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Hu X, Liao G, Wang J, Ye Y, Chen X, Bai L, Shi F, Liu K, Peng Y. Patient-Specific Factors Predicting Renal Denervation Response in Patients With Hypertension: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2024; 13:e034915. [PMID: 38979821 PMCID: PMC11292764 DOI: 10.1161/jaha.124.034915] [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: 02/11/2024] [Accepted: 06/05/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The accurate selection of patients likely to respond to renal denervation (RDN) is crucial for optimizing treatment outcomes in patients with hypertension. This systematic review was designed to evaluate patient-specific factors predicting the RDN response. METHODS AND RESULTS We focused on individuals with hypertension who underwent RDN. Patients were categorized based on their baseline characteristics. The primary outcome was blood pressure (BP) reduction after RDN. Both randomized controlled trials and nonrandomized studies were included. We assessed the risk of bias using corresponding tools and further employed the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the overall quality of evidence. A total of 50 studies were ultimately included in this systematic review, among which 17 studies were for meta-analysis. Higher baseline heart rate and lower pulse wave velocity were shown to be associated with significant antihypertensive efficacy of RDN on 24-hour systolic BP reduction (weighted mean difference, -4.05 [95% CI, -7.33 to -0.77]; weighted mean difference, -7.20 [95% CI, -9.79 to -4.62], respectively). In addition, based on qualitative analysis, higher baseline BP, orthostatic hypertension, impaired baroreflex sensitivity, and several biomarkers are also reported to be associated with significant BP reduction after RDN. CONCLUSIONS In patients with hypertension treated with the RDN, higher heart rate, and lower pulse wave velocity were associated with significant BP reduction after RDN. Other factors, including higher baseline BP, hypertensive patients with orthostatic hypertension, BP variability, impaired cardiac baroreflex sensitivity, and some biomarkers are also reported to be associated with a better BP response to RDN.
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Affiliation(s)
- Xin‐Ru Hu
- Department of CardiologyWest China Hospital, Sichuan UniversityChengduSichuanPeople’s Republic of China
| | - Guang‐Zhi Liao
- Department of CardiologyWest China Hospital, Sichuan UniversityChengduSichuanPeople’s Republic of China
| | - Jun‐Wen Wang
- Department of CardiologyWest China Hospital, Sichuan UniversityChengduSichuanPeople’s Republic of China
| | - Yu‐Yang Ye
- Department of CardiologyWest China Hospital, Sichuan UniversityChengduSichuanPeople’s Republic of China
| | - Xue‐Feng Chen
- Department of CardiologyWest China Hospital, Sichuan UniversityChengduSichuanPeople’s Republic of China
| | - Lin Bai
- Department of CardiologyWest China Hospital, Sichuan UniversityChengduSichuanPeople’s Republic of China
| | - Fan‐Fan Shi
- Department of Clinical Research and Management, Center of Biostatistics, Design, Measurement and Evaluation (CBDME)West China Hospital, Sichuan UniversityChengduSichuanPeople’s Republic of China
| | - Kai Liu
- Department of CardiologyWest China Hospital, Sichuan UniversityChengduSichuanPeople’s Republic of China
| | - Yong Peng
- Department of CardiologyWest China Hospital, Sichuan UniversityChengduSichuanPeople’s Republic of China
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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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Filippone EJ, Naccarelli GV, Foy AJ. Controversies in Hypertension IV: Renal Denervation. Am J Med 2023; 136:857-868. [PMID: 37230403 DOI: 10.1016/j.amjmed.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Abstract
Renal denervation is not a cure for hypertension. Although more recent sham-controlled trials were positive, a significant minority of patients in each trial were unresponsive. The optimal patient or patients need to be defined. Combined systolic/diastolic hypertension appears more responsive than isolated systolic hypertension. It remains uncertain whether patients with comorbidities associated with higher adrenergic tone should be targeted, including obesity, diabetes, sleep apnea, and chronic kidney disease. No biomarker can adequately predict response. A key to a successful response is the adequacy of denervation, which currently cannot be assessed in real time. It is uncertain what is the optimal denervation methodology: radiofrequency, ultrasound, or ethanol injection. Radiofrequency requires targeting the distal main renal artery plus major branches and accessory arteries. Although denervation appears to be safe, conclusive data on quality of life, improved target organ damage, and reduced cardiovascular events/mortality are required before denervation can be generally recommended.
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Affiliation(s)
- Edward J Filippone
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pa.
| | - Gerald V Naccarelli
- Department of Medicine, Penn State University Heart and Vascular Institute; Penn State M.S Hershey Medical Center and College of Medicine, Hershey, Pa
| | - Andrew J Foy
- Department of Medicine, Penn State University Heart and Vascular Institute; Penn State M.S Hershey Medical Center and College of Medicine, Hershey, Pa
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4
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Zeijen VJ, Feyz L, Kardys I, Geleijnse ML, Van Mieghem NM, Zijlstra F, Lafeber M, Van Der Geest RJ, Hirsch A, Daemen J. Association between renal sympathetic denervation and arterial stiffness: the ASORAS study. J Hypertens 2023; 41:476-485. [PMID: 36655697 PMCID: PMC9894147 DOI: 10.1097/hjh.0000000000003361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Renal sympathetic denervation (RDN) reduces blood pressure (BP). However, one out of three patients does not exhibit a significant BP response to the therapy. This study investigates the association between noninvasive vascular stiffness indices and RDN-mediated BP reduction. METHODS In this prospective, single-arm pilot study, patients with systolic office BP at least 140 mmHg, mean 24-h systolic ambulatory blood pressure (ABP) at least 130 mmHg and at least three prescribed antihypertensive drugs underwent radiofrequency RDN. The primary efficacy endpoint was temporal evolution of mean 24-h systolic ABP throughout 1-year post RDN (measured at baseline and 3-6-12 months). Effect modification was studied for baseline ultrasound carotid-femoral and magnetic resonance (MR) pulse wave velocity (PWV), MR aortic distensibility, cardiac MR left ventricular parameters and clinical variables. Statistical analyses were performed using linear mixed-effects models, and effect modification was assessed using interaction terms. RESULTS Thirty patients (mean age 62.5 ± 10.7 years, 50% women) with mean 24-h ABP 146.7/80.8 ± 13.7/12.0 mmHg were enrolled. Following RDN, mean 24-h systolic ABP changed with -8.4 (95% CI: -14.5 to -2.3) mmHg/year ( P = 0.007). Independent effect modifiers were CF-PWV [+2.7 (0.3 to 5.1) mmHg/year change in outcome for every m/s increase in CF-PWV; P = 0.03], daytime diastolic ABP [-0.4 (-0.8 to 0.0) mmHg/year per mmHg; P = 0.03], age [+0.6 (0.2 to 1.0) mmHg/year per year of age; P = 0.006], female sex [-14.0 (-23.1 to -5.0) mmHg/year as compared with men; P = 0.003] and BMI [+1.2 (0.1 to 2.2) mmHg/year per kg/m 2 ; P = 0.04]. CONCLUSION Higher CF-PWV at baseline was associated with a smaller reduction in systolic ABP following RDN. These findings could contribute to improve identification of RDN responders.
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Affiliation(s)
| | | | | | | | | | | | - Melvin Lafeber
- Department of Internal and Vascular Medicine, Erasmus University Medical Center, Rotterdam
| | | | - Alexander Hirsch
- Department of Cardiology
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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McCallinhart PE, Lee YU, Lee A, Anghelescu M, Tonniges JR, Calomeni E, Agarwal G, Lincoln J, Trask AJ. Dissociation of pulse wave velocity and aortic wall stiffness in diabetic db/db mice: The influence of blood pressure. Front Physiol 2023; 14:1154454. [PMID: 37035668 PMCID: PMC10080125 DOI: 10.3389/fphys.2023.1154454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction: Vascular stiffness is a predictor of cardiovascular disease and pulse wave velocity (PWV) is the current standard for measuring in vivo vascular stiffness. Mean arterial pressure is the largest confounding variable to PWV; therefore, in this study we aimed to test the hypothesis that increased aortic PWV in type 2 diabetic mice is driven by increased blood pressure rather than vascular biomechanics. Methods and Results: Using a combination of in vivo PWV and ex vivo pressure myography, our data demonstrate no difference in ex vivo passive mechanics, including outer diameter, inner diameter, compliance (Db/db: 0.0094 ± 0.0018 mm2/mmHg vs. db/db: 0.0080 ± 0.0008 mm2/mmHg, p > 0.05 at 100 mmHg), and incremental modulus (Db/db: 801.52 ± 135.87 kPa vs. db/db: 838.12 ± 44.90 kPa, p > 0.05 at 100 mmHg), in normal versus diabetic 16 week old mice. We further report no difference in basal or active aorta biomechanics in normal versus diabetic 16 week old mice. Finally, we show here that the increase in diabetic in vivo aortic pulse wave velocity at baseline was completely abolished when measured at equivalent pharmacologically-modulated blood pressures, indicating that the elevated PWV was attributed to the concomitant increase in blood pressure at baseline, and therefore "stiffness." Conclusions: Together, these animal model data suggest an intimate regulation of blood pressure during collection of pulse wave velocity when determining in vivo vascular stiffness. These data further indicate caution should be exerted when interpreting elevated PWV as the pure marker of vascular stiffness.
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Affiliation(s)
- Patricia E. McCallinhart
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, United States
- Center for Cardiovascular Research, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Yong Ung Lee
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, United States
- Tissue Engineering Program and Surgical Research, Columbus, OH, United States
| | - Avione Lee
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, United States
- Tissue Engineering Program and Surgical Research, Columbus, OH, United States
| | - Mircea Anghelescu
- Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine (PCOM), Suwanee, GA, United States
| | - Jeffrey R. Tonniges
- Biophysics Graduate Program at The Ohio State University, Columbus, OH, United States
| | - Ed Calomeni
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Gunjan Agarwal
- Biophysics Graduate Program at The Ohio State University, Columbus, OH, United States
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Joy Lincoln
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, United States
- Center for Cardiovascular Research, Nationwide Children’s Hospital, Columbus, OH, United States
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Aaron J. Trask
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, United States
- Center for Cardiovascular Research, Nationwide Children’s Hospital, Columbus, OH, United States
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, OH, United States
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States
- *Correspondence: Aaron J. Trask,
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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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Burlacu A, Brinza C, Floria M, Stefan AE, Covic A, Covic A. Predicting Renal Denervation Response in Resistant High Blood Pressure by Arterial Stiffness Assessment: A Systematic Review. J Clin Med 2022; 11:jcm11164837. [PMID: 36013092 PMCID: PMC9410368 DOI: 10.3390/jcm11164837] [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: 07/30/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Accurately selecting hypertensive candidates for renal denervation (RDN) therapy is required, as one-third of patients who undergo RDN are non-responders. We aimed to systematically review the literature on RDN response prediction using arterial stiffness assessment, optimizing the selection of patients referred for interventional blood pressure lowering procedures. Methods: A literature search was performed in MEDLINE, Embase, Scopus, and Cochrane databases to retrieve potential eligible studies from the inception to 30 June 2022. Results: Ten studies were finally included in this systematic review. Studies consistently documented that invasive pulse wave velocity (PWV) was correlated with RDN’s significant success. Nevertheless, non-invasive ambulatory arterial stiffness index and PWV derived from ambulatory blood pressure monitoring were independent predictors of blood pressure response (p = 0.04 and p < 0.0001). In some studies, magnetic resonance imaging parameters of arterial stiffness (ascending aortic distensibility, total arterial compliance) were correlated with blood pressure reduction (AUC = 0.828, p = 0.006). Conclusions: Assessing arterial stiffness prior to RDN predicted procedural success, since stiffness parameters were strongly correlated with a significant blood pressure response. Our endeavor should be tackled as a step forward in selecting appropriate hypertensive patients scheduled for RDN therapy. Non-invasive measurements could be an alternative to invasive parameters for response prediction.
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Affiliation(s)
- Alexandru Burlacu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
- Department of Interventional Cardiology, Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania
| | - Crischentian Brinza
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
- Department of Interventional Cardiology, Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania
- Correspondence: (C.B.); (M.F.)
| | - Mariana Floria
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
- Department of Internal Medicine and Cardiology—“St. Spiridon Hospital”, 700111 Iasi, Romania
- Correspondence: (C.B.); (M.F.)
| | - Anca Elena Stefan
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
- Dialysis and Renal Transplant Center, Nephrology Clinic, “C.I. Parhon” University Hospital, 700503 Iasi, Romania
| | - Andreea Covic
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
- Dialysis and Renal Transplant Center, Nephrology Clinic, “C.I. Parhon” University Hospital, 700503 Iasi, Romania
| | - Adrian Covic
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
- Dialysis and Renal Transplant Center, Nephrology Clinic, “C.I. Parhon” University Hospital, 700503 Iasi, Romania
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Present Evidence of Determinants to Predict the Efficacy of Renal Denervation. Int J Hypertens 2022; 2022:5694127. [PMID: 35992203 PMCID: PMC9391193 DOI: 10.1155/2022/5694127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Sympathetic overactivation is one of the main contributors to development and progress of hypertension. Renal denervation (RDN) has been evidenced by series of clinical trials for its efficacy and safety to treat overactivated sympathetic nervous system induced diseases. However, the results were inconsistent and not all patients benefited from RDN. Appropriate patient selection and intraoperative factors to improve the efficacy of RDN need to be solved urgently. Over the decade, research studies on the correlations between indicators and the antihypertensive effects have been conducted and made a fairly well progress. Herein, we comprehensively reviewed the research studies on how to make RDN more predictable or improve the efficacy of RDN and summarized these potential indicators or devices which might be applied in clinical settings.
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9
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Li S, Phillips JK. Patient Selection for Renal Denervation in Hypertensive Patients: What Makes a Good Candidate? Vasc Health Risk Manag 2022; 18:375-386. [PMID: 35592729 PMCID: PMC9113553 DOI: 10.2147/vhrm.s270182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/22/2022] [Indexed: 01/03/2023] Open
Affiliation(s)
- Sheran Li
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Correspondence: Sheran Li, Department of Emergency Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West Yanjiang Road, Yuexiu District, Guangzhou, Guangdong Province, 510120, People’s Republic of China, Tel +86 20 81332723, Fax +86 20 8133 2650, Email
| | - Jacqueline K Phillips
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Abstract
Purpose of Review To update on definition, diagnosis, prevalence, patient characteristics, pathophysiology, and treatment of refractory hypertension (RfHTN). Recent Findings Refractory hypertension (RfHTN) is defined as blood pressure (BP) that is uncontrolled despite using ≥ 5 antihypertensive medications of different classes, including a long-acting thiazide diuretic and a mineralocorticoid receptor antagonist (MRA) at maximal or maximally tolerated doses. This new phenotype is different from resistant hypertension (RHTN), defined as BP that is uncontrolled despite using ≥ 3 medications, commonly a long-acting calcium channel blocker (CCB), a blocker of the renin-angiotensin system (angiotensin-converting enzyme [ACE] inhibitor or angiotensin receptor blocker [ARB]), and a diuretic. The RHTN phenotype includes controlled RHTN, BP that is controlled on 4 or more medications. RfHTN is largely attributable to increased sympathetic activity, unlike RHTN, which is mainly due to increased intravascular fluid volume frequently caused by hyperaldosteronism and chronic excessive sodium ingestion. Compared to those with controlled RHTN, patients with RfHTN have a higher prevalence of target organ damage and do not have elevated aldosterone levels. Ongoing clinical trials are assessing the safety and efficacy of using devices to aid with BP control in patients with RfHTN. Summary RfHTN is a separate entity from RHTN and is generally attributable to increased sympathetic activity.
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Fengler K, Reimann P, Rommel KP, Kresoja KP, Blazek S, Unterhuber M, Besler C, von Roeder M, Böhm M, Desch S, Thiele H, Lurz P. Comparison of Long-Term Outcomes for Responders Versus Non-Responders Following Renal Denervation in Resistant Hypertension. J Am Heart Assoc 2021; 10:e022429. [PMID: 34713718 PMCID: PMC8751833 DOI: 10.1161/jaha.121.022429] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Recent trial results support the efficacy of renal sympathetic denervation in lowering blood pressure (BP). While BP reduction in general is associated with a clinically meaningful reduction in cardiovascular events and mortality, such a relationship has not been described for patients undergoing renal sympathetic denervation. Methods and Results Clinical events were assessed in patients who underwent renal sympathetic denervation at our center using telephone‐ and clinical follow‐up, interviews with general practitioners, as well as review of hospital databases. Event rates were compared between BP responders (≥5 mm Hg 24‐hour ambulatory BP reduction) and non‐responders; 296 patients were included. Compared with baseline, 24‐hour systolic ambulatory BP was reduced by 8.3±12.2 mm Hg and diastolic BP by 4.8±7.0 mm Hg (P<0.001 for both) after 3 months. One hundred eighty patients were classified as BP responders and 116 as non‐responders. During a median follow‐up time of 48 months, significantly less major adverse cardiovascular events (cardiovascular death, stroke, myocardial infarction, critical limb ischemia, renal failure) occurred in responders than in non‐responders (22 versus 23 events, hazard ratio [HR], 0.53 [95% CI, 0.28 to 0.97], P=0.041). This was consistent after adjustment for potential confounders as well as confirmed by propensity‐score matching. A proportional relationship was found between BP reduction after 3 months and frequency of major adverse cardiovascular events (HR, 0.75 [95% CI, 0.58 to 0.97] per 10 mm Hg 24‐hour systolic ambulatory BP reduction). Conclusions Based on these observational data, blood pressure response to renal sympathetic denervation is associated with improved long‐term clinical outcome.
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Affiliation(s)
- Karl Fengler
- Department of Cardiology Heart Center Leipzig at University of Leipzig Germany.,Leipzig Heart Institute Leipzig Germany
| | - Paul Reimann
- Department of Cardiology Heart Center Leipzig at University of Leipzig Germany.,Leipzig Heart Institute Leipzig Germany
| | - Karl-Philipp Rommel
- Department of Cardiology Heart Center Leipzig at University of Leipzig Germany.,Leipzig Heart Institute Leipzig Germany
| | - Karl-Patrik Kresoja
- Department of Cardiology Heart Center Leipzig at University of Leipzig Germany.,Leipzig Heart Institute Leipzig Germany
| | - Stephan Blazek
- Department of Cardiology Heart Center Leipzig at University of Leipzig Germany.,Leipzig Heart Institute Leipzig Germany
| | - Matthias Unterhuber
- Department of Cardiology Heart Center Leipzig at University of Leipzig Germany.,Leipzig Heart Institute Leipzig Germany
| | - Christian Besler
- Department of Cardiology Heart Center Leipzig at University of Leipzig Germany.,Leipzig Heart Institute Leipzig Germany
| | - Maximilian von Roeder
- Department of Cardiology Heart Center Leipzig at University of Leipzig Germany.,Leipzig Heart Institute Leipzig Germany
| | - Michael Böhm
- Klinik für Innere Medizin III Kardiologie, Angiologie und Internistische IntensivmedizinSaarland University Hospital Homburg/Saar Germany
| | - Steffen Desch
- Department of Cardiology Heart Center Leipzig at University of Leipzig Germany.,Leipzig Heart Institute Leipzig Germany
| | - Holger Thiele
- Department of Cardiology Heart Center Leipzig at University of Leipzig Germany.,Leipzig Heart Institute Leipzig Germany
| | - Philipp Lurz
- Department of Cardiology Heart Center Leipzig at University of Leipzig Germany.,Leipzig Heart Institute Leipzig Germany
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12
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Mahfoud F, Townsend RR, Kandzari DE, Kario K, Schmieder RE, Tsioufis K, Pocock S, David S, Patel K, Rao A, Walton A, Bloom JE, Weber T, Suppan M, Lauder L, Cohen SA, McKenna P, Fahy M, Böhm M, Weber MA. Changes in Plasma Renin Activity After Renal Artery Sympathetic Denervation. J Am Coll Cardiol 2021; 77:2909-2919. [PMID: 33957242 DOI: 10.1016/j.jacc.2021.04.044] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/23/2021] [Accepted: 04/12/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The renin-angiotensin-aldosterone system plays a key role in blood pressure (BP) regulation and is the target of several antihypertensive medications. Renal denervation (RDN) is thought to interrupt the sympathetic-mediated neurohormonal pathway as part of its mechanism of action to reduce BP. OBJECTIVES The purpose of this study was to evaluate plasma renin activity (PRA) and aldosterone before and after RDN and to assess whether these baseline neuroendocrine markers predict response to RDN. METHODS Analyses were conducted in patients with confirmed absence of antihypertensive medication. Aldosterone and PRA levels were compared at baseline and 3 months post-procedure for RDN and sham control groups. Patients in the SPYRAL HTN-OFF MED Pivotal trial were separated into 2 groups, those with baseline PRA ≥0.65 ng/ml/h (n = 110) versus <0.65 ng/ml/h (n = 116). Follow-up treatment differences between RDN and sham control groups were adjusted for baseline values using multivariable linear regression models. RESULTS Baseline PRA was similar between RDN and control groups (1.0 ± 1.1 ng/ml/h vs. 1.1 ± 1.1 ng/ml/h; p = 0.37). Change in PRA at 3 months from baseline was significantly greater for RDN compared with control subjects (-0.2 ± 1.0 ng/ml/h; p = 0.019 vs. 0.1 ± 0.9 ng/ml/h; p = 0.14), p = 0.001 for RDN versus control subjects, and similar differences were seen for aldosterone: RDN compared with control subjects (-1.2 ± 6.4 ng/dl; p = 0.04 vs. 0.4 ± 5.4 ng/dl; p = 0.40), p = 0.011. Treatment differences at 3 months in 24-h and office systolic blood pressure (SBP) for RDN versus control patients were significantly greater for patients with baseline PRA ≥0.65 ng/ml/h versus <0.65 ng/ml/h, despite similar baseline BP. Differences in office SBP changes according to baseline PRA were also observed earlier at 2 weeks post-RDN. CONCLUSIONS Plasma renin activity and aldosterone levels for RDN patients were significantly reduced at 3 months when compared with baseline as well as when compared with sham control. Higher baseline PRA levels were associated with a significantly greater reduction in office and 24-h SBP. (SPYRAL PIVOTAL - SPYRAL HTN-OFF MED Study; NCT02439749).
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Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany.
| | - Raymond R Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David E Kandzari
- Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Kazuomi Kario
- Department of Cardiovascular Medicine and Department of Sleep and Circadian Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Konstantinos Tsioufis
- Department of Cardiology, University of Athens, Hippocratio Hospital, Athens, Greece
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shukri David
- Department of Cardiology, Providence Hospital, Southfield, Michigan, USA
| | - Kiritkumar Patel
- Department of Cardiology, Saint Joseph Mercy Oakland, Bloomfield Hills, Michigan, USA
| | - Anjani Rao
- Department of Cardiology, Saint Joseph Mercy Oakland, Bloomfield Hills, Michigan, USA
| | - Antony Walton
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Jason E Bloom
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Thomas Weber
- Department of Cardiology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Markus Suppan
- Department of Cardiology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Lucas Lauder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Sidney A Cohen
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Coronary and Renal Denervation Division, Medtronic PLC, Santa Rosa, California, USA
| | - Pamela McKenna
- Coronary and Renal Denervation Division, Medtronic PLC, Santa Rosa, California, USA
| | - Martin Fahy
- Coronary and Renal Denervation Division, Medtronic PLC, Santa Rosa, California, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Michael A Weber
- Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, New York, USA
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13
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Kresoja KP, Rommel KP, Fengler K, von Roeder M, Besler C, Lücke C, Gutberlet M, Desch S, Thiele H, Böhm M, Lurz P. Renal Sympathetic Denervation in Patients With Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2021; 14:e007421. [PMID: 33706547 DOI: 10.1161/circheartfailure.120.007421] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Arterial hypertension is the most common comorbidity in patients with heart failure with preserved ejection fraction (HFpEF) and mediates adverse hemodynamics through related aortic stiffness and increased pulsatile load. We aimed to investigate the clinical and hemodynamic implications of renal sympathetic denervation (RDN) in patients with HFpEF and uncontrolled arterial hypertension. METHODS Patients undergoing RDN between 2011 and 2018 in a single-center were retrospectively analyzed and classified as HFpEF (n=99) or no HF (n=65). Stroke volume index and aortic distensibility were measured through cardiac magnetic resonance imaging, and left ventricular (LV) systolic and diastolic properties were assessed echocardiographically. RESULTS At baseline, patients with HFpEF had higher stroke volume index (median 40 [interquartile range, 33-48] versus 33 [26-40] mL/m2, P=0.002), pulse pressure (69 [63-77] versus 61 [55-67] mm Hg, P<0.001), but lower LV-VPES100mm Hg (18 [10-28] versus 24 [15-40] mL, P=0.007) and aortic distensibility (1.5 [1.1-2.6] versus 2.7 [1.1-3.5] 10-3 mm Hg-1, P=0.013) as compared to no-HF patients. Systolic blood pressure decreased comparable in patients with HFpEF and no-HF patients following RDN (-9 [-16 to -2], P<0.001). After RDN stroke volume index (-3 [-9 to +3] mL/m2, P=0.011) decreased and aortic distensibility (0.2 [-0.1 to +1.1] 10-3 mm Hg-1, P=0.007) and systolic stiffness (P<0.001) increased in HFpEF patients. LV diastolic stiffness and LV filling pressures as well as NT-proBNP (N-terminal pro-B-type natriuretic peptide) decreased after RDN in patients with HFpEF (P=0.032, P=0.043, and P<0.001, respectively). CONCLUSIONS Patients with HFpEF undergoing RDN showed increased stroke volume index, vascular, and LV stiffness as compared to no-HF patients. Following RDN those hemodynamic alterations and reduced systolic and diastolic LV stiffness were partly normalized, implying RDN might be a potential therapeutic strategy for arterial hypertension and HFpEF.
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Affiliation(s)
- Karl-Patrik Kresoja
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany.,Leipzig Heart Institute, Heart Center Leipzig, Germany (K.-P.K., K.-P.R., P.L.)
| | - Karl-Philipp Rommel
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany.,Leipzig Heart Institute, Heart Center Leipzig, Germany (K.-P.K., K.-P.R., P.L.)
| | - Karl Fengler
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Maximilian von Roeder
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Christian Besler
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Christian Lücke
- Department of Diagnostic and Interventional Radiology (C.L., M.G.), Heart Center Leipzig, University of Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology (C.L., M.G.), Heart Center Leipzig, University of Leipzig, Germany
| | - Steffen Desch
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Homburg/Saar, Germany (M.B.)
| | - Philipp Lurz
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany.,Leipzig Heart Institute, Heart Center Leipzig, Germany (K.-P.K., K.-P.R., P.L.)
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15
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Abstract
Despite availability of effective drugs for hypertension therapy, significant numbers of hypertensive patients fail to achieve recommended blood pressure levels on ≥3 antihypertensive drugs of different classes. These individuals have a high prevalence of adverse cardiovascular events and are defined as having resistant hypertension (RHT) although nonadherence to prescribed antihypertensive medications is common in patients with apparent RHT. Furthermore, apparent and true RHT often display increased sympathetic activity. Based on these findings, technology was developed to treat RHT by suppressing sympathetic activity with electrical stimulation of the carotid baroreflex and catheter-based renal denervation (RDN). Over the last 15 years, experimental and clinical studies have provided better understanding of the physiological mechanisms that account for blood pressure lowering with baroreflex activation and RDN and, in so doing, have provided insight into which patients in this heterogeneous hypertensive population are most likely to respond favorably to these device-based therapies. Experimental studies have also played a role in modifying device technology after early clinical trials failed to meet key endpoints for safety and efficacy. At the same time, these studies have exposed potential differences between baroreflex activation and RDN and common challenges that will likely impact antihypertensive treatment and clinical outcomes in patients with RHT. In this review, we emphasize physiological studies that provide mechanistic insights into blood pressure lowering with baroreflex activation and RDN in the context of progression of clinical studies, which are now at a critical point in determining their fate in RHT management.
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Affiliation(s)
- Thomas E Lohmeier
- From the Department of Physiology and Biophysics (T.E.L., J.E.H.), University of Mississippi Medical Center, Jackson
| | - John E Hall
- From the Department of Physiology and Biophysics (T.E.L., J.E.H.), University of Mississippi Medical Center, Jackson.,Mississippi Center for Obesity Research (J.E.H.), University of Mississippi Medical Center, Jackson
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16
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Kvasnička J, Lambert L, Waldauf P, Zelinka T, Petrák O, Štrauch B, Holaj R, Indra T, Krátká Z, Klímová J, Václavík J, Kociánová E, Nykl I, Jiravský O, Rappová G, Táborský M, Branny M, Widimský J, Rosa J. (Prediction of long-term renal denervation efficacy). COR ET VASA 2019. [DOI: 10.1016/j.crvasa.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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17
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Doumas M, Papademetriou V, Tsioufis C. Renal Sympathetic Denervation in Isolated Systolic Hypertension. Hypertension 2019; 74:255-256. [DOI: 10.1161/hypertensionaha.119.13168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Doumas
- From the Second Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece (M.D.)
| | | | - Costas Tsioufis
- First Cardiology Department, National and Kapodestrian University of Athens, Greece (C.T.)
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18
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Fengler K, Rommel KP, Lapusca R, Blazek S, Besler C, Hartung P, von Roeder M, Kresoja KP, Desch S, Thiele H, Lurz P. Renal Denervation in Isolated Systolic Hypertension Using Different Catheter Techniques and Technologies. Hypertension 2019; 74:341-348. [PMID: 31203726 DOI: 10.1161/hypertensionaha.119.13019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with isolated systolic hypertension (ISH) are thought to show a diminished blood pressure (BP)-lowering effect after renal sympathetic denervation (RDN). This conclusion is mostly derived from unipolar radiofrequency catheter ablation studies. Limited data for newer RDN technologies exist. We used data from the RADIOSOUND-HTN (Three-Arm Randomized Trial of Different Renal Denervation Devices and Techniques in Patients With Resistant Hypertension) comparing 3 different RDN approaches to investigate a possible interaction between ISH and RDN response. One hundred twenty patients were stratified by having ISH or combined systolic-diastolic hypertension (CH). Of these, 39 underwent radiofrequency ablation of the renal main arteries, 39 combined radiofrequency ablation of the main and branch arteries, and 42 were treated with ultrasound-based ablation of the main renal artery. Patients with ISH (n=61) were older and had lower systolic and diastolic BP on ambulatory measurement (ambulatory BP measurement) at baseline in comparison to CH (n=59). At 3 months, patients with ISH showed a less pronounced BP-lowering effect of RDN as compared to patients with CH (daytime average -5.9±11.8 versus -13.3±11.7 mm Hg, P=0.001). This difference was significant for radiofrequency ablation of the renal main arteries and ultrasound-based ablation of the main renal artery treatment but did not reach significance in the radiofrequency ablation of the main and branch arteries group. After adjustment for baseline BP values and age, there was no significant difference in BP reduction between ISH and CH. Using unadjusted BP values, RDN seems to be more effective in CH than in ISH. However, adjusting for baseline BP values revealed similar BP reduction in ISH and CH patients, irrespective of the RDN treatment used. The value of ISH as predictor for successful RDN might have been overestimated in the past. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02920034.
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Affiliation(s)
- Karl Fengler
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Karl-Philipp Rommel
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Razvan Lapusca
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Stephan Blazek
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Christian Besler
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Philipp Hartung
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Maximilian von Roeder
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Karl-Patrik Kresoja
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Steffen Desch
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Holger Thiele
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Philipp Lurz
- From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany
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19
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Al Raisi SI, Pouliopoulos J, Qian P, King P, Byth K, Barry MT, Swinnen J, Thiagalingam A, Kovoor P. Comparison of two different radiofrequency ablation systems for renal artery denervation: Evaluation of short-term and long-term follow up. Catheter Cardiovasc Interv 2018; 93:E105-E111. [PMID: 30549404 PMCID: PMC6590350 DOI: 10.1002/ccd.28038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 11/06/2018] [Accepted: 12/02/2018] [Indexed: 12/05/2022]
Abstract
Objectives To assess the clinical efficacy of renal artery denervation (RAD) in our center and to compare the efficacy of two different radiofrequency (RF) systems. Background Several systems are available for RF renal denervation. Whether there is a difference in clinical efficacy among various systems remains unknown. Methods Renal artery denervation was performed on 43 patients with resistant hypertension using either the single electrode Symplicity Flex (n = 20) or the multi‐electrode EnligHTN system (n = 23). Median post‐procedural follow‐up was 32.93 months. The primary outcome was post‐procedural change in office blood pressure (BP) within 1 year (short‐term follow‐up). Secondary outcomes were change in office BP between 1 and 4 years (long‐term follow‐up) and the difference in office BP reduction between the two systems at each follow‐up period. Results For the total cohort, mean baseline office BP (systolic/diastolic) was 174/94 mmHg. At follow‐up, mean changes in office BP from baseline were −19.70/−11.86 mmHg (P < 0.001) and −21.90/−13.94 mmHg (P < 0.001) for short‐term and long‐term follow‐up, respectively. The differences in office BP reduction between Symplicity and EnligHTN groups were 8.96/1.23 mmHg (P = 0.42 for systolic BP, P = 0.83 for diastolic BP) and 9.56/7.68 mmHg (P = 0.14 for systolic BP, P = 0.07 for diastolic BP) for short‐term and long‐term follow‐up, respectively. Conclusions In our cohort, there was a clinically significant office BP reduction after RAD, which persisted up to 4 years. No significant difference in office BP reduction between the two systems was found.
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Affiliation(s)
- Sara I Al Raisi
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jim Pouliopoulos
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Pierre Qian
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Patricia King
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Karen Byth
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Research and Educational Network, Westmead Hospital, Sydney, New South Wales, Australia
| | - Michael T Barry
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - John Swinnen
- Department of Vascular Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Aravinda Thiagalingam
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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20
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Mahfoud F, Schlaich M, Böhm M, Esler M, Lüscher TF. Catheter-based renal denervation: the next chapter begins. Eur Heart J 2018; 39:4144-4149. [DOI: 10.1093/eurheartj/ehy584] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Straße, Geb. 40, Homburg, Saar, Germany
- Institute for Medical Engineering and Science, MIT, Cambridge, MA, USA
| | - Markus Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Australia
- Department of Nephrology, Royal Perth Hospital, Perth, Australia
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Straße, Geb. 40, Homburg, Saar, Germany
| | - Murray Esler
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Thomas Felix Lüscher
- Royal Brompton & Harefield Hospitals and Imperial College, Cardiology, London, UK
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
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21
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Predictors for profound blood pressure response in patients undergoing renal sympathetic denervation. J Hypertens 2018; 36:1578-1584. [DOI: 10.1097/hjh.0000000000001739] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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22
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Ambulatory arterial stiffness index: a (too) easy predictor for renal denervation success? J Hypertens 2018; 36:1604-1605. [PMID: 29847454 DOI: 10.1097/hjh.0000000000001764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Cardiac magnetic resonance assessment of central and peripheral vascular function in patients undergoing renal sympathetic denervation as predictor for blood pressure response. Clin Res Cardiol 2018; 107:945-955. [DOI: 10.1007/s00392-018-1267-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
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24
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Ambulatory arterial stiffness index and blood pressure response to renal denervation. J Hypertens 2018; 36:1272-1275. [PMID: 29697480 DOI: 10.1097/hjh.0000000000001714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Ott C, Franzen KF, Graf T, Weil J, Schmieder RE, Reppel M, Mortensen K. Renal denervation improves 24-hour central and peripheral blood pressures, arterial stiffness, and peripheral resistance. J Clin Hypertens (Greenwich) 2018; 20:366-372. [DOI: 10.1111/jch.13193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/23/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Christian Ott
- Department of Nephrology and Hypertension; Friedrich-Alexander Universität Erlangen-Nürnberg; Erlangen Germany
| | - Klaas F. Franzen
- Campus Lübeck Medizinische Klinik III; Universitätsklinikum Schleswig-Holstein; Lübeck Germany
| | - Tobias Graf
- Campus Lübeck Medizinische Klinik II; Universitätsklinikum Schleswig-Holstein; Lübeck Germany
| | | | - Roland E. Schmieder
- Department of Nephrology and Hypertension; Friedrich-Alexander Universität Erlangen-Nürnberg; Erlangen Germany
| | - Michael Reppel
- Campus Lübeck Medizinische Klinik II; Universitätsklinikum Schleswig-Holstein; Lübeck Germany
- Cardiology Landsberg; Landsberg Germany
| | - Kai Mortensen
- Campus Lübeck Medizinische Klinik II; Universitätsklinikum Schleswig-Holstein; Lübeck Germany
- Cardiology Practice; Kiel Germany
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26
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Barber-Chamoux N, Esler MD. Predictive factors for successful renal denervation: should we use them in clinical trials? Eur J Clin Invest 2017; 47:860-867. [PMID: 28771706 DOI: 10.1111/eci.12792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/29/2017] [Indexed: 01/01/2023]
Abstract
Renal denervation (RDN) is facing various challenges to its initial claimed value in hypertension treatment. Major concerns are the choice of the patients and the technical efficacy of the RDN. Different factors have been described as predicting the capacity of RDN to decrease blood pressure. These factors are related to the patients, the procedure and the tools to confirm successful neural ablation. Their use in future trials should help to improve RDN trials understanding and outcomes. This review summarizes the different predictive factors available and their potential benefits in patient selection and in procedure guidance.
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Affiliation(s)
- Nicolas Barber-Chamoux
- Cardiology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.,Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia
| | - Murray D Esler
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia.,Heart Centre, Alfred Hospital, Melbourne, Vic., Australia
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Hildreth CM, Boyd R, Kouchaki Z, Butlin M, Avolio AP, Pilowsky PM, Phillips JK. Increased arterial stiffness does not respond to renal denervation in an animal model of secondary hypertension. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:258-261. [PMID: 29059859 DOI: 10.1109/embc.2017.8036811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Renal denervation is a novel device based therapy promoted to reduce high blood pressure. We examined the impact of renal denervation on systolic blood pressure, renal function, and arterial stiffness in the Lewis Polycystic Kidney disease (LPK) rodent model of kidney disease. Animals were subjected to bilateral renal denervation or sham surgeries at age 6 and 12 weeks. Systolic blood pressure was monitored by tail-cuff plethysmography and renal function by urinalysis and creatinine clearance. At age 16 weeks, beat-to-beat aortic pulse wave velocity as a functional indicator of arterial stiffness was determined. Renal denervation produced an overall reduction in blood pressure in the LPK [(denervated 164±4 vs. sham-operated 180±6 mmHg, n = 6 per group, P=0.003)] and delayed, but did not prevent, the decline in renal function. Aortic pulse wave velocity was markedly elevated in the LPK compared with Lewis and was not altered by renal denervation in the LPK however a reduction was seen in the control Lewis animals. These results support the hypothesis that renal nerves contribute to secondary hypertension in conditions such as kidney disease.
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Fengler K, Ewen S, Höllriegel R, Rommel KP, Kulenthiran S, Lauder L, Cremers B, Schuler G, Linke A, Böhm M, Mahfoud F, Lurz P. Blood Pressure Response to Main Renal Artery and Combined Main Renal Artery Plus Branch Renal Denervation in Patients With Resistant Hypertension. J Am Heart Assoc 2017; 6:JAHA.117.006196. [PMID: 28862930 PMCID: PMC5586457 DOI: 10.1161/jaha.117.006196] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Single‐electrode ablation of the main renal artery for renal sympathetic denervation showed mixed blood pressure (BP)‐lowering effects. Further improvement of the technique seems crucial to optimize effectiveness of the procedure. Because sympathetic nerve fibers are closer to the lumen in the distal part of the renal artery, treatment of the distal main artery and its branches has been shown to reduce variability in treatment effects in preclinical studies and a recent randomized trial. Whether this optimized technique improves clinical outcomes remains uncertain. We report a 2‐center experience of main renal artery and combined main renal artery plus branches renal denervation in patients with resistant hypertension using a multielectrode catheter. Methods and Results Twenty‐five patients with therapy‐resistant hypertension underwent renal sympathetic denervation with combined main renal artery and renal branch ablation and were compared to matched controls undergoing an ablation of the main renal artery only. BP change was assessed by ambulatory measurement at baseline and after 3 months. At baseline, BP was balanced between the groups. After 3 months, BP changed significantly in the combined ablation group (systolic/diastolic 24‐hour mean and daytime mean BP −8.5±9.8/−7.0±10.7 and −9.4±9.8/−7.1±13.5 mm Hg, P<0.001/0.003 and <0.001/0.016, respectively), but not in patients with main artery treatment (−3.5±11.1/−2.0±7.6 and −2.8±10.9/−1.8±7.7 mm Hg, P=0.19/0.20 and 0.19/0.24, respectively). Systolic daytime BP was significantly more reduced in patients with combined ablation than in patients with main artery ablation (P=0.033). Conclusions Combined ablation of the main renal artery and branches appears to improve BP‐lowering efficacy and should be further investigated.
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Affiliation(s)
- Karl Fengler
- Department of Internal Medicine/Cardiology, University Heart Center Leipzig, Leipzig, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Homburg/Saar, Germany
| | - Robert Höllriegel
- Department of Internal Medicine/Cardiology, University Heart Center Leipzig, Leipzig, Germany
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, University Heart Center Leipzig, Leipzig, Germany
| | - Saaraaken Kulenthiran
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Homburg/Saar, Germany
| | - Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Homburg/Saar, Germany
| | - Bodo Cremers
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Homburg/Saar, Germany
| | - Gerhard Schuler
- Department of Internal Medicine/Cardiology, University Heart Center Leipzig, Leipzig, Germany
| | - Axel Linke
- Department of Internal Medicine/Cardiology, University Heart Center Leipzig, Leipzig, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Homburg/Saar, Germany.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, University Heart Center Leipzig, Leipzig, Germany
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Effects of renal denervation on short-term blood pressure variability: lack of meta-analytic evidence. J Hypertens 2017; 35:1780-1781. [PMID: 28767486 DOI: 10.1097/hjh.0000000000001397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ultrasound-based renal sympathetic denervation for the treatment of therapy-resistant hypertension. J Hypertens 2017; 35:1310-1317. [DOI: 10.1097/hjh.0000000000001301] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Fengler K, Rommel KP, Hoellriegel R, Blazek S, Besler C, Desch S, Schuler G, Linke A, Lurz P. Pulse Wave Velocity Predicts Response to Renal Denervation in Isolated Systolic Hypertension. J Am Heart Assoc 2017; 6:JAHA.117.005879. [PMID: 28515119 PMCID: PMC5524114 DOI: 10.1161/jaha.117.005879] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Renal sympathetic denervation seems to be less effective as a treatment for hypertension in patients with isolated systolic hypertension, a condition associated with elevated central arterial stiffness. Because isolated systolic hypertension can also be caused by wave reflection or increased cardiac output, a more differentiated approach might improve patient preselection for renal sympathetic denervation. We sought to evaluate the additional predictive value of invasive pulse wave velocity for response to renal sympathetic denervation in patients with combined versus isolated systolic hypertension. Methods and Results Patients scheduled for renal sympathetic denervation underwent additional invasive measurement of pulse wave velocity and pulse pressure before denervation. Blood pressure was assessed via ambulatory measurement at baseline and after 3 months. In total 109 patients (40 patients with isolated systolic hypertension) were included in our analysis. After 3 months, blood pressure reduction was more pronounced among patients with combined hypertension compared with patients with isolated systolic hypertension (systolic 24‐hour average 9.3±10.5 versus 5.0±11.5 mm Hg, P=0.046). However, when stratifying patients with isolated systolic hypertension by invasive pulse wave velocity, patients in the lowest tertile of pulse wave velocity had comparable blood pressure reduction (12.1±12.6 mm Hg, P=0.006) despite lower baseline blood pressure than patients with combined hypertension (systolic 24‐hour average 154.8±12.5 mm Hg in combined hypertension versus 141.2±8.1, 148.4±10.9, and 150.5±12.7 mm Hg, respectively, by tertiles of pulse wave velocity, P=0.002). Conclusions Extended assessment of arterial stiffness can help improve patient preselection for renal sympathetic denervation and identify a subgroup of isolated systolic hypertension patients who benefit from sympathetic modulation.
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Affiliation(s)
- Karl Fengler
- Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Leipzig, Germany
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Leipzig, Germany
| | - Robert Hoellriegel
- Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Leipzig, Germany
| | - Stephan Blazek
- Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Leipzig, Germany
| | - Christian Besler
- Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Leipzig, Germany
| | - Steffen Desch
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Luebeck University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Gerhard Schuler
- Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Leipzig, Germany
| | - Axel Linke
- Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Leipzig, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, University Heart Centre Leipzig, Leipzig, Germany
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