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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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Götzinger F, Kunz M, Lauder L, Mahfoud F, Böhm M. Radio frequency-based renal denervation: a story of simplicity? Future Cardiol 2023; 19:431-440. [PMID: 37791469 DOI: 10.2217/fca-2023-0059] [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: 10/05/2023] Open
Abstract
Radio frequency-based renal denervation is a safe and effective way of lowering blood pressure, a common condition associated with high cardiovascular risk. Several catheters have been developed to administer energy to the renal arteries and their side branches, thereby modulating sympathetic renal activity. The Symplicity Flex™ and Symplicity Spyral™ are first- and second-generation devices, respectively, for radio frequency-based renal denervation. There is a continuous need to further improve and adjust interventional antihypertensive therapies. Several randomized controlled trials have been conducted to investigate the safety and efficacy of these catheters and most were able to show radio frequency-based renal denervation to be feasible, safe and effective in lowering blood pressure in hypertensive patients with and without concomitant antihypertensive medication. Herein, the authors discuss the pathophysiologic concepts of renal denervation and its procedural approaches, report catheter designs, summarize clinical trials outcomes and, finally, discuss real-world evidence.
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Affiliation(s)
- Felix Götzinger
- Department of Internal Medicine III, Cardiology, Angiology & Intensive Care Medicine, University Hospital Saarland, Saarland University, Homburg, 66421, Germany
| | - Michael Kunz
- Department of Internal Medicine III, Cardiology, Angiology & Intensive Care Medicine, University Hospital Saarland, Saarland University, Homburg, 66421, Germany
| | - Lucas Lauder
- Department of Internal Medicine III, Cardiology, Angiology & Intensive Care Medicine, University Hospital Saarland, Saarland University, Homburg, 66421, Germany
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology & Intensive Care Medicine, University Hospital Saarland, Saarland University, Homburg, 66421, Germany
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology & Intensive Care Medicine, University Hospital Saarland, Saarland University, Homburg, 66421, Germany
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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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Lin PL, Lin PY, Huang HP, Vaezi H, Liu LYM, Lee YH, Huang CC, Yang TF, Hsu L, Hsu CF. The autonomic balance of heart rhythm complexity after renal artery denervation: insight from entropy of entropy and average entropy analysis. Biomed Eng Online 2022; 21:32. [PMID: 35610703 PMCID: PMC9131559 DOI: 10.1186/s12938-022-00999-4] [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: 02/06/2022] [Accepted: 05/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background The current method to evaluate the autonomic balance after renal denervation (RDN) relies on heart rate variability (HRV). However, parameters of HRV were not always predictive of response to RDN. Therefore, the complexity and disorder of heart rhythm, measured by entropy of entropy (EoE) and average entropy (AE), have been used to analyze autonomic dysfunction. This study evaluated the dynamic changes in autonomic status after RDN via EoE and AE analysis. Methods Five patients were prospectively enrolled in the Global SYMPLICITY Registry from 2020 to 2021. 24-h Holter and ambulatory blood pressure monitoring (ABPM) was performed at baseline and 3 months after RDN procedures. The autonomic status was analyzed using the entropy-based AE and EoE analysis and the conventional HRV-based low frequency (LF), high frequency (HF), and LF/HF. Results After RDN, the ABPM of all patients showed a significant reduction in blood pressure (BP) and heart rate. Only AE and HF values of all patients had consistent changes after RDN (p < 0.05). The spearman rank-order correlation coefficient of AE vs. HF was 0.86, but AE had a lower coefficient of variation than HF. Conclusions Monitoring the AE and EoE analysis could be an alternative to interpreting autonomic status. In addition, a relative change of autonomic tone, especially an increasing parasympathetic activity, could restore autonomic balance after RDN. Supplementary Information The online version contains supplementary material available at 10.1186/s12938-022-00999-4.
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Nantha Kumar N, Nyatsuro K, Ahmad S, Fazmin IT, Saadeh K, Tse G, Jeevaratnam K. Systematic review of renal denervation for the management of cardiac arrhythmias. Clin Res Cardiol 2021; 111:971-993. [PMID: 34748053 PMCID: PMC9424137 DOI: 10.1007/s00392-021-01950-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/04/2021] [Indexed: 01/19/2023]
Abstract
Background In the wake of the controversy surrounding the SYMPLICITY HTN-3 trial and data from subsequent trials, this review aims to perform an updated and more comprehensive review of the impact of renal sympathetic denervation on cardiac arrhythmias. Methods and results A systematic search was performed using the Medline, Scopus and Embase databases using the terms “Renal Denervation” AND “Arrhythmias or Atrial or Ventricular”, limited to Human and English language studies within the last 10 years. This search yielded 19 relevant studies (n = 6 randomised controlled trials, n = 13 non-randomised cohort studies) which comprised 783 patients. The studies show RSD is a safe procedure, not associated with increases in complications or mortality post-procedure. Importantly, there is no evidence RSD is associated with a deterioration in renal function, even in patients with chronic kidney disease. RSD with or without adjunctive pulmonary vein isolation (PVI) is associated with improvements in freedom from atrial fibrillation (AF), premature atrial complexes (PACs), ventricular arrhythmias and other echocardiographic parameters. Significant reductions in ambulatory and office blood pressure were also observed in the majority of studies. Conclusion This review provides evidence based on original research that ‘second generation’ RSD is safe and is associated with reductions in short-term blood pressure and AF burden. However, the authors cannot draw firm conclusions with regards to less prominent arrhythmia subtypes due to the paucity of evidence available. Large multi-centre RCTs investigating the role of RSD are necessary to comprehensively assess the efficacy of the procedure treating various arrhythmias. Graphic abstract ![]()
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Affiliation(s)
- Nakulan Nantha Kumar
- Bristol Medical School, University of Bristol, Bristol, UK.,Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK
| | - Kuda Nyatsuro
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Shiraz Ahmad
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK
| | - Ibrahim T Fazmin
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK.,Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Khalil Saadeh
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Gary Tse
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK.
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Kiuchi MG, Carnagarin R, Nolde JM, Lugo-Gavidia LM, Ward NC, Schlaich MP. Renal denervation as a management strategy for hypertension: current evidence and recommendations. Expert Rev Cardiovasc Ther 2021; 19:825-835. [PMID: 34353197 DOI: 10.1080/14779072.2021.1965878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The concept of targeting the renal sympathetic nerves therapeutically to lower blood pressure (BP) is based on their crucial role in regulating both renal and cardiovascular control. These effects are mainly mediated via three major mechanisms including alteration of renal blood flow, renin-release, and Na+ retention. Initial surgical approaches applying crude and unselected sympathectomy, while rendering significant BP lowering and cardiovascular event reducing properties, where plagued by side effects. More modern selective catheter-based denervation approaches selectively targeting the renal nerves have been shown to be safe and effective in reducing BP in various forms of hypertension and multiple comorbidities. AREAS COVERED This article covers the background relevant for the concept of renal denervation (RDN), the evidence obtained from relevant randomized controlled trials to substantiate the safety and efficacy of RDN, and recently published clinical recommendations. EXPERT OPINION Catheter-based RDN is safe and has now been shown in sham-controlled randomized clinical trials to result in clinically meaningful BP lowering in both drug naïve hypertensive patients and those on concomitant antihypertensive therapy. Real world data from a large global registry further supports the clinical utility of RDN. It now seems time to embed renal denervation into routine clinical care.
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Affiliation(s)
- Márcio Galindo Kiuchi
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit and RPH Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, the University of Western Australia, Perth, Western Australia, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit and RPH Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, the University of Western Australia, Perth, Western Australia, Australia
| | - Janis M Nolde
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit and RPH Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, the University of Western Australia, Perth, Western Australia, Australia
| | - Leslie Marisol Lugo-Gavidia
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit and RPH Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, the University of Western Australia, Perth, Western Australia, Australia
| | - Natalie C Ward
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit and RPH Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, the University of Western Australia, Perth, Western Australia, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit and RPH Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, the University of Western Australia, Perth, Western Australia, Australia.,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia
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Ott C, Mahfoud F, Mancia G, Narkiewicz K, Ruilope LM, Fahy M, Schlaich MP, Böhm M, Schmieder RE. Renal denervation in patients with versus without chronic kidney disease: results from the global SYMPLICITY Registry with follow-up data of 3 years. Nephrol Dial Transplant 2021; 37:304-310. [PMID: 34109413 DOI: 10.1093/ndt/gfab154] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Activity of the sympathetic nervous system is increased in patients with hypertension and chronic kidney disease (CKD). Here we compare short- and long-term blood pressure (BP) lowering effects of renal denervation (RDN) between hypertensive patients with or without CKD in the Global SYMPLICITY Registry. METHODS Office and 24-hour ambulatory BP (ABP) were assessed at pre-specified time-points after RDN. The presence of CKD was defined according to estimated glomerular filtration rate (eGFR), and enrolled patients were stratified based on the presence (N = 475, eGFR < 60 ml/min/1.73m2) or absence (N = 1505, eGFR ≥ 60ml/min/1.73m2) of CKD. RESULTS Patients with CKD were older (p < 0.001) and were prescribed more antihypertensive medications (p < 0.001). eGFR-decline/year was not significantly different between groups after the first year. Office and 24-hour ABP were significantly reduced from baseline at all timepoints after RDN in both groups (all p < 0.001). After adjusting for baseline data, patients without CKD had a greater reduction in office systolic BP (-17.3 ± 28.3 vs. -11.7 ± 29.9 mmHg, p = 0.009), but not diastolic BP at 36 months compared to those with CKD. Similar BP and eGFR-results were found when the analysis was limited to patients with both baseline and 36-month BP data available. There was no difference in the safety profile of the RDN-procedure between groups. CONCLUSIONS After adjusting for baseline data, 24-hour systolic and diastolic ABP reduction was similar in patients with and without CKD after RDN, whereas office systolic but not diastolic BP was reduced less in patients with CKD. We conclude that RDN emerged as an effective antihypertensive treatment option in CKD patients.
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Affiliation(s)
- Christian Ott
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-, Nürnberg, Germany.,Department of Nephrology and Hypertension, Paracelsus Medical University, Nürnberg, Germany
| | - Felix Mahfoud
- Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany
| | - Giuseppe Mancia
- Department of Medicine, University of Milano-Bicocca, St. Gerardo Hospital, Monza, Italy
| | - Krzysztof Narkiewicz
- Medical University of Gdansk, Department of Hypertension and Diabetology, Gdansk, Poland
| | - Luis M Ruilope
- Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | | | - Markus P Schlaich
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, the University of Western Australia, Perth, Australia
| | - Michael Böhm
- Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-, Nürnberg, Germany
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Marin F, Fezzi S, Gambaro A, Ederle F, Castaldi G, Widmann M, Gangemi C, Ferrero V, Pesarini G, Pighi M, Ribichini FL. Insights on safety and efficacy of renal artery denervation for uncontrolled-resistant hypertension in a high risk population with chronic kidney disease: first Italian real-world experience. J Nephrol 2021; 34:1445-1455. [PMID: 33481223 PMCID: PMC8494706 DOI: 10.1007/s40620-021-00966-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/01/2021] [Indexed: 12/16/2022]
Abstract
Aims To evaluate the safety and efficacy of catheter-based radiofrequency renal sympathetic denervation (RSD) in a daily practice population of patients with uncontrolled resistant hypertension, on top of medical therapy. Methods Consecutive unselected patients with uncontrolled resistant hypertension undergoing RSD were enrolled. Office and ambulatory blood pressure (BP) measurements were collected at baseline and 3, 6 and 12 months after RSD. Efficacy was assessed even in patients with an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73 m2. Patients were defined as responders if systolic BP decreased by at least 5 mmHg at ambulatory BP or by 10 mmHg at office BP at their last follow-up visit. Results Forty patients with multiple comorbidities underwent RSD from 2012 to 2019. Baseline office and ambulatory BP was 159.0/84.9 ± 26.2/14.9 mmHg and 155.2/86.5 ± 20.9/14.0 mmHg, respectively. At 12-month follow up a significant reduction in office and ambulatory systolic BP, respectively by − 19.7 ± 27.1 mmHg and by − 13.9 ± 23.6 mmHg, was observed. BP reduction at 12-month follow-up among patients with eGFR < 45 mL/min was similar to that obtained in patients with higher eGFR. Twenty-nine patients (74.4%) were responders. Combined hypertension, higher ambulatory systolic BP and lower E/E’ at baseline emerged as predictors of successful RSD at univariate analysis. No major complications were observed and renal function (was stable up to 12 months), even in patients with the lowest eGFR values at baseline. Conclusion RSD is safe and feasible in patients with uncontrolled resistant hypertension on top of medical therapy, even in a high-risk CKD population with multiple comorbidities, with a significant reduction in systolic BP and a trend towards a reduction in diastolic BP lasting up to 12 months. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-00966-7.
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Affiliation(s)
- Federico Marin
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Simone Fezzi
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Alessia Gambaro
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Francesco Ederle
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Gianluca Castaldi
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Maddalena Widmann
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Concetta Gangemi
- Division of Nephrology, Department of Medicine, University of Verona, Verona, Italy
| | - Valeria Ferrero
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
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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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Mahfoud F, Mancia G, Schmieder R, Narkiewicz K, Ruilope L, Schlaich M, Whitbourn R, Zirlik A, Zeller T, Stawowy P, Cohen SA, Fahy M, Böhm M. Renal Denervation in High-Risk Patients With Hypertension. J Am Coll Cardiol 2020; 75:2879-2888. [DOI: 10.1016/j.jacc.2020.04.036] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/01/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
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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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Townsend RR. Revisiting Renal Denervation. Mayo Clin Proc 2019; 94:1665-1667. [PMID: 31402055 DOI: 10.1016/j.mayocp.2019.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia.
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Heradien MJ, Bijl PVD, Brink PA. Renal Denervation in High-risk Patients with Hypertension. Heart Int 2019; 13:12-16. [DOI: 10.17925/hi.2019.13.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/23/2019] [Indexed: 11/24/2022] Open
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Mahfoud F, Bakris G, Bhatt DL, Esler M, Ewen S, Fahy M, Kandzari D, Kario K, Mancia G, Weber M, Böhm M. Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry. Eur Heart J 2018; 38:93-100. [PMID: 28158510 PMCID: PMC5381589 DOI: 10.1093/eurheartj/ehw325] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/27/2016] [Accepted: 06/29/2016] [Indexed: 12/26/2022] Open
Abstract
Aims Catheter-based renal artery denervation (RDN) has been shown to lower blood pressure (BP) in certain patients with uncontrolled hypertension. Isolated systolic hypertension (ISH) (systolic BP [SBP] ≥140 mmHg and diastolic BP <90 mmHg), characterized by increased vascular stiffness, is the predominant hypertensive phenotype in elderly patients. This study compared baseline characteristics and SBP change at 6 months between patients with ISH and combined systolic–diastolic hypertension (CH). Methods and results This study pooled data from 1103 patients from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry. A total of 429 patients had ISH, and 674 had CH. Patients with ISH were significantly older than those with CH (66 vs. 55 years), had more type 2 diabetes mellitus (52.9 vs. 34.6%), and a lower estimated glomerular filtration rate (71.8 vs. 78.6 mL/min/1.73 m2); all P < 0.001. At 6 months, the SBP drop for CH patients was −18.7 ± 23.7 mmHg compared with a reduction of −10.9 ± 21.7 mmHg for ISH patients −7.8 mmHg, 95% confidence interval, CI, −10.5, −5.1, P < 0.001). The change in 24-h SBP at 6 months was −8.8 ± 16.2 mmHg in patients with CH vs. −5.8 ± 15.4 mmHg in ISH (−3.0 mmHg, 95% CI −5.4, −0.6, P = 0.015). Presence of ISH at baseline but not age was associated with less pronounced BP changes following the procedure. The strongest predictor of office SBP reduction at 6 months was CH, followed by aldosterone antagonist use and non-use of vasodilators. Conclusion The reduction in BP among patients with ISH following RDN was less pronounced than the reduction in patients with CH. Clinical.Trials.gov identifiers NCT01534299 and NCT01418261.
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Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Kirrberger Str., Geb. 40, Homburg/Saar 66421, Germany
- Corresponding author. Tel: +49 6841 16 15911, Fax: +49 6841 16 15910,
| | | | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Murray Esler
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Kirrberger Str., Geb. 40, Homburg/Saar 66421, Germany
| | | | | | - Kazuomi Kario
- Jichi Medical University School of Medicine, Tochigi, Japan
| | - Giuseppe Mancia
- University of Milano-Bicocca and Istituto Auxologico Italiano, Milan, Italy
| | | | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Kirrberger Str., Geb. 40, Homburg/Saar 66421, Germany
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Renal artery denervation for treatment of patients with self-reported obstructive sleep apnea and resistant hypertension: results from the Global SYMPLICITY Registry. J Hypertens 2017; 35:148-153. [PMID: 27906840 DOI: 10.1097/hjh.0000000000001142] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sleep-disordered breathing, predominantly obstructive sleep apnea (OSA), is highly prevalent in patients with hypertension. OSA may underlie the progression to resistant hypertension, partly due to increased activation of the sympathetic nervous system. This analysis of patients with and without OSA evaluated the blood pressure (BP)-lowering effect of sympathetic modulation by renal denervation (RDN) in a real-world setting. METHODS The Global SYMPLICITY Registry (NCT01534299) is a prospective, open-label, multicenter registry conducted worldwide to evaluate the safety and effectiveness of RDN in patients with uncontrolled hypertension. Office and 24-h ambulatory BP were reported for all patients, based on the presence of OSA. RESULTS Among 1868 patients, self-reported OSA occurred in 205 patients, who were more likely to be men (76 vs 57%, P < 0.001), have a higher BMI (34 ± 6 vs 30 ± 5 kg/m, P < 0.001), chronic kidney disease (30 vs 21%, P = 0.003), left ventricular hypertrophy (25 vs 15%, P < 0.001), and type 2 diabetes (50 vs 36%, P < 0.001). Among OSA patients, the baseline office SBP (166 ± 26 mmHg) was reduced by 14.0 ± 25.3 mmHg at 6 months (P < 0.001). Ambulatory 24-h SBP was reduced by 4.9 ± 18.0 mmHg (n = 115, P = 0.005) from 155 ± 19 mmHg at baseline. The 6-month change in SBP from baseline was not statistically different between OSA and non-OSA patients. BP reduction after RDN was also similar in OSA patients already treated with and not treated with continuous positive airway pressure. CONCLUSION RDN resulted in significant BP reductions at 6 months in hypertensive patients with and without OSA, and regardless of continuous positive airway pressure usage in OSA patients.
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Renal denervation reduces office and ambulatory heart rate in patients with uncontrolled hypertension: 12-month outcomes from the global SYMPLICITY registry. J Hypertens 2017; 34:2480-2486. [PMID: 27755390 DOI: 10.1097/hjh.0000000000001085] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Renal denervation (RDN) can reduce sympathetic activity and blood pressure (BP) in patients with hypertension. The effects on resting and ambulatory heart rate (HR), also regulated by the sympathetic nervous system, are not established. METHODS Herein, we report 12-month outcomes from the Global SYMPLICITY Registry on office and ambulatory HR and BP in patients with uncontrolled hypertension (n = 846). RESULTS HR declined in correlation with the HR at baseline and at 12 months, in particular, in patients in the upper tertile of HR (>74 bpm). BP reduction was similar in the tertiles of HR at baseline. Similar effects were observed when 24-h ambulatory HR and SBP were determined. Office HR was similarly decreased when patients were on a β-blocker or not. Antihypertensive treatment remained unchanged during the 12-month period of the Global SYMPLICITY Registry. CONCLUSION RDN reduces BP independent from HR. A HR reduction is dependent on baseline HR and unchanged by β-blocker treatment. The effects of RDN on SBP and HR are durable up to 1 year. HR reduction might be a target for RDN in patients with high HR at baseline, which needs to be scrutinized in prospective trials.
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Impact of Renal Sympathetic Denervation on Left Ventricular Structure and Function at 1-Year Follow-Up. PLoS One 2016; 11:e0149855. [PMID: 26934735 PMCID: PMC4774915 DOI: 10.1371/journal.pone.0149855] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/05/2016] [Indexed: 01/19/2023] Open
Abstract
Background Catheter-based sympathetic renal denervation (RDN) is a recent therapeutic option for patients with resistant hypertension. However, the impact of RDN in left ventricular (LV) mass and function is not completely established. Our aim was to evaluate the effects of RDN on LV structure and function (systolic and diastolic) in patients with resistant hypertension (HTN). Methods and Results From a single centre prospective registry including 65 consecutive patients with resistant HTN submitted to RDN between July-2011 and April-2015, 31 patients with baseline and 1-year follow-up echocardiogram were included in this analysis. Mean age was 65±7 years, 48% were males, 71% had type 2 diabetes. Most had hypertension lasting for more than 10 years (90%), and were being treated with a median number of 6 anti-hypertensive drugs, including 74% on spironolactone. At 1-year, there was a significant decrease both on office SBP (176±24 to 149±13mmHg, p<0.001) and DBP (90±14 to 79±11mmHg, p<0.001), and also in 24h ABPM SBP (150±20 to 132±14mmhg, p<0.001) and DBP (83±10 to 74±9mmHg, p<0.001). There was also a significant decrease in LV mass from 152±32 to 136±34g/m2 (p<0.001), an increase in LV end diastolic volume (93±18 to 111±27 mL, p = 0.004), an increase in LV ejection fraction (65±9 to 68±9%, p = 0.001) and mitral valve E deceleration time (225±49 to 247±51ms, p = 0.015) at 1-year follow up. There were no significant changes in left atrium volume index or in the distribution of patients among the different left ventricle geometric patterns and diastolic function subgroups. Conclusions In this single centre registry of patients with resistant hypertension, renal denervation was associated with significant reduction in both office and ABPM blood pressure and a significant decrease in left ventricle mass evaluated by transthoracic echocardiogram at 1 year follow-up.
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Sievert H, Schofer J, Ormiston J, Hoppe UC, Meredith IT, Walters DL, Azizi M, Diaz-Cartelle J, Cohen-Mazor M. Renal denervation with a percutaneous bipolar radiofrequency balloon catheter in patients with resistant hypertension: 6-month results from the REDUCE-HTN clinical study. EUROINTERVENTION 2015; 10:1213-20. [PMID: 25452197 DOI: 10.4244/eijy14m12_01] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To evaluate the safety and efficacy of the balloon-based bipolar Vessix Renal Denervation System in treating patients with resistant hypertension. METHODS AND RESULTS In this prospective, multicentre, single-arm study, 146 patients (age 58.6±10.5 years; 61% men) with office systolic blood pressure (BP) ≥160 mmHg despite ≥3 antihypertensive medications at maximally tolerated doses were treated with the Vessix System. Efficacy endpoints were reductions in office and 24-hour ambulatory systolic and diastolic BPs at six months. Acute and long-term safety, with a focus on the renal artery and estimated glomerular filtration rate (eGFR), were assessed. Baseline office and ambulatory BPs were 182.4±18.4/100.2±14.0 mmHg and 153.0±15.1/87.5±13.2 mmHg, respectively. No acute renal artery injury requiring intervention or serious periprocedural cardiovascular events occurred. At six months, office BP was reduced by 24.7±22.1/10.3±12.7 mmHg (p<0.0001) and ambulatory BP was reduced by 8.4±14.4/5.9±9.1 mmHg (N=69; p<0.0001). Twenty-six patients (18%) achieved an office systolic BP <140 mmHg. One patient had renal artery stenosis which required stenting. Mean eGFR remained stable. CONCLUSIONS Renal artery denervation with the Vessix System reduced both office and ambulatory BP at six months in patients with resistant hypertension. Renal artery safety and renal function results are favourable.
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Affiliation(s)
- Horst Sievert
- CardioVascular Center Frankfurt CVC, Frankfurt, Germany
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Galve E, Martell-Claros N, Camafort-Babkowski M. [Renal denervation as treatment of resistant hypertension]. Med Clin (Barc) 2015; 145:131-5. [PMID: 25746610 DOI: 10.1016/j.medcli.2014.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 12/04/2014] [Accepted: 12/11/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Enrique Galve
- Servicio de Cardiología, Hospital Vall d'Hebron, Barcelona, España.
| | | | - Miguel Camafort-Babkowski
- Departamento de Medicina Interna, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, España
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Tsioufis CP, Papademetriou V, Dimitriadis KS, Kasiakogias A, Tsiachris D, Worthley MI, Sinhal AR, Chew DP, Meredith IT, Malaiapan Y, Thomopoulos C, Kallikazaros I, Tousoulis D, Worthley SG. Catheter-based renal denervation for resistant hypertension: Twenty-four month results of the EnligHTN I first-in-human study using a multi-electrode ablation system. Int J Cardiol 2015; 201:345-50. [PMID: 26301677 DOI: 10.1016/j.ijcard.2015.08.069] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Long term safety and efficacy data of multi-electrode ablation system for renal denervation (RDN) in patients with drug resistant hypertension (dRHT) are limited. METHODS AND RESULTS We studied 46 patients (age: 60 ± 10 years, 4.7 ± 1.0 antihypertensive drugs) with drug resistant hypertension (dRHT). Reduction in office BP at 24 months from baseline was -29/-13 mmHg, while the reduction in 24-hour ambulatory BP and in home BP at 24 months were -13/-7 mmHg and -11/-6 mmHg respectively (p<0.05 for all). A correlation analysis revealed that baseline office and ambulatory BP were related to the extent of office and ambulatory BP drop. Apart from higher body mass index (33.3 ± 4.7 vs 29.5 ± 6.2 kg/m(2), p<0.05), there were no differences in patients that were RDN responders defined as ≥10 mmHg decrease (74%, n=34) compared to non-responders. Stepwise logistic regression analysis revealed no prognosticators of RDN response (p=NS for all). At 24 months there were no new serious device or procedure related adverse events. CONCLUSIONS The EnligHTN I study shows that the multi-electrode ablation system provides a safe method of RDN in dRHT accompanied by a clinically relevant and sustained BP reduction.
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Affiliation(s)
- Costas P Tsioufis
- First Cardiology Clinic, University of Athens, Hippocration Hospital, Athens, Greece.
| | - Vasilios Papademetriou
- First Cardiology Clinic, University of Athens, Hippocration Hospital, Athens, Greece; Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University Medical Center, Washington, DC, USA
| | | | | | - Dimitrios Tsiachris
- First Cardiology Clinic, University of Athens, Hippocration Hospital, Athens, Greece
| | | | - Ajay R Sinhal
- The Department of Cardiology, Flinders University, Bedford Park, Australia
| | - Derek P Chew
- The Department of Cardiology, Flinders University, Bedford Park, Australia
| | - Ian T Meredith
- The Monash Heart and Monash University, Melbourne, Australia
| | - Yuvi Malaiapan
- The Monash Heart and Monash University, Melbourne, Australia
| | - Costas Thomopoulos
- First Cardiology Clinic, University of Athens, Hippocration Hospital, Athens, Greece
| | - Ioannis Kallikazaros
- First Cardiology Clinic, University of Athens, Hippocration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, University of Athens, Hippocration Hospital, Athens, Greece
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Renal denervation for treatment of uncontrolled hypertension in an Asian population: results from the Global SYMPLICITY Registry in South Korea (GSR Korea). J Hum Hypertens 2015; 30:315-21. [DOI: 10.1038/jhh.2015.77] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/03/2015] [Accepted: 06/10/2015] [Indexed: 11/08/2022]
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Grassi G, Seravalle G, Brambilla G, Trabattoni D, Cuspidi C, Corso R, Pieruzzi F, Genovesi S, Stella A, Facchetti R, Spaziani D, Bartorelli A, Mancia G. Blood Pressure Responses to Renal Denervation Precede and Are Independent of the Sympathetic and Baroreflex Effects. Hypertension 2015; 65:1209-16. [DOI: 10.1161/hypertensionaha.114.04823] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/05/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Guido Grassi
- From the Clinica Medica, Dipartimento di Scienze Della Salute, Universita` Milano-Bicocca (G.G., G.B., C.C., R.F., G.M.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Istituto Auxologico Italiano, Milano, Italy (G.S., C.C., G.M.); Centro Cardiologico Monzino, Milano, Italy (D.T., A.B.); Clinica Nefrologica, Ospedale San Gerardo, Monza, Italy (R.C., F.P., S.G., A.S.); and Unità Operativa di Cardiologia, Ospedale Magenta, Milano, Italy (D.S.)
| | - Gino Seravalle
- From the Clinica Medica, Dipartimento di Scienze Della Salute, Universita` Milano-Bicocca (G.G., G.B., C.C., R.F., G.M.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Istituto Auxologico Italiano, Milano, Italy (G.S., C.C., G.M.); Centro Cardiologico Monzino, Milano, Italy (D.T., A.B.); Clinica Nefrologica, Ospedale San Gerardo, Monza, Italy (R.C., F.P., S.G., A.S.); and Unità Operativa di Cardiologia, Ospedale Magenta, Milano, Italy (D.S.)
| | - Gianmaria Brambilla
- From the Clinica Medica, Dipartimento di Scienze Della Salute, Universita` Milano-Bicocca (G.G., G.B., C.C., R.F., G.M.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Istituto Auxologico Italiano, Milano, Italy (G.S., C.C., G.M.); Centro Cardiologico Monzino, Milano, Italy (D.T., A.B.); Clinica Nefrologica, Ospedale San Gerardo, Monza, Italy (R.C., F.P., S.G., A.S.); and Unità Operativa di Cardiologia, Ospedale Magenta, Milano, Italy (D.S.)
| | - Daniela Trabattoni
- From the Clinica Medica, Dipartimento di Scienze Della Salute, Universita` Milano-Bicocca (G.G., G.B., C.C., R.F., G.M.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Istituto Auxologico Italiano, Milano, Italy (G.S., C.C., G.M.); Centro Cardiologico Monzino, Milano, Italy (D.T., A.B.); Clinica Nefrologica, Ospedale San Gerardo, Monza, Italy (R.C., F.P., S.G., A.S.); and Unità Operativa di Cardiologia, Ospedale Magenta, Milano, Italy (D.S.)
| | - Cesare Cuspidi
- From the Clinica Medica, Dipartimento di Scienze Della Salute, Universita` Milano-Bicocca (G.G., G.B., C.C., R.F., G.M.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Istituto Auxologico Italiano, Milano, Italy (G.S., C.C., G.M.); Centro Cardiologico Monzino, Milano, Italy (D.T., A.B.); Clinica Nefrologica, Ospedale San Gerardo, Monza, Italy (R.C., F.P., S.G., A.S.); and Unità Operativa di Cardiologia, Ospedale Magenta, Milano, Italy (D.S.)
| | - Rocco Corso
- From the Clinica Medica, Dipartimento di Scienze Della Salute, Universita` Milano-Bicocca (G.G., G.B., C.C., R.F., G.M.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Istituto Auxologico Italiano, Milano, Italy (G.S., C.C., G.M.); Centro Cardiologico Monzino, Milano, Italy (D.T., A.B.); Clinica Nefrologica, Ospedale San Gerardo, Monza, Italy (R.C., F.P., S.G., A.S.); and Unità Operativa di Cardiologia, Ospedale Magenta, Milano, Italy (D.S.)
| | - Federico Pieruzzi
- From the Clinica Medica, Dipartimento di Scienze Della Salute, Universita` Milano-Bicocca (G.G., G.B., C.C., R.F., G.M.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Istituto Auxologico Italiano, Milano, Italy (G.S., C.C., G.M.); Centro Cardiologico Monzino, Milano, Italy (D.T., A.B.); Clinica Nefrologica, Ospedale San Gerardo, Monza, Italy (R.C., F.P., S.G., A.S.); and Unità Operativa di Cardiologia, Ospedale Magenta, Milano, Italy (D.S.)
| | - Simonetta Genovesi
- From the Clinica Medica, Dipartimento di Scienze Della Salute, Universita` Milano-Bicocca (G.G., G.B., C.C., R.F., G.M.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Istituto Auxologico Italiano, Milano, Italy (G.S., C.C., G.M.); Centro Cardiologico Monzino, Milano, Italy (D.T., A.B.); Clinica Nefrologica, Ospedale San Gerardo, Monza, Italy (R.C., F.P., S.G., A.S.); and Unità Operativa di Cardiologia, Ospedale Magenta, Milano, Italy (D.S.)
| | - Andrea Stella
- From the Clinica Medica, Dipartimento di Scienze Della Salute, Universita` Milano-Bicocca (G.G., G.B., C.C., R.F., G.M.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Istituto Auxologico Italiano, Milano, Italy (G.S., C.C., G.M.); Centro Cardiologico Monzino, Milano, Italy (D.T., A.B.); Clinica Nefrologica, Ospedale San Gerardo, Monza, Italy (R.C., F.P., S.G., A.S.); and Unità Operativa di Cardiologia, Ospedale Magenta, Milano, Italy (D.S.)
| | - Rita Facchetti
- From the Clinica Medica, Dipartimento di Scienze Della Salute, Universita` Milano-Bicocca (G.G., G.B., C.C., R.F., G.M.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Istituto Auxologico Italiano, Milano, Italy (G.S., C.C., G.M.); Centro Cardiologico Monzino, Milano, Italy (D.T., A.B.); Clinica Nefrologica, Ospedale San Gerardo, Monza, Italy (R.C., F.P., S.G., A.S.); and Unità Operativa di Cardiologia, Ospedale Magenta, Milano, Italy (D.S.)
| | - Domenico Spaziani
- From the Clinica Medica, Dipartimento di Scienze Della Salute, Universita` Milano-Bicocca (G.G., G.B., C.C., R.F., G.M.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Istituto Auxologico Italiano, Milano, Italy (G.S., C.C., G.M.); Centro Cardiologico Monzino, Milano, Italy (D.T., A.B.); Clinica Nefrologica, Ospedale San Gerardo, Monza, Italy (R.C., F.P., S.G., A.S.); and Unità Operativa di Cardiologia, Ospedale Magenta, Milano, Italy (D.S.)
| | - Antonio Bartorelli
- From the Clinica Medica, Dipartimento di Scienze Della Salute, Universita` Milano-Bicocca (G.G., G.B., C.C., R.F., G.M.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Istituto Auxologico Italiano, Milano, Italy (G.S., C.C., G.M.); Centro Cardiologico Monzino, Milano, Italy (D.T., A.B.); Clinica Nefrologica, Ospedale San Gerardo, Monza, Italy (R.C., F.P., S.G., A.S.); and Unità Operativa di Cardiologia, Ospedale Magenta, Milano, Italy (D.S.)
| | - Giuseppe Mancia
- From the Clinica Medica, Dipartimento di Scienze Della Salute, Universita` Milano-Bicocca (G.G., G.B., C.C., R.F., G.M.); IRCCS Multimedica, Sesto San Giovanni, Milano, Italy (G.G.); Istituto Auxologico Italiano, Milano, Italy (G.S., C.C., G.M.); Centro Cardiologico Monzino, Milano, Italy (D.T., A.B.); Clinica Nefrologica, Ospedale San Gerardo, Monza, Italy (R.C., F.P., S.G., A.S.); and Unità Operativa di Cardiologia, Ospedale Magenta, Milano, Italy (D.S.)
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Böhm M, Mahfoud F, Ukena C, Hoppe UC, Narkiewicz K, Negoita M, Ruilope L, Schlaich MP, Schmieder RE, Whitbourn R, Williams B, Zeymer U, Zirlik A, Mancia G. First report of the Global SYMPLICITY Registry on the effect of renal artery denervation in patients with uncontrolled hypertension. Hypertension 2015; 65:766-74. [PMID: 25691618 DOI: 10.1161/hypertensionaha.114.05010] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
UNLABELLED This study aimed to assess the safety and effectiveness of renal denervation using the Symplicity system in real-world patients with uncontrolled hypertension (NCT01534299). The Global SYMPLICITY Registry is a prospective, open-label, multicenter registry. Office and 24-hour ambulatory blood pressures (BPs) were measured. Change from baseline to 6 months was analyzed for all patients and for subgroups based on baseline office systolic BP, diabetic status, and renal function; a cohort with severe hypertension (office systolic pressure, ≥160 mm Hg; 24-hour systolic pressure, ≥135 mm Hg; and ≥3 antihypertensive medication classes) was also included. The analysis included protocol-defined safety events. Six-month outcomes for 998 patients, including 323 in the severe hypertension cohort, are reported. Mean baseline office systolic BP was 163.5±24.0 mm Hg for all patients and 179.3±16.5 mm Hg for the severe cohort; the corresponding baseline 24-hour mean systolic BPs were 151.5±17.0 and 159.0±15.6 mm Hg. At 6 months, the changes in office and 24-hour systolic BPs were -11.6±25.3 and -6.6±18.0 mm Hg for all patients (P<0.001 for both) and -20.3±22.8 and -8.9±16.9 mm Hg for those with severe hypertension (P<0.001 for both). Renal denervation was associated with low rates of adverse events. After the procedure through 6 months, there was 1 new renal artery stenosis >70% and 5 cases of hospitalization for a hypertensive emergency. In clinical practice, renal denervation resulted in significant reductions in office and 24-hour BPs with a favorable safety profile. Greater BP-lowering effects occurred in patients with higher baseline pressures. CLINICAL TRIAL REGISTRATION URL: www.clinicaltrials.gov. Unique identifier: NCT01534299.
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Affiliation(s)
- Michael Böhm
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.).
| | - Felix Mahfoud
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Christian Ukena
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Uta C Hoppe
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Krzysztof Narkiewicz
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Manuela Negoita
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Luis Ruilope
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Markus P Schlaich
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Roland E Schmieder
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Robert Whitbourn
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Bryan Williams
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Uwe Zeymer
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Andreas Zirlik
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Giuseppe Mancia
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
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de Sousa Almeida M, de Araújo Gonçalves P, Infante de Oliveira E, Cyrne de Carvalho H. Renal denervation for resistant hypertension. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2014.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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de Sousa Almeida M, de Araújo Gonçalves P, Infante de Oliveira E, Cyrne de Carvalho H. Renal denervation for resistant hypertension. Rev Port Cardiol 2015; 34:125-35. [DOI: 10.1016/j.repc.2014.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/31/2014] [Indexed: 12/24/2022] Open
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Affiliation(s)
- Luca Donazzan
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Stephan H Schirmer
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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Ruilope LM, Arribas F. Hipertensión arterial resistente y denervación renal. Reflexiones tras el estudio Symplicity HTN-3. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Aronow HD, Li J, Parikh SA. Where and when device therapy may be useful in the management of drug-resistant hypertension. Curr Cardiol Rep 2014; 16:546. [PMID: 25326400 DOI: 10.1007/s11886-014-0546-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Device therapy for the treatment of uncontrolled and resistant hypertension has evolved significantly over the past several decades. Both renal artery disease and sympathetic hyperactivity have been linked to resistant hypertension. This manuscript will review the current evidence base supporting device therapy (e.g., renal artery revascularization, sympathetic nervous system modulation) for resistant hypertension.
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Affiliation(s)
- Herbert D Aronow
- Michigan Heart, 5325 Elliott Dr., Ste. #202, Ypsilanti, MI, 48197, USA,
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Resistant hypertension and renal denervation. Considerations on the results of the SYMPLICITY HTN-3 trial. ACTA ACUST UNITED AC 2014; 67:881-2. [PMID: 25242659 DOI: 10.1016/j.rec.2014.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 06/26/2014] [Indexed: 11/23/2022]
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Interventional management in hypertension: where do we stand? Curr Opin Nephrol Hypertens 2014; 23:444-8. [PMID: 25061991 DOI: 10.1097/mnh.0000000000000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Device-based interventions to lower drug-resistant hypertension have made the management of this disorder more complicated. In this review, we will focus on developments in this approach to blood pressure care which have appeared over the last year in a published or abstract form. RECENT FINDINGS Much of the recent literature in this area is characterized by very large office systolic blood pressure reductions, on the order of 25 mmHg at 6 months after intervention. However, the largest and the most rigorously conducted trial of renal denervation failed to meet its efficacy endpoint. We will review some speculations on why that may have occurred. SUMMARY There is little guidance for the management of drug-resistant hypertension in existing guidelines due largely to an absence of clinical trials with hard cardiovascular outcomes; thus, most of the literature relies on short-term (generally less than 1 year) studies that are oriented toward efficacy (i.e., blood pressure reduction per se). With the failure of the Symplicity HTN3 trial to meet its efficacy endpoint, the entire field of renal denervation is under careful scrutiny. From this reviewer's perspective, this finding seems to be more of a speed-bump than a 'road closed' sign for renal denervation, a prompt to reconsider the adequacy of denervation techniques and an encouragement to continue the search for robust predictors of clinical response.
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Böhm M, Linz D, Ukena C, Esler M, Mahfoud F. Renal Denervation for the Treatment of Cardiovascular High Risk-Hypertension or Beyond? Circ Res 2014; 115:400-9. [DOI: 10.1161/circresaha.115.302522] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Michael Böhm
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
| | - Dominik Linz
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
| | - Christian Ukena
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
| | - Murray Esler
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
| | - Felix Mahfoud
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
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White WB, Turner JR, Sica DA, Bisognano JD, Calhoun DA, Townsend RR, Aronow HD, Bhatt DL, Bakris GL. Detection, evaluation, and treatment of severe and resistant hypertension: proceedings from an American Society of Hypertension Interactive forum held in Bethesda, MD, U.S.A., October 10th 2013. ACTA ACUST UNITED AC 2014; 8:743-57. [PMID: 25418497 DOI: 10.1016/j.jash.2014.06.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 06/26/2014] [Indexed: 01/13/2023]
Abstract
The epidemiology, evaluation, and management of severe and resistant hypertension in the United States (US) are evolving. The American Society of Hypertension held a multi-disciplinary forum in October 2013 to review the available evidence related to the management of resistant hypertension with both drug and device therapies. There is strong evidence that resistant hypertension is an important clinical problem in the US and many other regions of the world. Complex drug therapy is effective in most of the patients with severe and resistant hypertension, but there are certain individuals who may be refractory to multiple-drug regimens or have adverse effects that make adherence to the regimen difficult. When secondary forms of hypertension and pseudo-resistance, such as medication nonadherence, or white-coat hypertension based on marked differences between clinic and 24-hour ambulatory blood pressure monitoring, have been excluded, the impact of device therapy is under evaluation through clinical trials in the US and from clinical practice registries in Europe and Australia. Clinical trial data have been obtained primarily in patients whose resistant hypertension is defined as systolic clinic blood pressures of ≥160 mm Hg (or ≥ 150 mm Hg in type 2 diabetes) despite pharmacologic treatment with at least three antihypertensive drugs (one of which is a thiazide or loop diuretic). Baroreceptor stimulation therapy has shown modest benefit in a moderately sized sham-controlled study in drug-resistant hypertension. Patients selected for renal denervation have typically been restricted to those with preserved kidney function (estimated glomerular filtration rate ≥ 45 mL/min/1.73 m2). The first sham-controlled safety and efficacy trial for renal denervation (SYMPLICITY HTN-3) did not show benefit in this population when used in addition to an average of five antihypertensive medications. Analyses of controlled clinical trial data from future trials with novel designs will be of critical importance to determine the effectiveness of device therapy for patients with severe and resistant hypertension and will allow for proper determination of patient selection and whether it will be acceptable for clinical practice. At present, the focus on the management of severe and resistant hypertension will be through careful evaluation for pseudo-resistance and secondary forms of hypertension, appropriate use of combination pharmacologic therapy, and greater utility of specialists in hypertension.
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Affiliation(s)
- William B White
- Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, USA.
| | | | - Domenic A Sica
- Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | | | - David A Calhoun
- University of Alabama School of Medicine, Birmingham, AL, USA
| | - Raymond R Townsend
- Clinical & Translational Research Center at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Deepak L Bhatt
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Hypertensive subjects with type-2 diabetes, the sympathetic nervous system, and treatment implications. Int J Cardiol 2014; 174:702-9. [DOI: 10.1016/j.ijcard.2014.04.204] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 04/19/2014] [Accepted: 04/19/2014] [Indexed: 11/19/2022]
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Zubcevic J, Santisteban MM, Pitts T, Baekey DM, Perez PD, Bolser DC, Febo M, Raizada MK. Functional neural-bone marrow pathways: implications in hypertension and cardiovascular disease. Hypertension 2014; 63:e129-39. [PMID: 24688127 PMCID: PMC4295780 DOI: 10.1161/hypertensionaha.114.02440] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/07/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Jasenka Zubcevic
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville FL 32610
| | - Monica M. Santisteban
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville FL 32610
| | - Teresa Pitts
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville FL 32610
| | - David M. Baekey
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville FL 32610
| | - Pablo D. Perez
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville FL 32610
| | - Donald C. Bolser
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville FL 32610
| | - Marcelo Febo
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville FL 32610
| | - Mohan K. Raizada
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville FL 32610
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Infante de Oliveira E. Renal sympathetic denervation - phenomenon or noumenon? Rev Port Cardiol 2014; 33:205-6. [PMID: 24798063 DOI: 10.1016/j.repc.2014.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- Eduardo Infante de Oliveira
- Serviço de Cardiologia, Hospital de Santa Maria, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
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38
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Todoran TM, Basile JN, Zile MR. Renal sympathetic denervation for blood pressure control: a review of the current evidence and ongoing studies. J Clin Hypertens (Greenwich) 2014; 16:331-41. [PMID: 24655555 PMCID: PMC8031833 DOI: 10.1111/jch.12285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hypertensive heart disease is the leading cause of mortality and morbidity in the United States. Despite widespread availability of medical therapy, it remains a challenge to treat. Autonomic nervous system imbalance resulting in overactivity of the sympathetic nervous system is integral to the development of hypertension and ultimately the development of hypertensive heart disease. Although the results with renal sympathetic denervation so far have been encouraging, optimism has recently been tempered with the broadcast alert from Medtronic, the sponsor of Symplicity HTN-3, that the trial did not meet its primary efficacy endpoint. The principal focus of this article is to review the developments in renal sympathetic denervation for the treatment of resistant hypertension.
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Affiliation(s)
- Thomas M. Todoran
- Division of CardiologyMedical University of South CarolinaCharlestonSC
- Ralph H. Johnson Department of Veterans Affairs Medical CenterCharlestonSC
| | - Jan N. Basile
- Division of CardiologyMedical University of South CarolinaCharlestonSC
- Ralph H. Johnson Department of Veterans Affairs Medical CenterCharlestonSC
| | - Michael R. Zile
- Division of CardiologyMedical University of South CarolinaCharlestonSC
- Ralph H. Johnson Department of Veterans Affairs Medical CenterCharlestonSC
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Hernández Hernández F, Rumoroso Cuevas JR, García Del Blanco B, Trillo Nouche R. Update on interventional cardiology 2013. ACTA ACUST UNITED AC 2014; 67:305-11. [PMID: 24774593 DOI: 10.1016/j.rec.2013.10.026] [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: 10/10/2013] [Accepted: 10/23/2013] [Indexed: 10/25/2022]
Abstract
The present article reviews the most important publications and studies in the field of interventional cardiology in 2013. Coronary interventions for ST-segment elevation myocardial infarction are among the most important, with studies that assess different devices and pharmacologic and mechanical strategies in primary angioplasty. Increasingly large groups of patients (with diabetes, of advanced age) and the best coronary revascularization strategy are also the focus of exhaustive research. Percutaneous procedures in the left main coronary artery continue to give rise to a significant number of publications, both because of the results of using different types of stent and because of the intravascular imaging techniques used to guide procedures and the results of their use. New bioabsorbable polymer-coated drug-eluting stents or bioresorbable drug-eluting scaffolds are being compared with second-generation drug-eluting stents to show their efficacy in preventing restenosis and reducing incidence of late thrombosis. Percutaneous treatment of structural heart disease continues to produce many publications, especially regarding percutaneous aortic prostheses, but also on closure of foramen ovale and of left atrial appendage. Finally, renal denervation continues to arouse much interest in the medical literature.
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Affiliation(s)
| | | | | | - Ramiro Trillo Nouche
- Departamento de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Infante de Oliveira E. Renal sympathetic denervation – Phenomenon or noumenon? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ewen S, Ukena C, Pöss J, Linz D, Böhm M, Mahfoud F. [Interventional hypertension therapy in diabetes mellitus. Effects on blood pressure and glucose metabolism?]. Herz 2014; 39:325-30. [PMID: 24671666 DOI: 10.1007/s00059-014-4088-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hypertension is the most common chronic cardiovascular disease with increasing prevalence all over the world. Despite the availability of many effective antihypertensive drugs, blood pressure control to target values remains low. In the pathophysiology of therapy resistant hypertension, increased activity of the sympathetic nervous system with an imbalance between sympathetic and parasympathetic activity has been identified as a main contributor to the development and maintenance of hypertension. Catheter-based denervation of the renal sympathetic nerves has been described as reducing blood pressure and decreasing sympathetic activity in patients with resistant hypertension. Supplementary beneficial effects on common cardiovascular comorbidities, such as diabetes type 2, have been reported. The present review aims to give an overview about percutaneous renal denervation for treatment of hypertension and potential new therapeutic options to improve glycemic control.
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Affiliation(s)
- S Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Deutschland
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Angle JF, Prince EA, Matsumoto AH, Lohmeier TE, Roberts AM, Misra S, Razavi MK, Katholi RE, Sarin SN, Sica DA, Shivkumar K, Ahrar K. Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel on Renal Sympathetic Denervation. J Vasc Interv Radiol 2014; 25:497-509. [PMID: 24674208 DOI: 10.1016/j.jvir.2013.12.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 12/27/2013] [Accepted: 12/27/2013] [Indexed: 10/25/2022] Open
Affiliation(s)
- John F Angle
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908.
| | - Ethan A Prince
- Department of Radiology, Division of Vascular and Interventional Radiology, Brown University, Providence, Rhode Island
| | - Alan H Matsumoto
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908
| | - Thomas E Lohmeier
- Department of Physiology, University of Mississippi, Jackson, Mississippi
| | - Andrew M Roberts
- Department of Physiology, University of Louisville, Louisville, Kentucky
| | - Sanjay Misra
- Department of Radiology, Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, Minnesota
| | - Mahmood K Razavi
- Vascular & Interventional Specialists of Orange County, Inc., Los Angeles, California
| | - Richard E Katholi
- Department of Cardiology, Prairie Heart Institute at St. John's Hospital, Springfield, Illinois
| | - Shawn N Sarin
- Department of Radiology, Division of Vascular and Interventional Radiology, George Washington University, Washington, D.C
| | - Domenic A Sica
- Department of Internal Medicine, Division of Nephrology, Virginia Commonwealth University, Richmond, Virginia
| | - Kalyanam Shivkumar
- Department of Internal Medicine, Division of Cardiology, University of California, Los Angeles, Los Angeles, California
| | - Kamran Ahrar
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Texas, MD Anderson Cancer Center, Houston, Texas
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Krum H, Schlaich MP, Sobotka PA, Böhm M, Mahfoud F, Rocha-Singh K, Katholi R, Esler MD. Percutaneous renal denervation in patients with treatment-resistant hypertension: final 3-year report of the Symplicity HTN-1 study. Lancet 2014; 383:622-9. [PMID: 24210779 DOI: 10.1016/s0140-6736(13)62192-3] [Citation(s) in RCA: 453] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Renal denervation (RDN) with radiofrequency ablation substantially reduces blood pressure in patients with treatment-resistant hypertension. We assessed the long-term antihypertensive effects and safety. METHODS Symplicity HTN-1 is an open-label study that enrolled 153 patients, of whom 111 consented to follow-up for 36 months. Eligible patients had a systolic blood pressure of at least 160 mm Hg and were taking at least three antihypertensive drugs, including a diuretic, at the optimum doses. Changes in office systolic blood pressure and safety were assessed every 6 months and reported every 12 months. This study is registered with ClinicalTrials.gov, numbers NCT00483808, NCT00664638, and NCT00753285. FINDINGS 88 patients had complete data at 36 months. At baseline the mean age was 57 (SD 11) years, 37 (42%) patients were women, 25 (28%) had type 2 diabetes mellitus, the mean estimated glomerular filtration rate was 85 (SD 19) mL/min per 1·73 m(2), and mean blood pressure was 175/98 (SD 16/14) mm Hg. At 36 months significant changes were seen in systolic (-32·0 mm Hg, 95% CI -35·7 to -28·2) and diastolic blood pressure (-14·4 mm Hg, -16·9 to -11·9). Drops of 10 mm Hg or more in systolic blood pressure were seen in 69% of patients at 1 month, 81% at 6 months, 85% at 12 months, 83% at 24 months, and 93% at 36 months. One new renal artery stenosis requiring stenting and three deaths unrelated to RDN occurred during follow-up. INTERPRETATION Changes in blood pressure after RDN persist long term in patients with treatment-resistant hypertension, with good safety. FUNDING Ardian LLC/Medtronic Inc.
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Affiliation(s)
- Henry Krum
- Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC, Australia.
| | - Markus P Schlaich
- Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute and Heart Centre, Alfred Hospital, Melbourne, VIC, Australia
| | - Paul A Sobotka
- Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, USA
| | - Michael Böhm
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinium des Saarlandes, Homburg, Germany
| | - Felix Mahfoud
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinium des Saarlandes, Homburg, Germany
| | | | - Richard Katholi
- Prairie Heart Institute at St John's Hospital, Springfield, IL, USA
| | - Murray D Esler
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
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