on primary cardiomyocytes through regulation of the MAPK signaling pathways.
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Affiliation(s)
- Yi Shen
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyi Zhang
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chenguang Li
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiang Wang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Ye
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Yuan
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui Gong
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunzeng Zou
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
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Xiao B, Liu F, Jin YH, Jin YQ, Wang L, Lu JC, Yang XC. Renal sympathetic denervation attenuates left ventricle hypertrophy in spontaneously hypertensive rats by suppressing the Raf/MEK/ERK signaling pathway. Clin Exp Hypertens 2020; 43:142-150. [PMID: 33070656 DOI: 10.1080/10641963.2020.1833022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To explore the effect of renal sympathetic denervation (RSD) on left ventricle hypertrophy and the Raf/MEK/ERK signaling pathway in spontaneously hypertensive rats (SHRs). METHODS SHRs were divided into SHR, SHR + Sham, SHR + RSD and SHR + U0126 groups, with WKY rats as the baseline controls. The blood pressure of rats was observed, while myocardial fibrosis was evaluated through Masson staining. Thereafter, real-time quantitative polymerase chain reaction (qRT-PCR) was carried out to determine the levels of myocardial-hypertrophy-related markers, and Western blotting was used to measure the activity of the Raf/MEK/ERK signaling pathway. RESULTS In comparison with the WKY group, significant increases were observed in the systolic pressure and diastolic pressure of rats from the other four groups at different time points after surgery. In addition, rats in these groups had obvious increases in LVMI, renal NE and IVSd and decreases in LVEDd, LVEF and LVFS. In addition, the CVF of myocardial tissues was increased, with the upregulation of ANP, BNP and β-MHC and the downregulation of α-MHC. For the activity of the Raf/MEK/ERK signaling pathway, the levels of p-Raf/Raf, p-MEK/MEK and p-ERK1/2/ERK1/2 were all remarkably elevated (all P < .05). Further comparison with the SHR group showed that the above indexes in the rats were significantly improved in the RSD group and SHR + U0126 group (all P < .05). CONCLUSION RSD may decrease blood pressure, mitigate hypertension-induced left ventricle hypertrophy and improve cardiac function efficiently in SHRs via the suppression of the Raf/MEK/ERK signaling pathway.
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Affiliation(s)
- Bing Xiao
- Department of Cardiology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Fan Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Ye-Hui Jin
- Department of Cardiology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Ya-Qiong Jin
- Department of Cardiology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Li Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Jing-Chao Lu
- Department of Cardiology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Xiu-Chun Yang
- Department of Cardiology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
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Mahfoud F, Böhm M, Schmieder R, Narkiewicz K, Ewen S, Ruilope L, Schlaich M, Williams B, Fahy M, Mancia G. Effects of renal denervation on kidney function and long-term outcomes: 3-year follow-up from the Global SYMPLICITY Registry. Eur Heart J 2020; 40:3474-3482. [PMID: 30907413 PMCID: PMC6837160 DOI: 10.1093/eurheartj/ehz118] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/01/2018] [Accepted: 02/20/2019] [Indexed: 12/12/2022] Open
Abstract
Aims Several studies and registries have demonstrated sustained reductions in blood pressure (BP) after renal denervation (RDN). The long-term safety and efficacy after RDN in real-world patients with uncontrolled hypertension, however, remains unknown. The objective of this study was to assess the long-term safety and efficacy of RDN, including its effects on renal function. Methods and results The Global SYMPLICITY Registry is a prospective, open-label registry conducted at 196 active sites worldwide in hypertensive patients receiving RDN treatment. Among 2237 patients enrolled and treated with the SYMPLICITY Flex catheter, 1742 were eligible for follow-up at 3 years. Baseline office and 24-h ambulatory systolic BP (SBP) were 166 ± 25 and 154 ± 18 mmHg, respectively. SBP reduction after RDN was sustained over 3 years, including decreases in both office (−16.5 ± 28.6 mmHg, P < 0.001) and 24-h ambulatory SBP (−8.0 ± 20.0 mmHg; P < 0.001). Twenty-one percent of patients had a baseline estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Between baseline and 3 years, renal function declined by 7.1 mL/min/1.73 m2 in patients without chronic kidney disease (CKD; eGFR ≥60 mL/min/1.73 m2; baseline eGFR 87 ± 17 mL/min/1.73 m2) and by 3.7 mL/min/1.73 m2 in patients with CKD (eGFR <60 mL/min/1.73 m2; baseline eGFR 47 ± 11 mL/min/1.73 m2). No long-term safety concerns were observed following the RDN procedure. Conclusion Long-term data from the Global SYMPLICITY Registry representing the largest available cohort of hypertensive patients receiving RDN in a real-world clinical setting demonstrate both the safety and efficacy of the procedure with significant and sustained office and ambulatory BP reductions out to 3 years. ![]()
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Affiliation(s)
- Felix Mahfoud
- Department of Internal Medicine, Saarland University Hospital, Geb. 41, Kirrberger Strasse 1, 66421 Homburg/Saar, Germany
| | - Michael Böhm
- Department of Internal Medicine, Saarland University Hospital, Geb. 41, Kirrberger Strasse 1, 66421 Homburg/Saar, Germany
| | - Roland Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Maximilianspl. 2, 91054 Erlangen, Germany
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Marii Skłodowska-Curie 3a, 80-210 Gdansk, Poland
| | - Sebastian Ewen
- Department of Internal Medicine, Saarland University Hospital, Geb. 41, Kirrberger Strasse 1, 66421 Homburg/Saar, Germany
| | - Luis Ruilope
- Department of Cardiovascular Risk, Hypertension Unit and Cardiorenal Translational Research Laboratory, Institute of Research i + 12, Hospital Universitario 12 de Octubre and CIBERCV, School of Doctoral Studies and Research, Universidad Europea de Madrid, Av. Cordoba, s/n, 28041 Madrid, Spain
| | - Markus Schlaich
- Department of Medicine, Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, The University of Western Australia, 197 Wellington St, Perth, WA 6000, Australia
| | - Bryan Williams
- Department of Medicine, Institute of Cardiovascular Sciences, University College London, National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, Gower St, Bloomsbury, London WC1E 6BT, UK
| | - Martin Fahy
- Coronary and Structural Heart Division, Medtronic PLC, 3576 Unocal Place, Santa Rosa, CA 95403, USA
| | - Giuseppe Mancia
- Professor Emeritus, University of Milano-Bicocca, P.za dei Daini, 4 - 20126 Milano, Italy
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Naduvathumuriyil T, Held U, Steigmiller K, Denegri A, Cantatore S, Obeid S, Flammer AJ, Ruschitzka F, Lüscher TF, Sudano I. Clinical benefits and safety of renal denervation in severe arterial hypertension: A long‐term follow‐up study. J Clin Hypertens (Greenwich) 2020; 22:1854-1864. [DOI: 10.1111/jch.14005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/01/2020] [Accepted: 05/17/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Tino Naduvathumuriyil
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute University of Zurich Zurich Switzerland
| | - Klaus Steigmiller
- Epidemiology, Biostatistics and Prevention Institute University of Zurich Zurich Switzerland
| | - Andrea Denegri
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
- Cardiology Division Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio EmiliaPoliclinico di Modena Modena Italy
| | - Silviya Cantatore
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Slayman Obeid
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Andreas J. Flammer
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Frank Ruschitzka
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Thomas F. Lüscher
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
- Royal Brompton & Harefield HospitalImperial College London UK
- Center for Molecular Cardiology University of Zurich Zurich Switzerland
| | - Isabella Sudano
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
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Development and Evaluation of a Disease Large Animal Model for Preclinical Assessment of Renal Denervation Therapies. Animals (Basel) 2020; 10:ani10091446. [PMID: 32824935 PMCID: PMC7552649 DOI: 10.3390/ani10091446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 11/17/2022] Open
Abstract
New-generation catheters-based renal denervation (RDN) is under investigation for the treatment of uncontrolled hypertension (HTN). We assessed the feasibility of a large animal model of HTN to accommodate the human RDN devices. Ten minipigs were instrumented to measure blood pressure (BP) in an awake-state. HTN was induced with subcutaneous 11-deoxycorticosterone (DOCA, 100 mg/kg) implants. Five months after, the surviving animals underwent RDN with the Symplicity® system. Norepinephrine (NE) renal gradients were determined before and 1 month after RDN. Renal arteries were processed for histological (hematoxylin-eosin, Movat pentachrome) and immunohistochemical (S100, tyrosine-hydroxylase) analyses. BP significantly rose after DOCA implants. Six animals died prematurely, mainly from infectious causes. The surviving animals showed stable BP levels after 5 months. One month after RDN, nerve damage was showed in three animals, with impedance drop >10%, NE gradient drop and reduction in BP. The fourth animal showed no nerve damage, impedance drop <10%, NE gradient increase and no change in BP. In conclusion, the minipig model of DOCA-induced HTN is feasible, showing durable effects. High mortality should be addressed in next iterations of this model. RDN may partially offset the DOCA-induced HTN. Impedance drop and NE renal gradient could be markers of RDN success.
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Rodriguez-Leor O, Segura J, García Donaire JA, Gutiérrez-Ibañes E, Oliveras A, Mediavilla JD, Serrador A, Prado JC, Nuñez-Gil I, Díez-Delhoyo F, Clarà Velasco A, Jaén Águila F, Amat-Santos I, Bayes-Genis A, Troya Saborido MI. Denervación renal para el tratamiento de la hipertensión arterial resistente en España. Registro Flex-Spyral. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Blood pressure changes after renal denervation are more pronounced in women and nondiabetic patients: findings from the Austrian Transcatheter Renal Denervation Registry. J Hypertens 2020; 37:2290-2297. [PMID: 31335512 DOI: 10.1097/hjh.0000000000002190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVES Three recently published sham-controlled studies proved the efficacy of renal denervation (RDN) in hypertensive patients. The study presented here analyzed a nationwide multicentre registry database to clarify which patient subgroups benefit most from radiofrequency RDN. METHODS This is a post hoc analysis from the multicentre Austrian Transcatheter Renal Denervation Registry hosted by the Austrian Society of Hypertension. We correlated change of SBP after RDN to sex and presence/absence of comorbidities. Univariable correlation and multiple linear regression analyses were performed. RESULTS Two hundred and ninety-one patients (43% women, median age 64 years) undergoing RDN between April 2011 and September 2014 were included in this analysis. Mean baseline ambulatory 24 h BP (systolic/diastolic) was 150 ± 18/89 ± 14 mmHg and mean baseline office BP was 170 ± 16/94 ± 14 mmHg.After RDN, mean ambulatory 24 h BP reduction was 9 ± 19/6 ± 16 mmHg. The following features were associated with a good response to RDN: high baseline systolic ambulatory BP, high baseline diastolic office BP, female sex, absence of diabetes mellitus, and absence of peripheral artery disease. Multivariable analysis identified female sex and absence of diabetes mellitus as strongest predictors for ambulatory BP reduction, although those groups had the lowest baseline ambulatory BP. DISCUSSION Ambulatory BP reductions after RDN were substantially more pronounced in female and in nondiabetic patients despite lower baseline BP. It is concluded that in terms of efficacy female patients and nondiabetic patients might benefit more from RDN.
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Aronow HD, Sardar P. Renal Sympathetic Denervation for Hypertension: Outside-In and Inside-Out. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:538-539. [PMID: 32563528 DOI: 10.1016/j.carrev.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Herbert D Aronow
- Division of Cardiology, Warren Alpert Medical School at Brown University/Lifespan Cardiovascular Institute, Providence, RI, USA.
| | - Partha Sardar
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
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Shao C, Zhou Y, You T, Xue B, Stella PR, Jiang TB, Miao Z, Xu L, Yin, Lan L, Rong G. Laparoscopic based renal denervation in a canine neurogenic hypertension model. BMC Cardiovasc Disord 2020; 20:285. [PMID: 32527220 PMCID: PMC7291739 DOI: 10.1186/s12872-020-01546-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 05/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous renal denervation (RDN) studies showed controversial results in reducing blood pressure. The aim of this study was to provide evidence supporting the effectiveness of laparoscopic-based renal denervation (L-RDN) in treating hypertension. METHODS Sixteen Beagle dogs were randomly divided into RDN group (n = 12) and sham group (n = 4). Neurogenic hypertension was generated in all dogs via carotid artery route. L-RDN was performed in the RDN group, with sham operation performed as a control. Blood pressure (BP) changes were recorded at 2, 4, 6, and 8 weeks after the procedure. Changes in serum creatinine (sCr), blood urea nitrogen (BUN) and level of norepinephrine (NE) were analyzed. Histological changes of kidney and renal arteries were also evaluated. RESULTS BP and NE levels were significantly elevated after hypertension induction (p < 0.01). Systolic and diastolic BP of RDN group were decreased by 15.5 mmHg and 7.3 mmHg (p < 0.0001 and p = 0.0021, respectively) at the eighth week after L-RDN. Invasive systolic and diastolic BP of RDN group were significantly decreased by 14.5 mmHg and 15.3 mmHg (p < 0.0001). In contrast, there was no significant decrease in blood pressure in the sham group. In addition, RDN group but not the sham group showed a significant decrease in NE levels (p < 0.001), while no significant changes in sCr and BUN were observed in both groups. Pathological examinations showed no discernible damage, tear, or dissection to the renal arteries in RND group. CONCLUSIONS L-RDN lowered BP and NE levels in hypertensive dogs without affecting renal artery morphology and kidney function.
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Affiliation(s)
- Chunlai Shao
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd., Gusu District, Suzhou, 215004, Jiangsu, China
| | - Yan Zhou
- Department of Urology, Anhui No.2 Provincial People's Hospital, 1868 Dangshan Road, Hefei, 230000, Anhui, China
| | - Tao You
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd., Gusu District, Suzhou, 215004, Jiangsu, China
| | - Boxin Xue
- Department of Urology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd., Gusu District, Suzhou, 215004, Jiangsu, China
| | - Pieter R Stella
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Ting Bo Jiang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, 899 Pinghai Rd., Gusu District, Suzhou, 215000, Jiangsu, China.
| | - Zhigang Miao
- Institute of Neuroscience, Laboratory Animal Center, Soochow University, 199 Ren Ai Rd. Industrial Park, Suzhou, 215123, Jiangsu, China
| | - Longjiang Xu
- Department of Pathology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd., Gusu District, Suzhou, 215004, Jiangsu, China
| | - Yin
- Laboratory Animal Center, Soochow University, 199 Ren Ai Rd. Industrial Park, Suzhou, 215123, Jiangsu, China
| | - Longsheng Lan
- Department of Publicity, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd., Gusu District, Suzhou, 215004, Jiangsu, China
| | - Guang Rong
- Department of Nuclear Medicine, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd., Gusu District, Suzhou, 215004, Jiangsu, China
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Catheter-based renal denervation as adjunct to pulmonary vein isolation for treatment of atrial fibrillation: a systematic review and meta-analysis. J Hypertens 2020; 38:783-790. [DOI: 10.1097/hjh.0000000000002335] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Kobalava ZD, Konradi AO, Nedogoda SV, Shlyakhto EV, Arutyunov GP, Baranova EI, Barbarash OL, Boitsov SA, Vavilova TV, Villevalde SV, Galyavich AS, Glezer MG, Grineva EN, Grinstein YI, Drapkina OM, Zhernakova YV, Zvartau NE, Kislyak OA, Koziolova NA, Kosmacheva ED, Kotovskaya YV, Libis RA, Lopatin YM, Nebiridze DV, Nedoshivin AO, Ostroumova OD, Oschepkova EV, Ratova LG, Skibitsky VV, Tkacheva ON, Chazova IE, Chesnikova AI, Chumakova GA, Shalnova SA, Shestakova MV, Yakushin SS, Yanishevsky SN. Arterial hypertension in adults. Clinical guidelines 2020. ACTA ACUST UNITED AC 2020. [DOI: 10.15829/1560-4071-2020-3-3786] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Arterial hypertension in adults. Clinical guidelines 2020
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Kario K, Kim BK, Aoki J, Wong AYT, Lee YH, Wongpraparut N, Nguyen QN, Ahmad WAW, Lim ST, Ong TK, Wang TD. Renal Denervation in Asia: Consensus Statement of the Asia Renal Denervation Consortium. Hypertension 2020; 75:590-602. [PMID: 32008432 PMCID: PMC8032219 DOI: 10.1161/hypertensionaha.119.13671] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The Asia Renal Denervation Consortium consensus conference of Asian physicians actively performing renal denervation (RDN) was recently convened to share up-to-date information and regional perspectives, with the goal of consensus on RDN in Asia. First- and second-generation trials of RDN have demonstrated the efficacy and safety of this treatment modality for lowering blood pressure in patients with resistant hypertension. Considering the ethnic differences of the hypertension profile and demographics of cardiovascular disease demonstrated in the SYMPLICITY HTN (Renal Denervation in Patients With Uncontrolled Hypertension)-Japan study and Global SYMPLICITY registry data from Korea and Taiwan, RDN might be an effective hypertension management strategy in Asia. Patient preference for device-based therapy should be considered as part of a shared patient-physician decision process. A practical population for RDN treatment could consist of Asian patients with uncontrolled essential hypertension, including resistant hypertension. Opportunities to refine the procedure, expand the therapy to other sympathetically mediated diseases, and explore the specific effects on nocturnal and morning hypertension offer a promising future for RDN. Based on available evidence, RDN should not be considered a therapy of last resort but as an initial therapy option that may be applied alone or as a complementary therapy to antihypertensive medication.
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Affiliation(s)
- Kazuomi Kario
- From the Department of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tokyo, Japan (K.K.)
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (B.-K.K.)
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan (J.A.)
| | - Anthony Yiu-tung Wong
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, HKSAR (A.Y.-T.W.)
| | - Ying-Hsiang Lee
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan (Y.-H.L.)
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan (Y.-H.L.)
| | - Nattawut Wongpraparut
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (N.W.)
| | - Quang Ngoc Nguyen
- Department of Cardiology, Hanoi Medical University, Vietnam (Q.N.N.)
| | - Wan Azman Wan Ahmad
- Division of Cardiology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia (W.A.W.A)
| | - Soo Teik Lim
- Department of Cardiology, National Heart Center, Singapore (S.T.L.)
| | - Tiong Kiam Ong
- Department of Cardiology, Sarawak Heart Centre, Malaysia (T.K.O.)
| | - Tzung-Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-D.W.)
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Mahfoud F, Renkin J, Sievert H, Bertog S, Ewen S, Böhm M, Lengelé JP, Wojakowski W, Schmieder R, van der Giet M, Parise H, Haratani N, Pathak A, Persu A. Alcohol-Mediated Renal Denervation Using the Peregrine System Infusion Catheter for Treatment of Hypertension. JACC Cardiovasc Interv 2020; 13:471-484. [DOI: 10.1016/j.jcin.2019.10.048] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 12/20/2022]
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Peixoto AJ. Is There a Role for Device Therapies in Resistant Hypertension?: The CON Side. KIDNEY360 2020; 1:9-13. [PMID: 35372851 PMCID: PMC8808493 DOI: 10.34067/kid.0000742019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Aldo J. Peixoto
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; and
- Hypertension Program, Yale New Haven Hospital Heart and Vascular Center, New Haven, Connecticut
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Fengler K, Rommel KP, Blazek S, Besler C, Hartung P, von Roeder M, Petzold M, Winkler S, Höllriegel R, Desch S, Thiele H, Lurz P. A Three-Arm Randomized Trial of Different Renal Denervation Devices and Techniques in Patients With Resistant Hypertension (RADIOSOUND-HTN). Circulation 2019; 139:590-600. [PMID: 30586691 DOI: 10.1161/circulationaha.118.037654] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Both radiofrequency and ultrasound endovascular renal sympathetic denervation (RDN) have proven clinical efficacy for the treatment of hypertension. We performed a head-to-head comparison of these technologies. METHODS Patients with resistant hypertension were randomly assigned in a 1:1:1 manner to receive either treatment with (1) radiofrequency RDN of the main renal arteries; (2) radiofrequency RDN of the main renal arteries, side branches, and accessories; or (3) an endovascular ultrasound-based RDN of the main renal artery. The primary end point was change in systolic daytime ambulatory blood pressure at 3 months. RESULTS Between June 2015 and June 2018, 120 patients were enrolled (mean age, 64±9 years±SD; mean daytime blood pressure, 153/86±12/13 mm Hg). Of these, 39 were randomly assigned to radiofrequency main renal artery ablation, 39 to combined radiofrequency ablation of the main artery and branches, and 42 to ultrasound-based treatment. Baseline daytime blood pressure, clinical characteristics, and treatment were well balanced between the groups. At 3 months, systolic daytime ambulatory blood pressure decreased by 9.5±12.3 mm Hg ( P<0.001) in the whole cohort. Although blood pressure was significantly more reduced in the ultrasound ablation group than in the radiofrequency ablation group of the main renal artery (-13.2±13.7 versus -6.5±10.3 mm Hg; mean difference, -6.7 mm Hg; global P=0.038 by ANOVA, adjusted P=0.043), no significant difference was found between the radiofrequency ablation groups (-8.3±11.7 mm Hg for additional side branch ablation; mean difference, -1.8 mm Hg; adjusted P>0.99). Similarly, the blood pressure reduction was not found to be significantly different between the ultrasound and the side branch ablation groups. Frequencies of blood pressure response ≥5 mm Hg were not significantly different (global P=0.77). CONCLUSIONS In patients with resistant hypertension, endovascular ultrasound-based RDN was found to be superior to radiofrequency ablation of the main renal arteries only, whereas a combined approach of radiofrequency ablation of the main arteries, accessories, and side branches was not. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT02920034.
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Affiliation(s)
- Karl Fengler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Karl-Philipp Rommel
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Stephan Blazek
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Philipp Hartung
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Maximilian von Roeder
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Martin Petzold
- Leipzig Heart Institute at Heart Center Leipzig, Germany (M.P.)
| | - Sindy Winkler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Robert Höllriegel
- Technische Universität Dresden, Heart Center Dresden University Hospital, Germany (R.H.)
| | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
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Papademetriou V, Stavropoulos K, Imprialos K, Doumas M, Schmieder RE, Pathak A, Tsioufis C. New data, new studies, new hopes for renal denervation in patients with uncontrolled hypertension. INTERNATIONAL JOURNAL CARDIOLOGY HYPERTENSION 2019; 3:100022. [PMID: 33447752 PMCID: PMC7803019 DOI: 10.1016/j.ijchy.2019.100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/11/2019] [Accepted: 11/07/2019] [Indexed: 11/27/2022]
Abstract
Background following the publication of SYMPLICITY HTN-3 the field of renal of denervation was put on hold. Although SYMPLICITY HTN-3 was well-designed and sham-controlled trial it failed to show any meaningful reduction in office or 24 h ambulatory blood pressure. The procedure was however safe and allowed research to continue. Although several pitfalls of the study have been pointed out, incomplete renal denervation was also implicated. Since then, a great deal of basic and clinical research took place and will be briefly commented on in this article. Methods and results Before and after SYMPLICITY-HTN-3, numerous uncontrolled, single or unblinded studies have shown substantial office BP reduction ranging from -7.7 to -32 mmHg and ambulatory BP ranging from -2.2 to 10.2 mmHg. Average weighted office systolic BP reduction was -20.8 mmHg and weighted average 24 h ambulatory BPM reduction was -7.8 mmHg. National and international registries have shown similar BP reductions, but results remained unconvincing due to lack of reliable sham controls. In recent years, 5 well-designed sham - controlled studies (beyond, SYMPLICITY-HTN-3) have been published. Of those studies two were single center and three were multicenter international studies. Four studies used single tip or multi-electrode, radiofrequency catheters and one used focused ultrasound. The three multicenter studies reported positive-placebo subtracted results and established BP reductions measured both in the office and by ambulatory monitoring. No serious adverse events were reported. Conclusions It can therefore be concluded that the latest sham controlled studies established efficacy and safety of renal denervation.
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Affiliation(s)
| | - Konstantinos Stavropoulos
- Georgetown University and VA Medical Center, Washington DC, USA.,Aristotle University, Thessaloniki, Greece
| | - Kostas Imprialos
- Georgetown University and VA Medical Center, Washington DC, USA.,Aristotle University, Thessaloniki, Greece
| | | | - Roland E Schmieder
- University Hospital Erlangen, Friedrich Alexander University, Erlangen/Nuremberg, Germany
| | - Atul Pathak
- Clinique Pasteur, Hypertension, Risk Factors and Heart Failure Unit, INSERM 1048, Clinical Research Center, Toulouse, France
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Lobo MD, Sharp ASP, Kapil V, Davies J, de Belder MA, Cleveland T, Bent C, Chapman N, Dasgupta I, Levy T, Mathur A, Matson M, Saxena M, Cappuccio FP. Joint UK societies' 2019 consensus statement on renal denervation. Heart 2019; 105:1456-1463. [PMID: 31292190 PMCID: PMC6817707 DOI: 10.1136/heartjnl-2019-315098] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 02/06/2023] Open
Abstract
Improved and durable control of hypertension is a global priority for healthcare providers and policymakers. There are several lifestyle measures that are proven to result in improved blood pressure (BP) control. Moreover, there is incontrovertible evidence from large scale randomised controlled trials (RCTs) that antihypertensive drugs lower BP safely and effectively in the long-term resulting in substantial reduction in cardiovascular morbidity and mortality. Importantly, however, evidence is accumulating to suggest that patients neither sustain long-term healthy behaviours nor adhere to lifelong drug treatment regimens and thus alternative measures to control hypertension warrant further investigation. Endovascular renal denervation (RDN) appears to hold some promise as a non-pharmacological approach to lowering BP and achieves renal sympathectomy using either radiofrequency energy or ultrasound-based approaches. This treatment modality has been evaluated in clinical trials in humans since 2009 but initial studies were compromised by being non-randomised, without sham control and small in size. Subsequently, clinical trial design and rigour of execution has been greatly improved resulting in recent sham-controlled RCTs that demonstrate short-term reduction in ambulatory BP without any significant safety concerns in both medication-naïve and medication-treated hypertensive patients. Despite this, the joint UK societies still feel that further evaluation of this therapy is warranted and that RDN should not be offered to patients outside of the context of clinical trials. This document reviews the updated evidence since our last consensus statement from 2014 and provides a research agenda for future clinical studies.
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Affiliation(s)
- Melvin D Lobo
- William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK
- Department of Cardiovascular Medicine, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Andrew S P Sharp
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Department of Cardiology, Exeter Hospital, University of Exeter, Exeter, UK
| | - Vikas Kapil
- William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK
- Department of Cardiovascular Medicine, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Justin Davies
- Department of Cardiology, Imperial College Healthcare Trust, London, UK
| | - Mark A de Belder
- Department of Cardiology, James Cook University Hospital, Middlesborough, UK
- The National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
| | - Trevor Cleveland
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHSFT, Northern General Hospital, Sheffield, UK
| | - Clare Bent
- Department of Interventional Radiology, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Neil Chapman
- Department of Cardiology, Imperial College Healthcare Trust, London, UK
| | - Indranil Dasgupta
- Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK
| | - Terry Levy
- Department of Interventional Radiology, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Anthony Mathur
- William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK
- Department of Cardiovascular Medicine, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | - Manish Saxena
- William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK
- Department of Cardiovascular Medicine, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Francesco P Cappuccio
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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Rodriguez-Leor O, Segura J, García Donaire JA, Gutiérrez-Ibañes E, Oliveras A, Mediavilla JD, Serrador A, Prado JC, Nuñez-Gil I, Díez-Delhoyo F, Clarà Velasco A, Jaén Águila F, Amat-Santos I, Bayes-Genis A, Troya Saborido MI. Renal denervation for the treatment of resistant hypertension in Spain. The Flex-Spyral Registry. ACTA ACUST UNITED AC 2019; 73:615-622. [PMID: 31561981 DOI: 10.1016/j.rec.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES Renal denervation is a percutaneous intervention for the treatment of resistant hypertension. Randomized studies have shown contradictory results on its efficacy. We present the results of a renal denervation registry for the treatment of resistant hypertension in real-life patients in Spain. METHODS Multicenter registry of consecutive patients with resistant hypertension treated with renal denervation in Spain between 2009 and 2018. RESULTS We included 125 patients (mean age, 56 years; 41% female; mean onset of hypertension 14±9 years previously). Office systolic and diastolic blood pressure and ambulatory blood pressure monitoring decreased 6 months after the intervention (166±20/95±16 to 149±22/87±16 mmHg and 151±14/89±12 to 143±15/84±11, both P <.0001). At 12 months, the blood pressure reduction was maintained and the number of antihypertensive drugs decreased from 4.9±1.2 to 4.4±1.5 (P=.0001). There were no significant procedure-related complications. The response rate to denervation at 1 year was 80%, but there were wide differences between centers. CONCLUSIONS In patients with resistant hypertension, treatment with renal denervation was related to a decrease in office blood pressure and, more importantly, in ambulatory blood pressure monitoring, with a significant reduction in pharmacological treatment.
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Affiliation(s)
- Oriol Rodriguez-Leor
- Institut del Cor (ICOR), Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut per la Recerca Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
| | - Julián Segura
- Departamento de Nefrología, Hospital 12 de Octubre, Madrid, Spain
| | | | - Enrique Gutiérrez-Ibañes
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Cardiología, Hospital Gregorio Marañón, Madrid, Spain
| | - Anna Oliveras
- Departamento de Nefrología, Hospital del Mar, Barcelona, Spain
| | | | - Ana Serrador
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Cardiología, Hospital Clínico, Valladolid, Spain
| | | | - Iván Nuñez-Gil
- Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Felipe Díez-Delhoyo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Cardiología, Hospital Gregorio Marañón, Madrid, Spain
| | | | | | - Ignacio Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Cardiología, Hospital Clínico, Valladolid, Spain
| | - Antoni Bayes-Genis
- Institut del Cor (ICOR), Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut per la Recerca Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - María Isabel Troya Saborido
- Institut per la Recerca Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Nefrología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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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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Selective renal denervation guided by renal nerve stimulation: mapping renal nerves for unmet clinical needs. J Hum Hypertens 2019; 33:716-724. [DOI: 10.1038/s41371-019-0244-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 07/10/2019] [Accepted: 07/29/2019] [Indexed: 01/01/2023]
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Abstract
PURPOSE OF REVIEW Interventional cardiology and in particular the field of renal denervation is subject to constant change. This review provides an up to date overview of renal denervation trials and an outlook on what to expect in the future. RECENT FINDINGS After the sham-controlled SYMPLICITY HTN-3 trial dampened the euphoria following early renal denervation trials, the recently published results of the sham-controlled SPYRAL HTN and RADIANCE HTN trials provided proof-of-principle for the blood pressure-lowering efficacy of renal denervation. However, these studies underline the major issue of patients' non-adherence to antihypertensive medication as well as the need for reliable patient- and procedure-related predictors of response. The second generation of sham-controlled renal denervation trials provided proof of principle for the blood pressure-lowering efficacy of RDN. However, larger trials have to assess long-term safety and efficacy.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany.
| | - Milan A Wolf
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
| | - Sean S Scholz
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
| | - Mathias Hohl
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
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Renal sympathetic denervation for treatment of hypertension: where are we now in 2019? Curr Opin Nephrol Hypertens 2019; 28:498-506. [PMID: 31268917 DOI: 10.1097/mnh.0000000000000532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Although sound physiological principles and surgical precedent underpin renal denervation as a therapy for treatment resistant hypertension, and early clinical studies had produced encouraging results, the first sham-controlled study (SYMPLICITY HTN-3) failed to achieve its primary efficacy endpoint. Lessons learnt from this trial, and the knowledge derived from further animal and autopsy work, have been applied in three recently published sham-controlled trials. RECENT FINDINGS These trials - SPYRAL OFF-MED, RADIANCE SOLO and SPYRAL ON-MED - using newer technologies, demonstrate a 5-10 mmHg incremental reduction in ambulatory SBP from RDN against sham-control, in patients with mild-to-moderate hypertension taking 0-3 drugs. SUMMARY These results provide proof of principle of the blood pressure-lowering effect of renal denervation. We now require data on long-term safety and durability of the procedure. Research is needed to identify predictive markers of response as about one-third of individuals do not respond to renal denervation. Hard-outcome data would be welcome but might be difficult to acquire. Individuals with treatment resistance are obvious treatment candidates, but RDN may also potentially benefit those with medication nonadherence and/or intolerance and those unwilling to take pills.
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Pappaccogli M, Di Monaco S, Georges CM, Petit G, Eula E, Ritscher S, Lengelé JP, Fanelli E, Severino F, Renkin J, Avataneo V, Wallemacq P, Toennes SW, de Timary P, Rabbia F, Persu A. Predictors of blood pressure control in patients with resistant hypertension after intensive management in two expert centres: the Brussels-Torino experience. Blood Press 2019; 28:336-344. [DOI: 10.1080/08037051.2019.1633908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Marco Pappaccogli
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Silvia Di Monaco
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Coralie M.G. Georges
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Géraldine Petit
- Adult Psychiatry Department and Institute of Neuroscience, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Elisabetta Eula
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Sabrina Ritscher
- Institute of Legal Medicine, Department of Forensic Toxicology, University Hospital Frankfurt, Goethe-University, Frankfurt, Frankfurt/Main, Germany
| | - Jean-Philippe Lengelé
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- Department of Nephrology, Grand Hôpital de Charleroi, Gilly, Belgium
| | - Elvira Fanelli
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesca Severino
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Jean Renkin
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Valeria Avataneo
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Pierre Wallemacq
- Clinical Chemistry Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Centre for Toxicology and Applied Pharmacology, Université Catholique de Louvain, Brussels, Belgium
| | - Stefan W. Toennes
- Institute of Legal Medicine, Department of Forensic Toxicology, University Hospital Frankfurt, Goethe-University, Frankfurt, Frankfurt/Main, Germany
| | - Philippe de Timary
- Adult Psychiatry Department and Institute of Neuroscience, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Franco Rabbia
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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Lurz P, Fengler K. Lessons Learned from RADIOSOUND-HTN: Different Technologies and Techniques for Catheter-based Renal Denervation and Their Effect on Blood Pressure. Interv Cardiol 2019; 14:102-106. [PMID: 31178937 PMCID: PMC6545992 DOI: 10.15420/icr.2019.03.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/23/2019] [Indexed: 12/18/2022] Open
Abstract
The interest in renal denervation (RDN) as a treatment for arterial hypertension has returned with three proof of principle trials that have shown recently RDN to be superior to sham treatment. Nevertheless, many questions about this treatment remain open, including those around the optimal interventional technique and technology. To clarify this important question, the authors designed and conducted the Randomized Trial of Different Renal Denervation Devices and Techniques in Patients with Resistant Hypertension (RADIOSOUND-HTN) trial, which compared three RDN treatment arms in a prospective randomised clinical trial. In this article, they comment on the background and results of this trial, and discuss which conclusions can be drawn from the trial, and which questions remain open for future studies in this field.
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Affiliation(s)
- Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig Leipzig, Germany
| | - Karl Fengler
- Department of Cardiology, Heart Center Leipzig, University of Leipzig Leipzig, Germany
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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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Affiliation(s)
- Reetu R Singh
- From the Department of Physiology, Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Kate M Denton
- From the Department of Physiology, Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
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Wilson AL, Gandhi J, Suh Y, Joshi G, Smith NL, Khan SA. Renal Innervation in Resistant Hypertension: A Review of Pathophysiology and Renal Denervation as Potential Treatment. Curr Hypertens Rev 2019; 16:115-127. [PMID: 30827252 PMCID: PMC7527543 DOI: 10.2174/1573402115666190301154100] [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: 02/19/2019] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 12/30/2022]
Abstract
Background Advances in treatment and increased awareness have improved the prognosis for many patients with hypertension (HTN). Resistant hypertension (RH) refers to a subset of hypertensive individuals who fail to achieve a desired blood pressure (BP) despite concurrent use of 3 different classes antihypertensive agents, one being a diuretic, and proper lifestyle changes. The prevalence and prognosis of RH are unclear owing to its heterogeneous etiologies, risk factors, and secondary comorbidities. Previous research has provided evidence that increased renal sympathetic nerve activity (RSNA) within the renal artery contributes to RH development. Renal denervation (RDN) is a procedure that attempts to ameliorate the effects of heightened RSNA via ablation renal sympathetic fibers. BP reductions associated with RDN may be attributed to decreased norepinephrine spillover, restoration of natriuresis, increasing renal blood flow, and lowering plasma renin activity. Early clinical trials perpetuated positive results, and enthusiasm grew exponentially. However, recent clinical trials have called into question RDN's efficacy. Numerous limitations must be addressed to discern the true effectiveness of RDN as a therapeutic option for RH. Objective We aimed to review the current understanding of RH, the anatomy of renal arteries, physiology of RH on renal arteries, anatomical pathways of the sympathetic involved in RH, RDN as a treatment option, and all relevant clinical trials treating RH with RDN. Methods We piloted a MEDLINE® database search of literature extending from 1980 to 2017, with emphasis on the previous five years, combining keywords such as “resistant hypertension” and
“renal denervation.” Conclusion A plethora of information is available regarding heightened RSNA leading to RH. RDN as a possible treatment option has shown a range of results. Reconciling RDN's true efficacy requires future trials to increased sites of nerve ablation, standardized protocol, increased anatomical understanding per individual basis, stricter guidelines regarding study design, increased operator experience, and integrating the use of a multielectrode catheter.
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Affiliation(s)
- Anthony L Wilson
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, United States
| | - Jason Gandhi
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, United States
| | - Yiji Suh
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, United States
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, NY 11968, United States
| | - Noel L Smith
- Foley Plaza Medical, New York, NY 10007, United States
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, United States
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Papademetriou V, Stavropoulos K, Doumas M, Tsioufis K. Now That Renal Denervation Works, How Do We Proceed? Circ Res 2019; 124:693-695. [DOI: 10.1161/circresaha.119.314695] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Vasilios Papademetriou
- From the Department of Cardiology, VA Medical Center, Georgetown University, Washington, DC (V.P.)
| | | | - Michael Doumas
- Faculty of Medicine, Aristotle University of Thessaloniki, Greece (K.S., M.D.)
| | - Konstantinos Tsioufis
- Department of Cardiology, National and Kapodistrian University of Athens, Greece (K.T.)
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Böhm M, Mahfoud F, Townsend RR, Kandzari DE, Pocock S, Ukena C, Weber MA, Hoshide S, Patel M, Tyson CC, Weil J, Agdirlioglu T, Fahy M, Kario K. Ambulatory heart rate reduction after catheter-based renal denervation in hypertensive patients not receiving anti-hypertensive medications: data from SPYRAL HTN-OFF MED, a randomized, sham-controlled, proof-of-concept trial. Eur Heart J 2019; 40:743-751. [DOI: 10.1093/eurheartj/ehy871] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/22/2018] [Accepted: 12/18/2018] [Indexed: 01/01/2023] Open
Affiliation(s)
- Michael Böhm
- Department of Internal Medicine III, University Hospital of Saarland, Saarland University, Kirrberger Street 1, Homburg/Saar, Germany
| | - Felix Mahfoud
- Department of Internal Medicine III, University Hospital of Saarland, Saarland University, Kirrberger Street 1, Homburg/Saar, Germany
| | - Raymond R Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - David E Kandzari
- Department of Interventional Cardiology, Piedmont Heart Institute, 275 Collier Rd NW #500, Atlanta, GA, USA
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, UK
| | - Christian Ukena
- Department of Internal Medicine III, University Hospital of Saarland, Saarland University, Kirrberger Street 1, Homburg/Saar, Germany
| | - Michael A Weber
- Department of Medicine, SUNY Downstate College of Medicine, 450 Clarkson Ave, Brooklyn, NY, USA
| | - Satoshi Hoshide
- Department of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Tochigi-ken, Japan
| | - Manesh Patel
- Department of Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, USA
| | - Crystal C Tyson
- Department of Internal Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC, USA
| | - Joachim Weil
- Department of Cardiology, Sana Cardiomed Heart Center, Kronsforder Allee 71, Lübeck, Germany
| | - Tolga Agdirlioglu
- Department of Cardiology, Sana Cardiomed Heart Center, Kronsforder Allee 71, Lübeck, Germany
| | | | - Kazuomo Kario
- Department of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Tochigi-ken, Japan
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Sakaoka A, Rousselle SD, Hagiwara H, Tellez A, Hubbard B, Sakakura K. Safety of catheter-based radiofrequency renal denervation on branch renal arteries in a porcine model. Catheter Cardiovasc Interv 2018; 93:494-502. [PMID: 30407718 PMCID: PMC6587466 DOI: 10.1002/ccd.27953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/22/2018] [Accepted: 10/10/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We aimed to investigate the safety of radiofrequency (RF)-renal denervation (RDN) on branch renal arteries (RAs) in a porcine model. BACKGROUND The efficacy of RF-RDN was enhanced by treatment of the branch RA, in addition to the main RA. However, there are concerns regarding the safety of RF-RDN on branch RA because of their smaller diameter and proximity to the kidney. METHODS RF was delivered to 24 RA from 12 swine. A total of 8 RA from 4 swine were untreated. Treated RA were examined by angiography and histopathology at 7, 30, and 90 days. Serum creatinine concentration, biophysical parameters during RF delivery, and renal norepinephrine concentration were also assessed. RESULTS Angiography revealed minimal late lumen loss and diameter stenosis in the main and branch RA at any time point. There was no change in serum creatinine after RF-RDN. Histopathologically, no augmentation of medial damage or neointimal formation was found in branch RA compared with main RA. No or minimal damage to surrounding tissues including the kidneys, ureters, lymph nodes, and muscles was observed at any time point in both the main and branch RA. Equivalent electrode temperature in the main and branch RA was achieved by automatic adjustment of output power by the generator. The renal norepinephrine concentration was significantly lower in the treated group compared with the untreated group. CONCLUSIONS RF-RDN on branch RA was safe in a porcine model, with stenosis-free healing of treated arteries and negligible kidney damage at 7, 30, and 90 days.
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Affiliation(s)
- Atsushi Sakaoka
- Evaluation Center, R&D Administration and Promotion Department, Terumo Corporation, Kanagawa, Japan
| | | | - Hitomi Hagiwara
- Evaluation Center, R&D Administration and Promotion Department, Terumo Corporation, Kanagawa, Japan
| | - Armando Tellez
- Alizée Pathology, LLC, Thurmont, Maryland.,Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | | | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Chan PL, Tan FHS. Renin dependent hypertension caused by accessory renal arteries. Clin Hypertens 2018; 24:15. [PMID: 30410790 PMCID: PMC6211501 DOI: 10.1186/s40885-018-0100-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 10/08/2018] [Indexed: 11/18/2022] Open
Abstract
Background Hypokalemia in the presence of hypertension is often attributed to primary hyperaldosteronism as a cause of secondary hypertension, however secondary hyperaldosteronism may present similarly. Accessory renal arteries are variants in the vascular anatomy which are often thought to be innocuous but in some circumstances can cause renovascular hypertension leading to secondary hyperaldosteronism. Case presentation We report 2 cases of hypertension with secondary hyperaldosteronism associated with accessory renal arteries. Both patients presented with hypokalemia and further investigations revealed hyperaldosteronism with unsuppressed renin levels. Imaging studies showed the presence of accessory renal artery. Conclusion Accessory renal arteries are a potential cause renovascular hypertension which can be detected via CT angiography or magnetic resonance angiography. Hormonal evaluation should be undertaken to determine whether its presence contributes to hypertension in the patient as targeted treatment such as aldosterone antagonist can be initiated. Surgical intervention or renal denervation may be considered in resistant cases.
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Affiliation(s)
- Pei Lin Chan
- Department of Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586 Kuching, Sarawak Malaysia
| | - Florence Hui Sieng Tan
- Department of Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586 Kuching, Sarawak Malaysia
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