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Renal sympathetic denervation

Michael Böhm, Christian Ukena, Sebastian Ewen, Dominik Linz, Ina Zivanovic, Uta Hoppe, Krzysztof Narkiewicz, Luis Ruilope, Manuela Negoita, Roland Schmieder, Bryan Williams, Uwe Zeymer, Andreas Zirlik, Guiseppe Mancia, Felix Mahfoud
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)...
October 15, 2016: Journal of Hypertension
Byeong-Keuk Kim
Catheter-based renal sympathetic denervation (RDN) has opened the new world in the treatment of resistant or refractory hypertension. However, SYMPLICITY HTN-3, 2:1 randomization, blinded and sham-controlled study did not show a significant reduction of systolic blood pressure (BP) in patients with resistant hypertension 6 months after RDN as compared with a sham control. After that, substudy investigating the predictors of BP responses in SYMPLICITY HTN-3 trial was reported; racial difference and optimal medical treatment were issued for the optimal denervation therapy...
September 2016: Journal of Hypertension
David Harrison
Hypertension remains an enormous health care burden that affects one third of the population. Despite its prevalence the cause of most cases of hypertension remains unknown. Our laboratory has defined a novel mechanism for hypertension involving adaptive immunity. We found that mice lacking lymphocytes (RAG-1 mice) develop blunted hypertensive responses to a variety of stimuli including chronic angiotensin II infusion, DOCA-salt challenge and norepinephrine infusion. Adoptive transfer of T cells, but not B cells, restores the hypertensive responses to these stimuli...
September 2016: Journal of Hypertension
George Bakris
Renal denervation started out as a very promising approach to treat resistant hypertension with a very strong conceptual and basic science frame work from Gerald DiBona's lab and extending into the early non shame clinical studies demonstrating proof of concept in SYMPLICITY HTN-1 and 2. SYMPLICITY-HTN 3 a properly done, sham control trial failed to show a benefit on further reduction of BP compared to the sham group. The conclusion the procedure doesn't work. How could this be-it was clearly effective in animal models but why not in man...
September 2016: Journal of Hypertension
Markus Schlaich
Accumulating evidence from mainly uncontrolled and unblinded clinical studies with various types of ablation catheters have shown that renal denervation (RDN) can be applied safely and is effective in lowering blood pressure (BP) in most patients with treatment resistant hypertension. Sustained BP lowering has been documented up to 3 years at this stage. Furthermore, RDN has been associated with regression of target organ damage, such as left ventricular hypertrophy, arterial stiffness and others. Several studies indicate potential benefit in other common clinical conditions associated with increased sympathetic tone including chronic kidney disease and heart failure...
September 2016: Journal of Hypertension
Kate Denton, Karen Moritz, Lindsey Booth, Clive May, Geoff Head, Markus Schlaich, Reetu Singh
OBJECTIVE: Renal sympathetic nerves contribute significantly to the control of kidney function and blood pressure. A critical question is whether catheter-based renal denervation (cDNX) has adverse consequences, in situations of clinical challenge, such as hemorrhage. The aim was to examine the effects of cDNX on basal mean arterial pressure (MAP) and glomerular filtration rate (GFR) and in response to hemorrhage in hypertensive sheep with chronic kidney disease (CKD). DESIGN AND METHOD: Hypertension and CKD was induced in sheep by performing fetal unilateral nephrectomy (CKD; N = 14)...
September 2016: Journal of Hypertension
Xiaodong Li, Mona Hong, Dingliang Zhu, Pingjin Gao
OBJECTIVE: The sympathetic nervous system interacts with the renin-angiotensin-aldosterone system (RAAS) contributing to cardiovascular diseases. In this study, we sought to determine if renal denervation (RDN) inhibits aldosterone expression and associated cardiovascular pathophysiological changes in angiotensin II (Ang II)-induced hypertension. DESIGN AND METHOD: Bilateral RDN or SHAM operation was performed before chronic 14-day Ang II infusion (200 ng/kg/min) in male Sprague-Dawley rats...
September 2016: Journal of Hypertension
Tilmann Ditting, Kristina Rodionova, Sonja Heinlein, Karl Friedrich Hilgers, Christian Ott, Roland Schmieder, Kerstin Amann, Roland Veelken
OBJECTIVE: Afferent renal nerves exhibit a dual function. They influence intrarenal immunological processes by release of neurokinins like CGRP and control central sympathetic outflow via afferent electrical activity. The former seems to be important in renal inflammation whereas the sympathetic modulation by afferent electrical activity is not fully understood in cardiovascular disease and hypertension. Hence, we hypothesized that augmented effects of CGRP in renal inflammation occur with increased afferent renal nerve activity...
September 2016: Journal of Hypertension
Christian Ott, Iris Kistner, Axel Schmid, Stefanie Friedrich, Tilmann Ditting, Roland Veelken, Felix Mahfoud, Michael Böhm, Michael Uder, Roland Schmieder
OBJECTIVE: Renal denervation (RDN) lowers blood pressure (BP) by interruption of sympathetic nerve activity. A high sympathetic tone increases not only BP but also decreases pancreatic beta cell insulin secretion. Hence, the objective of the study was to analyze whether RDN improves secretory capacity of beta cells. DESIGN AND METHOD: In 40 patients (7 diabetics, 19 prediabetics, 14 non diabetics) with treatment resistant hypertension (defined by office BP ≥ 140/90 mmHg and diagnosis confirmed with 24-h ambulatory BP ≥ 130/80 mmHg), insulin secretion was measured before and 6 months after RDN (Simplicity flex catheter, Medtronic) by glucagon test...
September 2016: Journal of Hypertension
Markus Schlaich, Dagmara Hering, Petra Marusic, Antony Walton, Elisabeth Lambert, Henry Krum, Gavin Lambert, Murray Esler, Nina Eikelis
OBJECTIVE: We have previously demonstrated the effectiveness of renal denervation (RDN) to lower blood pressure (BP) in part via the reduction of renal sympathetic activity. The aim of this study was to examine the effect of RDN on adipokines. In particular, whether BP reduction, associated with RDN treatment, has a favorable outcome on adipokine profile in patients with resistant hypertension (RH). DESIGN AND METHOD: Fifty seven patients with RH undergoing RDN have been recruited for the study (65% males, age 60...
September 2016: Journal of Hypertension
Alejandro De La Sierra, Julia Pareja, Angela Barrera, Sergi Yun, Pedro Armario, Anna Oliveras
OBJECTIVE: To compare the effect on circadian blood pressure (BP) and BP variability of treatment with sympathetic renal denervation versus spironolactone in resistant hypertensive patients. DESIGN AND METHOD: The DENERVHTA study was a randomized, open trial in 23 resistant hypertensive patients (office systolic BP > 150 and 24-hour systolic BP > 140, while on treatment with at least 3 antihypertensive drugs, one of them a diuretic). Good compliance with antihypertensive medication and eligibility of renal arteries anatomy was ensured before randomization...
September 2016: Journal of Hypertension
Dagmara Hering, Petra Marusic, Jacqueline Duval, Yusuke Sata, Murray Esler, Antony Walton, Markus Schlaich
OBJECTIVE: Previous studies have shown that renal denervation has the potential to reduce blood pressure (BP) and slow the decline of renal function in chronic kidney disease (CKD) patients up to 12 months post procedure. The effects of RDN on estimated glomerular filtration rate (eGFR) and BP reduction beyond the first year remain unknown. This study investigated the effects of RDN on renal function and BP in CKD patients (eGFR ≤ 60 ml/min/1.73 m) out to 24 months post procedure. DESIGN AND METHOD: eGFR from the previous 60 months were retrospectively collected from 46 CKD patients who were scheduled for RDN...
September 2016: Journal of Hypertension
David John Webb
Treatment-resistant hypertension (TRH) is defined as the failure to achieve an office BP target of <140/90 mmHg (<130/80 mmHg in patients with chronic kidney disease (CKD) or diabetes) in patients with hypertension (HT), despite adherence to at least 3 antihypertensive medications at optimal tolerated doses, ideally including a diuretic (Calhoun et al., Circulation 2008). TRH identifies patients with hard-to-treat HT, who might benefit from specialist investigation and treatment. Although some studies put the prevalence of TRH as >10%, these levels may be inflated by white-coat hypertension and poor adherence...
September 2016: Journal of Hypertension
George Bakris
Resistant hypertension is defined as a blood pressure above 140/90 mmHg despite adherence to a combination of at least three optimally dosed antihypertensive medications, one of which is a diuretic. Chronic kidney disease (CKD) is one of the more common patient comorbidities associated with resistant hypertension. Recommended low-salt diet and triple antihypertensive drug regimens that include a diuretic, should be complemented by the sequential addition of other antihypertensive drugs. CKD is associated with premature vascular ageing, characterized by accelerated arteriosclerosis or atherosclerosis and endothelial dysfunction...
September 2016: Journal of Hypertension
Akira Nishiyama, Hirofumi Hitomi, Daisuke Nakano, Yoshihide Fujisawa
OBJECTIVE: Clinical studies have indicated that renal denervation (RDN) suppresses sympathetic overactivity in hypertensive patients, suggesting that afferent renal nerve activity (ARNA) enhances sympathetic outflow via central nervous system. To investigate the possible role of ARNA in the pathophysiology of renovascular hypertension, we examined the effect of RDN on blood pressure and urinary norepinephrine in two-kidney, one-clip (2K1C) Goldblatt rats. DESIGN AND METHOD: Male Wister-Kyoto rats were divided 3 groups: sham, 2K1C and 2K1C with RDN...
September 2016: Journal of Hypertension
Chan Joo Lee, Yeongmin Woo, Byeong-Keuk Kim, Kyung Bong Yoon, Hae-Young Lee, Sungha Park
A 30-year-old woman was referred to our hospital due to high blood pressure, dizziness, headache and blurred vision. She had past history of preeclampsia and gestational hypertension 4 years ago but she had not taken antihypertensive medication in spite of remained hypertension after delivery. She was hospitalized for fever due to urinary tract infection and severe hypertension which was above 210/140 mmHg. Despite maximal medical treatment with telmisartan 80 mg, nifedipine 120 mg, carvedilol 50 mg, doxazocin 8 mg, chlorthalidone 50 mg, spironolactone 50 mg#2, isosorbide dinitrate 80 mg and intermittent intravenous administration of nicardipine and labetalol, her systolic blood pressure remained above 160 mmHg and repeatedly measured above 200 mmHg...
September 2016: Journal of Hypertension
Kazuomi Kario
The essential benefit of the management of hypertension is derived from the blood pressure (BP) lowering per se, indicating the importance of BP throughout 24 hours. Recent guidelines stressed the importance of home BP for the diagnosis and management of hypertension. It is well-known that cardiovascular events occur more frequently in the morning BP levels have been shown to increase during the period from night to early morning. Clinical research using ambulatory BP monitoring (ABPM) or home BP monitoring has clarified that morning BP and BP surge are more closely related to the cardiovascular risk than office BP (Kario et al...
September 2016: Journal of Hypertension
Masatsugu Horiuchi
Hypertensive patients have greater chances of such cardiovascular events as stroke, coronary heart disease, heart or renal failure, peripheral artery disease, and dementia. It is also well recognized that diabetes increases the cardiovascular risks in concert with hypertension. Therefore, main goals for an innovation of anti-hypertensive therapy would be to achieve further risk reduction by targeting the functional, metabolic, and structural alterations associated with hypertension. Professors Dzau and Braunwald et al proposed the concept of "the cardiovascular disease continuum" in 1991, and that hypertension may trigger the chain of events, leading to end-stage heart disease; however, this concept was quite new at that time, and there was some discussion whether "the cardiovascular disease continuum" is true or not...
September 2016: Journal of Hypertension
Peng Li, Pei-Pei Huang, Yun Yang, Chi Liu, Yan Lu, Fang Wang, Wei Sun, Xiang-Qing Kong
Sympathetic activity is enhanced in patients with essential or secondary hypertension, as well as in various hypertensive animal models. Therapeutic targeting of sympathetic activation is considered an effective antihypertensive strategy. We hypothesized that renal sympathetic denervation (RSD) attenuates hypertension and improves vascular remodeling and renal disease in the 2-kidney, 1-clip (2K1C) rat model. Rats underwent 2K1C modeling or sham surgery; then, rats underwent RSD or sham 4 weeks later, thus resulting in four groups (normotensive-sham, normotensive-RSD, 2K1C-sham, and 2K1C-RSD)...
October 14, 2016: Journal of Applied Physiology
Masaaki Nishihara, Ko Takesue, Yoshitaka Hirooka
OBJECTIVE: Sympathoexcitation plays an important role in the pathogenesis of hypertension in patients with chronic kidney disease (CKD). The paraventricular nucleus of the hypothalamus (PVN) in the brain controls sympathetic outflow through γ-amino butyric acid (GABA)-ergic mechanisms. Renal denervation (RDN) exerts a long-term antihypertensive effect in hypertension with CKD; however, the effects of RDN on sympathetic nerve activity and GABA-ergic modulation in the PVN are not clear...
October 4, 2016: Autonomic Neuroscience: Basic & Clinical
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