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Renal denervation

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https://www.readbyqxmd.com/read/28531827/safety-and-performance-of-the-second-generation-enlightn%C3%A2-renal-denervation-system-in-patients-with-drug-resistant-uncontrolled-hypertension
#1
Stephen G Worthley, Gerard T Wilkins, Mark W Webster, Joseph K Montarello, Sinny Delacroix, Robert J Whitbourn, Roderic J Warren
BACKGROUND AND AIMS: Catheter-based renal denervation for the treatment of drug-resistant hypertension has been intensively investigated in recent years. To date, only limited data have been published using multi-electrode radiofrequency ablation systems that can deliver lesions with a pre-determined pattern. This study was designed to evaluate the safety and performance of the second generation EnligHTN™ Renal Denervation System. METHODS: This first-in-human, prospective, multi-center, non-randomized study included 39 patients (62% male, mean age 63 years, and mean baseline office blood pressure 174/93 mmHg) with drug-resistant hypertension...
May 3, 2017: Atherosclerosis
https://www.readbyqxmd.com/read/28515119/pulse-wave-velocity-predicts-response-to-renal-denervation-in-isolated-systolic-hypertension
#2
Karl Fengler, Karl-Philipp Rommel, Robert Hoellriegel, Stephan Blazek, Christian Besler, Steffen Desch, Gerhard Schuler, Axel Linke, Philipp Lurz
BACKGROUND: Renal sympathetic denervation seems to be less effective as a treatment for hypertension in patients with isolated systolic hypertension, a condition associated with elevated central arterial stiffness. Because isolated systolic hypertension can also be caused by wave reflection or increased cardiac output, a more differentiated approach might improve patient preselection for renal sympathetic denervation. We sought to evaluate the additional predictive value of invasive pulse wave velocity for response to renal sympathetic denervation in patients with combined versus isolated systolic hypertension...
May 17, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28507735/does-dysfunction-of-the-autonomic-nervous-system-affect-success-of-renal-denervation-in-reducing-blood-pressure
#3
Lisa Fricke, David Petroff, Steffen Desch, Philipp Lurz, Sebastian Reinhardt, Melanie Sonnabend, Joseph Classen, Petra Baum
OBJECTIVES: Renal denervation is an interventional approach aiming to reduce high blood pressure. Its efficacy is subject of controversial debate. We analyzed autonomic function in patients undergoing renal denervation to identify responders. METHODS: A total of 21 patients with treatment-resistant hypertension scheduled for renal denervation were included. Heart rate variability, pupillary function and sympathetic skin response were examined prior to intervention...
2017: SAGE Open Medicine
https://www.readbyqxmd.com/read/28505064/changes-in-renal-artery-dimensions-are-associated-with-clinical-response-to-radiofrequency-renal-denervation-a-series-of-studies-using-quantitative-angiography-and-intravascular-ultrasound
#4
Thomas Weber, Jörg Kellermair, Karen T Witberg, Jurgen Ligthart, Robert J Melder, Thomas Forstner, Bernd Eber
OBJECTIVE: Renal denervation (RDN) can cause focal (notches) and global (spasms) changes in renal artery dimensions. We quantified these changes and related them to renal norepinephrin tissue content in animals and to blood pressure (BP) changes in patients. METHODS: We measured renal artery dimensions pre-RDN and post-RDN, utilizing quantitative renal angiography (QRA) in a porcine model and in a retrospective patient cohort, and intravascular ultrasound (IVUS) in a prospective patient cohort...
May 12, 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28505045/resistant-hypertension-in-2017
#5
Sartaj Hans, John P Reilly
PURPOSE OF REVIEW: Hypertension (HTN) is a ubiquitous condition and cause for significant morbidity and mortality. Over 400 000 deaths in the United States are related to HTN every year, more than all the Americans who died through all of World War II. As many as half the patients with HTN in the United States have resistant HTN, a blood pressure greater than 140/90 mmHg despite three medications including a diuretic. It appears that the prevalence of HTN and resistant HTN is increasing over time...
May 12, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/28501794/cochrane-corner-renal-denervation-for-resistant-hypertension-a-broken-promise
#6
EDITORIAL
Davide Bolignano, Giuseppe Coppolino
No abstract text is available yet for this article.
May 13, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28498963/hypertension-in-kidney-transplantation-is-associated-with-an-early-renal-nerve-sprouting
#7
Alessandro Mauriello, Valentina Rovella, Filippo Borri, Lucia Anemona, Elena Giannini, Erica Giacobbi, Andrea Saggini, Giampiero Palmieri, Alessandro Anselmo, Pierluigi Bove, Gerry Melino, Guardini Valentina, Manfredi Tesauro, D'Urso Gabriele, Nicola Di Daniele
Background.: Normalization of arterial pressure occurs in just a few patients with hypertensive chronic kidney disease undergoing kidney transplantation. Hypertension in kidney transplant recipients may be related to multiple factors. We aimed to assess whether hypertension in kidney-transplanted patients may be linked to reinnervation of renal arteries of the transplanted kidney. Methods.: We investigated renal arteries innervation from native and transplanted kidneys in three patients 5 months, 2 years and 11 years after transplantation, respectively...
May 12, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28497431/effect-of-catheter-based-renal-denervation-on-left-ventricular-function-mass-and-un-twist-with-two-dimensional-speckle-tracking-echocardiography
#8
Lida Feyz, Bas M van Dalen, Marcel L Geleijnse, Nicolas M Van Mieghem, Ron T van Domburg, Joost Daemen
BACKGROUND: Speckle tracking echocardiography (STE) is an echocardiography modality that is able to measure left ventricular (LV) characteristics, including rotation, strain and strain rate. Strain measures myocardial fibre contraction and relaxation. This study aims to assess the effect of renal sympathetic denervation (RDN) on functional myocardial parameters, including STE, and to identify potential differences between responders and non-responders. METHODS: The study population consisted of 31 consecutive patients undergoing RDN in the context of treatment for resistant hypertension...
May 11, 2017: Journal of Echocardiography
https://www.readbyqxmd.com/read/28495182/threats-to-internal-validity-in-renal-sympathetic-denervation-trials
#9
Eduardo Infante de Oliveira
No abstract text is available yet for this article.
May 8, 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/28489464/results-of-a-randomized-controlled-pilot-trial-of-intravascular-renal-denervation-for-management-of-treatment-resistant-hypertension
#10
Lotte Jacobs, Alexandre Persu, Qi-Fang Huang, Jean-Philippe Lengelé, Lutgarde Thijs, Frank Hammer, Wen-Yi Yang, Zhen-Yu Zhang, Jean Renkin, Peter Sinnaeve, Fang-Fei Wei, Agnès Pasquet, Fadl Elmula M Fadl Elmula, Marc Carlier, Arif Elvan, Cora Wunder, Sverre E Kjeldsen, Stefan W Toennes, Stefan Janssens, Peter Verhamme, Jan A Staessen
OBJECTIVE: Previous trials of catheter-based renal-artery denervation (RDN) as treatment modality in resistant hypertension (rHT) generated unconvincing results. In the Investigator-Steered Project on Intravascular Denervation for Management of Treatment-Resistant Hypertension (INSPiRED; NCT01505010), we optimized selection and management of rHT patients. METHODS: With ethical clearance to randomize 18 patients, three Belgian hypertension centers screened 29 rHT patients on treatment with ≥3 drugs, of whom 17 after optimization of treatment (age <70 years; systolic/diastolic office blood pressure (BP) ≥ 140/90 mm Hg; 24-h BP ≥130/80 mm Hg; glomerular filtration rate [eGFR] ≥ 45 mL/min/1...
May 10, 2017: Blood Pressure
https://www.readbyqxmd.com/read/28480523/improvement-in-health-related-quality-of-life-after-renal-sympathetic-denervation-in-real-world-hypertensive-patients-12-month-outcomes-in-the-global-symplicity-registry
#11
Ingrid Kindermann, Sonja Maria Wedegärtner, Felix Mahfoud, Joachim Weil, Nicole Brilakis, Julia Ukena, Sebastian Ewen, Dominik Linz, Martin Fahy, Giuseppe Mancia, Michael Böhm
Renal denervation has been shown to reduce blood pressure in patients with uncontrolled hypertension, but less is known about its impact on quality of life. This analysis evaluated 12-month blood pressure and quality of life outcomes in 934 patients from the Global SYMPLICITY Registry who completed the EuroQoL five-dimensions three-level questionnaire (EQ-5D-3L). At baseline, 32% of patients reported anxiety/depression and 48% reported pain/discomfort. At 12 months (n=496), office and 24-hour ambulatory systolic blood pressure were reduced by 13...
May 7, 2017: Journal of Clinical Hypertension
https://www.readbyqxmd.com/read/28474289/renal-denervation-a%C3%A2-glimpse-of-hope
#12
EDITORIAL
M Voskuil
No abstract text is available yet for this article.
May 4, 2017: Netherlands Heart Journal
https://www.readbyqxmd.com/read/28465113/comparison-of-branch-and-distally-focused-main-renal-artery-denervation-using-two-different-radio-frequency-systems-in-a-porcine-model
#13
Felix Mahfoud, Catherine A Pipenhagen, L Boyce Moon, Sebastian Ewen, Saarraaken Kulenthiran, Jeffrey M Fish, James A Jensen, Renu Virmani, Michael Joner, Kazuyuki Yahagi, Costas Tsioufis, Michael Böhm
OBJECTIVES: Anatomic placement of lesions may impact efficacy of radio-frequency (RF) catheter renal denervation (RDN). However, it is unclear if it is necessary to perform treatments post bifurcation with systems that may provide deeper penetration to achieve successful RDN. METHODS: Sixteen domestic swine (n=16) were randomly assigned to 4 groups: 1) 8 lesions created in the branch arteries using the Spyral catheter (SP8); 2) 8 lesions created in the branch arteries plus 4 lesions created in the main artery using the SP catheter (SP12); 3) 8 lesions created in the main artery using the EnligHTN catheter with the distal position as close as possible to the bifurcation (EN8); and 4) 12 lesions created in the main artery using the EN catheter with the distal position as close as possible to the bifurcation (EN12)...
April 26, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28462724/non-pharmacological-modulation-of-the-autonomic-nervous-system-for-heart-failure-treatment-where-do-we-stand
#14
Costas Tsioufis, Panayiotis Iliakis, Alexandros Kasiakogias, Dimitrios Konstantinidis, Dragan Lovic, Dimitrios Petras, Michalis Doumas, Eleftherios Tsiamis, Vasilios Papademetriou, Dimitrios Tousoulis
An imbalance in the autonomic nervous system (ANS) is a central pathophysiologic mechanism in heart failure (HF) and has been a principal target of treatment in these patients. Traditional pharmacologic agents do not provide specific modulation of discrete arms of the ANS, while side effects may lead to poor tolerance. Technological advances have provided a series of invasive methods that may provide a focused effect on the ANS in selected patient groups. Renal denervation, initially targeted for patients with resistant hypertension, has given positive preliminary results in terms of heart structure and function...
April 28, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/28462715/clinical-value-of-measuring-the-renin-aldosterone-levels-optimising-the-management-of-uncontrolled-resistant-hypertension
#15
Michalis Doumas, Chrysoula Boutari, Costas Tsioufis, Kyriakos Dimitriadis, Areti Triantafyllou, Stella Douma
Resistant hypertension (HT) is a common clinical entity with debilitating cardiovascular consequences. The highly heterogeneous nature of resistant HT requires a meticulous work-up to exclude 'pseudo-resistance' and secondary forms of arterial HT. Resistant HT has recently gained wide scientific interest due to the introduction of interventional methods (renal sympathetic denervation and carotid baroreceptor stimulation) for blood pressure (BP) reduction in this patient population. Despite however the recent advances in understanding the pathophysiology and the clinical characteristics of the disease, the appropriate management of resistant HT remains elusive...
April 26, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/28462714/renal-denervation-therapy-can-it-contribute-to-better-blood-pressure-control-in-hypertension
#16
Costas Tsioufis, Kyriakos Dimitriadis, Athanasios Kordalis, Michalis Doumas, Dimitris Konstantinidis, Theodoros Kalos, Felix Mahfoud, Vasilios Papademetriou, Dimitrios Tousoulis
Although the first results from studies suggested important benefits regarding blood pressure (BP) control in resistant hypertension by the use of diverse systems of renal denervation (RDN) in the setting of resistant hypertension, the Symplicity HTN-3, randomized sham-controlled trial reduced the enthusiasm and led to a more critical approach towards this neuromodulation innovative therapy. Nowadays there is an ongoing research attempt to justify the pathophysiological background of RDN since overdrive of the sympathetic nervous system is one of the key mechanisms leading to the development and progression of the hypertensive and cardiovascular diseases...
April 26, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/28459715/biphasic-renal-sympathetic-response-to-hemorrhagic-hypotension-in-mice
#17
Tao Zhang, Mamoru Tanida, Kunitoshi Uchida, Yoshiro Suzuki, Wei Yang, Yuhichi Kuda, Yasutaka Kurata, Makoto Tominaga, Toshishige Shibamoto
AIM: The inhibitory responses of renal sympathetic nerve activity (RSNA) and heart rate (HR) to sustained hemorrhagic shock occurred in anesthetized rats, but have not yet been determined in mice. Here, we investigated the responses of RSNA and HR to hemorrhagic hypotension in anesthetized mice, with an emphasis on the molecule-based mechanism for roles of afferent vagal nerves. METHODS: RSNA, HR, and mean systemic arterial pressure (MAP) were continuously measured in male pentobarbital-anesthetized C57BL/6N mice...
April 28, 2017: Shock
https://www.readbyqxmd.com/read/28456548/changes-in-albumin-to-creatinine-ratio-at-12-month-follow-up-in-patients-undergoing-renal-denervation
#18
Henrique Sousa, Patrícia Branco, Manuel de Sousa Almeida, Pedro de Araújo Gonçalves, Augusta Gaspar, Hélder Dores, João Mesquita, Maria João Andrade, Nuno Neuparth, Ana Aleixo, Miguel Mendes, José Diogo Barata
INTRODUCTION: Sympathetic renal denervation (RDN) was developed as a treatment for the management of patients with resistant hypertension. This procedure may have a positive impact on hypertension-related target organ damage, particularly renal disease, but the evidence is still limited. OBJECTIVE: To assess the impact of RDN on the albumin-to-creatinine ratio (ACR) at 12-month follow-up. METHODS AND RESULTS: From a single-center prospective registry including 65 patients with resistant hypertension undergoing renal denervation, 31 patients with complete baseline and 12-month follow-up blood pressure (BP) measurements (both office and 24-h ambulatory blood pressure monitoring [ABPM]) and ACR were included in the present study...
April 26, 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/28456134/improvement-in-baroreflex-control-of-renal-sympathetic-nerve-activity-in-obese-sprague-dawley-rats-following-immunosuppression
#19
Safia Akhtar Khan, Munavvar Zubaid Abdul Sattar, Nor Azizan Abdullah, Hassaan Anwer Rathore, Ashfaq Ahmad, Mohammed Hadi Abdulla, Edward James Johns
AIM: This investigation explored the hypothesis that in obesity an inflammatory response in the kidney contributed to a renal nerve-dependent blunting of the baroreflex regulation of renal sympathetic nerve activity. METHODS: Rats received a normal (12%Kcal) or high-fat (45%Kcal) diet for 8 weeks plus daily injections of vehicle (0.9% NaCl i.p) or tacrolimus (0.25mg kg(-1) day(-1) i.p) from weeks 3-8. Following anaesthesia, left renal sympathetic nerve activity was recorded, baroreflex gain curves were generated, by infusing phenylephrine and sodium nitroprusside, and cardiopulmonary baroreceptors challenged by infusing a saline load...
April 29, 2017: Acta Physiologica
https://www.readbyqxmd.com/read/28455809/renal-denervation-therapy-for-drug-resistant-hypertension-does-it-still-work
#20
REVIEW
Venkatesh K Raman, Costas Tsioufis, Michael Doumas, Vasilios Papademetriou
Hypertension is a global public health problem affecting one-fourth of the world's population. A subset of these patients with resistant hypertension presents a particular management problem and suffers a marked increase in cardiovascular risk. Treatment options have been limited, but the past decade has witnessed the emergence of catheter-based renal denervation to interrupt the sympathetic nervous system, long considered to play an important role in the development and maintenance of hypertension. Phase 1 and 2 studies reported remarkable reductions in blood pressure and sparked an excessive exuberance that ground to a halt with negative results of the SYMPLICITY HTN-3 pivotal trial...
May 2017: Current Treatment Options in Cardiovascular Medicine
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