Read by QxMD icon Read

renal denervation in management of resistant HTN

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
Chongjia Chen, Ashish Upadhyay
PURPOSE OF REVIEW: Hypertension (HTN) is a major global public health problem. Endovascular catheter-based radiofrequency ablation of renal sympathetic nerve endings (renal denervation) is a novel treatment option for uncontrolled HTN. RECENT FINDINGS: Early clinical studies primarily in Australia and Europe established renal denervation as a well tolerated and feasible procedure that resulted in a sustained reduction in blood pressure among individuals with severe resistant HTN...
March 2017: Current Opinion in Nephrology and Hypertension
David A Calhoun
No abstract text is available yet for this article.
September 20, 2016: Circulation
Charan Yerasi, Nevin C Baker, Anil K Jonnalagadda, Rebecca Torguson, Suman Singh, Judith Vies, Ron Waksman
The screening of patients referred for the Symplicity Renal-Denervation Catheter Therapy on Resistant Hypertension (SYMPLICITY HTN-3) trial was rigorous, with many found not eligible to participate. We investigate patients who were not included in the trial and evaluate their current hypertensive (HTN) therapy, control and clinical status. A retrospective review and telephone interview was performed 8-10 months postscreening on 45 patients and their referring providers who were ultimately not included. Patients were grouped into 4 categories: (1) noninterest; (2) excluded (not meeting inclusion criteria); (3) screen failure (excluded during screening visits due to adequate blood pressure control guided by HTN specialist); or (4) referred after enrollment closure...
December 2015: Journal of the American Society of Hypertension: JASH
Hitesh C Patel, Carl Hayward, Vassilis Vassiliou, Ketna Patel, James P Howard, Carlo Di Mario
Renal sympathetic denervation (RSD) as a therapy for patients with resistant hypertension has attracted great interest. The majority of studies in this field have demonstrated impressive reductions in blood pressure (BP). However, these trials were not randomized or sham-controlled and hence, the findings may have been overinflated due to trial biases. SYMPLICITY HTN-3 was the first randomized controlled trial to use a blinded sham-control and ambulatory BP monitoring. A surprise to many was that this study was neutral...
2015: Integrated Blood Pressure Control
Aditya Bhat, Ye Min Kuang, Gary C H Gan, David Burgess, Alan Robert Denniss
Hypertension is a globally prevalent condition, with a heavy clinical and economic burden. It is the predominant risk factor for premature cardiovascular and cerebrovascular disease, and is associated with a variety of clinical disorders including stroke, congestive cardiac failure, ischaemic heart disease, chronic renal failure, and peripheral arterial disease. A significant subset of hypertensive patients have resistant hypertensive disease. In this group of patients, catheter-based renal artery denervation has emerged as a potential therapy, with favourable clinical efficacy and safety in early trials...
2015: BioMed Research International
Matthew G Denker, Debbie L Cohen, Raymond R Townsend
Resistant hypertension affects approximately 10-15 % of the hypertensive population and is associated with an increased occurrence of adverse cardiovascular outcomes. Recently, renal denervation (RDN) has emerged as a novel, non-pharmacologic therapy for resistant hypertension that is designed to ablate the sympathetic nerves distributed around the renal arteries, thus diminishing sympathetic nervous system activity and its influence on hypertension. RDN appeared to have a powerful BP-lowering effect in early clinical trials...
October 2015: Current Atherosclerosis Reports
Pierre Lantelme, Brahim Harbaoui, Pierre-Yyes Courand
Resistant hypertension remains a frequent and difficult situation; its management has been recently clarified by guidelines from the French Society of Hypertension. Baroreceptor stimulation (BAROSTIM) is an emerging technique aimed at decreasing blood pressure in resistant hypertension. BAROSTIM interferes with baroreflex loop by stimulating baroreceptors and afferences of the baroreflex. There is only one randomized control trial with this technique which showed a modest but apparently durable blood pressure reduction...
July 2015: La Presse Médicale
K Kario, G L Bakris, D Bhatt
OBJECTIVE: To study the impact of catheter-based renal artery denervation (RDN) on change in morning and night systolic BP (SBP) defined by ambulatory BP measurements (ABPM) 6 months post-randomization. DESIGN AND METHOD: SYMPLICITY HTN-3 and SYMPLICITY HTN-Japan are prospective, randomized, controlled trials of RDN for treatment of resistant hypertension. However, SYMPLICITY HTN-3 included a blinded, sham control and HTN-Japan control patients were not blinded and continued medical management alone...
June 2015: Journal of Hypertension
Sibu P Saha, Khaled M Ziada, Thomas F Whayne
The prevalence of hypertension around the world has increased significantly with projections for an increasing major global burden of hypertension. Medication-resistant hypertension can be perplexing and frustrating. The existence of these difficult patients results in the need for additional approaches to treatment including surgery, percutaneous interventions, and device management. The sophistication of these techniques has progressed markedly and initial procedures such as classical sympathectomy and renal artery bypass are almost never performed...
March 2015: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Athanasios J Manolis, Manolis S Kallistratos, Michalis Doumas, Stamatina Pagoni, Leonidas Poulimenos
And suddenly, following the preliminary results of renal denervation and carotid baroreceptor stimulation, a big interest in resistant hypertension rose, and all interventionists, many of them with no previous experience with hypertension, fell in love with hypertension and especially resistant hypertension. In the European Society of Hypertension/International Society of Hypertension (ESH/ISH) 2014 Joint Hypertension meeting in Athens, there were no more than four to five sessions related to resistant hypertension and renal denervation, while in the 2014 EuroPCR meeting there were more than 60 renal denervation sessions! In light of the growing scientific interest in the treatment of this patient group, an update on the treatment available and some concerns regarding the definition and treatment of resistant hypertension is presented...
2015: F1000Prime Reports
R Wachter, J Menne
A number of invasive treatment approaches have become established in the management of severe treatment-resistant hypertension in recent years, including renal denervation and baroreceptor activation therapy. Both methods achieve their antihypertensive effect by influencing the autonomic nervous system. Renal denervation in particular has stimulated considerable interest, since it is simple to perform and initial studies have yielded highly promising results. However, enthusiasm has waned significantly since the initial euphoria...
March 2015: Der Internist
Michel Azizi, Marc Sapoval, Philippe Gosse, Matthieu Monge, Guillaume Bobrie, Pascal Delsart, Marco Midulla, Claire Mounier-Véhier, Pierre-Yves Courand, Pierre Lantelme, Thierry Denolle, Caroline Dourmap-Collas, Hervé Trillaud, Helena Pereira, Pierre-François Plouin, Gilles Chatellier
BACKGROUND: Conflicting blood pressure-lowering effects of catheter-based renal artery denervation have been reported in patients with resistant hypertension. We compared the ambulatory blood pressure-lowering efficacy and safety of radiofrequency-based renal denervation added to a standardised stepped-care antihypertensive treatment (SSAHT) with the same SSAHT alone in patients with resistant hypertension. METHODS: The Renal Denervation for Hypertension (DENERHTN) trial was a prospective, open-label randomised controlled trial with blinded endpoint evaluation in patients with resistant hypertension, done in 15 French tertiary care centres specialised in hypertension management...
May 16, 2015: Lancet
J Schrader, S Lüders
BACKGROUND: Therapy-resistant hypertension is commonly encountered in daily practice. It is present when the therapeutic goal is not achieved after trying at least three antihypertensives from different groups with adequate doses and including a diuretic. Between 10 and 20% of patients are affected and their prognosis is poor. Thus, intensive strategies are required to achieve normotension. DIAGNOSIS: An exact diagnosis is essential. Pseudoresistance needs to be excluded in addition to secondary hypertension and sleep apnea syndrome...
February 2015: Der Internist
Bing Huang, Benjamin J Scherlag, Lilei Yu, Zhibing Lu, Bo He, Hong Jiang
Ventricular arrhythmias (VAs) remain the major cause of mortality and sudden cardiac death (SCD) in almost all forms of heart disease. Despite so many therapeutic advances, such as pharmacological therapies, catheter ablation, and arrhythmia surgery, management of VAs remains a great challenge for cardiologists. Evidence from histological studies and from direct nerve activity recordings have suggested that increased sympathetic nerve density and activity contribute to the generation of VAs and SCD. It is well known that renal sympathetic nerve (RSN), either afferent component or efferent component, plays an important role in modulation of central sympathetic activity...
July 2015: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Michel Azizi
The failure of pharmacological approaches to treat resistant hypertension has stimulated interest in invasive device-based treatments. New catheter systems using radiofrequency or ultrasound energy have been developed, allowing a percutaneous endovascular approach to renal denervation for patients with resistant hypertension. To date, this technique has been evaluated only in a few open-label trials including small numbers and the available evidence suggests a favorable blood pressure-lowering effect in the short-term and a low incidence of immediate complications...
2014: Biologie Aujourd'hui
Thierry Denolle, Bernard Chamontin, Gérard Doll, Jean-Pierre Fauvel, Xavier Girerd, Daniel Herpin, Bernard Vaïsse, Frédéric Villeneuve, Jean-Michel Halimi
To improve the management of resistant hypertension, the French Society of Hypertension, an affiliate of the French Society of Cardiology, has published a set of eleven recommendations. The primary objective is to provide the most up-to-date information, based on the strongest scientific rationale and which is easily applicable to daily clinical practice for health professionals working within the French health system. Resistant hypertension is defined as uncontrolled blood pressure (BP) both on office measurements and confirmed by out-of-office measurements despite a therapeutic strategy comprising appropriate lifestyle and dietary measures and the concurrent use of three antihypertensive agents including a thiazide diuretic, a renin-angiotensin system blocker (ARB or ACEI) and a calcium channel blocker, for at least four weeks, at optimal doses...
December 2014: La Presse Médicale
Melvin D Lobo, Mark A de Belder, Trevor Cleveland, David Collier, Indranil Dasgupta, John Deanfield, Vikas Kapil, Charles Knight, Matthew Matson, Jonathan Moss, Julian F R Paton, Neil Poulter, Iain Simpson, Bryan Williams, Mark J Caulfield
Resistant hypertension continues to pose a major challenge to clinicians worldwide and has serious implications for patients who are at increased risk of cardiovascular morbidity and mortality with this diagnosis. Pharmacological therapy for resistant hypertension follows guidelines-based regimens although there is surprisingly scant evidence for beneficial outcomes using additional drug treatment after three antihypertensives have failed to achieve target blood pressure. Recently there has been considerable interest in the use of endoluminal renal denervation as an interventional technique to achieve renal nerve ablation and lower blood pressure...
January 2015: Heart: Official Journal of the British Cardiac Society
William B White, J Rick Turner, Domenic A Sica, John D Bisognano, David A Calhoun, Raymond R Townsend, Herbert D Aronow, Deepak L Bhatt, George L Bakris
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...
October 2014: Journal of the American Society of Hypertension: JASH
Vito M Campese
Hypertension associated with chronic kidney diseases often is resistant to drug treatment. This review deals with two main aspects of the management of CKD patients with hypertension: the role of sodium/volume and the need for dietary salt restriction, as well as appropriate use of diuretics and what currently is called sequential nephron blockade; the second aspect that is addressed extensively in this review is the role of the sympathetic nervous system and the possible clinical use of renal denervation.
2014: Seminars in Nephrology
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"