Abstract-We aimed to investigate for the first time the blood pressure (BP)-lowering effect of renal sympathetic denervation (RDN) versus clinically adjusted drug treatment in true treatment-resistant hypertension (TRH) after excluding patients with confounding poor drug adherence. Patients with apparent TRH (n=65) were referred for RDN, and those with secondary and spurious hypertension (n=26) were excluded. TRH was defined as office systolic BP (SBP) >140 mm Hg, despite maximally tolerated doses of ≥3 antihypertensive drugs including a diuretic. In addition, ambulatory daytime SBP >135 mm Hg after witnessed intake of antihypertensive drugs was required, after which 20 patients had normalized BP and were excluded. Patients with true TRH were randomized and underwent RDN (n=9) performed with Symplicity Catheter System versus clinically adjusted drug treatment (n=10

The strong associations between symptom clusters and depressive symptoms and the physical and mental domains of HRQOL should lead to an increased focus on symptom-alleviating interventions. Additional research is warranted to determine whether treatment of symptom clusters rather than single symptoms will improve HRQOL.

Diastolic blood pressure was increased in these white HIV-infected patients compared with the general population, but there was no difference in the prevalence of hypertension. However, the duration of combination antiretroviral therapy predicted hypertension independently.

This analysis of current European clinical practice shows that-consistent with findings from randomized controlled trials and retrospective observational studies-cinacalcet improves attainment of KDOQI bone metabolism targets in dialysis patients with various stages of SHPT.

Abstract-Baroreceptor reflex sensitivity (BRS) has been found lower and heart rate variability (HRV) parasympathetic markers have been found higher in healthy women than in healthy men. Thus, in the present study we hypothesized gender differences in the autonomic function among hypertensive subjects. Forty-one hypertensive patients and 34 normotensive subjects, age 53Ϯ1 years, were examined. Four weeks after cessation of antihypertensive therapy, HRV was assessed in 24-hour Holter ECGs, and BRS was calculated with the transfer technique. A t test was performed after log transformation of spectral values. Resting blood pressure and heart rate in the hypertensive and the normotensive groups were 150Ϯ2/100Ϯ1 (meanϮSEM) and 121Ϯ2/81Ϯ1 mm Hg, respectively, and 68Ϯ1 and 60Ϯ1 bpm, respectively (PϽ0.0005). Compared with normotensive controls, hypertensive patients had lower total power (1224Ϯ116 versus 1797Ϯ241 ms 2 ; Pϭ0.03), lower low frequency power (550Ϯ57 versus 813Ϯ115 ms 2 ; Pϭ0.04), lower high frequency power (141Ϯ23 versus 215Ϯ38 ms 2 ; Pϭ0.06), lower root mean square successive difference (28.7Ϯ2.7 versus 35.7Ϯ3.0 ms; Pϭ0.03), and PNN50 (4.9Ϯ0.6% versus 9.8Ϯ1.5%; Pϭ0.003). BRS was also lower in the hypertensive subjects (7.6Ϯ0.6 versus 10.4Ϯ0.8 ms/mm Hg; Pϭ0.005). When comparing the same parameters between normotensive subjects and hypertensive subjects within the same gender group, we found significant reduction (PϽ0.05) only within the female group. The difference in BRS within the female group was twice that within the male group. Stepwise multiple regression analysis revealed gender, age, HDL cholesterol, and blood pressure as independent explanatory variables of BRS and HRV. Our results suggest that gender is an important determinant of BRS and HRV. Autonomic function parameters were especially impaired in hypertensive women compared with hypertensive men. Key Words: hypertension Ⅲ gender Ⅲ baroreflex Ⅲ catecholamines Ⅲ heart rate T he autonomic nervous system plays a crucial role in blood pressure (BP) and heart rate (HR) control and may thus be an important pathophysiological factor in the development of hypertension. There have been numerous studies on plasma catecholamines in essential hypertension, 1 most of which have shown increased levels in hypertensive subjects. Moreover, disturbed autonomic HR and BP control has been demonstrated in several studies by means of HR variability (HRV) and baroreceptor reflex sensitivity (BRS). [2][3][4][5][6][7][8][9][10] HRV, which estimates the tonic HR control, 11-13 is generally reduced (standard deviation of all R-R intervals [SDNN] and total power [energy in the heart period spectrum between 0.0033 and 0.40 Hz] [TP]) in hypertensive patients. 2,4 -6 Markers of sympathetic predominance are increased in some 3 but not all studies. 4 -6 BRS, which estimates the reflex vagal HR control, 11-13 is reduced in hypertensive subjects. 6 -10 Both BRS and HRV parameters (except low frequency power [energy in the heart period spectrum between 0.04 and 0.15 Hz] [LF]/h...

A pproximately 10% of patients treated for hypertension remain with uncontrolled high blood pressure (BP), despite prescription of antihypertensive drugs.1 Renal sympathetic denervation has been introduced as a new treatment of hypertension apparently resistant to drug treatment.2 However, it has been known for decades that poor drug adherence is a major problem among these patients. 3,4 It is unknown to what degree the decline in BP after renal denervation (RDN) 2 is caused by denervation itself or concomitantly improved drug adherence. We aimed to investigate for the first time the BP lowering effect of RDN in treatment-resistant hypertension after witnessed intake of medication just before qualifying ambulatory BP. Methods Study Design and PatientsPatients referred specifically for RDN from hospitals and specialist practices in the southern part of Norway (n=18) after publication of the Symplicity HTN-2 study 2 were worked up in the nephrology outpatient clinic at Oslo University Hospital, Ullevål in the time period from December 2011 through June 2012. Treatment-resistant hypertension was defined as uncontrolled hypertension (office systolic BP >140 mm Hg), despite regular intake of maximally tolerated doses of ≥3 antihypertensive drugs, including a diuretic. In addition, patients had to qualify by having mean ambulatory daytime systolic BP >135 mm Hg immediately after investigator witnessed intake of their antihypertensive morning drugs. Patients were asked to bring their prescribed medication to the clinical visit with one of the investigators (one of the authors of the article). Medication was documented and administered by the investigator and swallowed by the patient under continuous observation, to secure the intake of prescribed medication in prescribed doses. Patients were then continuously under the observation by the investigator to prohibit throwing up again of the pills until 24-hour ambulatory BP device had been mounted and tested out in a somewhat more lengthy procedure than usually to prolong the period of observation. Patients stayed in the hospital for 2 hours to capture those with potential symptomatic hypotension caused by full intake of medication. Visits with subsequent ambulatory BP measurements were done in the morning, and further observation of patients in the hospital was done during working hours.Plasma and urine metabolites of drugs were not measured because these tests would not have contributed in the present situation. Such tests could have identified the nondrug compliant patients but not secured their intake of medication. See Editorial Commentary, pp 450-452Abstract-It is unknown whether the decline in blood pressure (BP) after renal denervation (RDN) is caused by denervation itself or concomitantly improved drug adherence. We aimed to investigate the BP lowering effect of RDN in true treatmentresistant hypertension by excluding patients with poor drug adherence. Patients with resistant hypertension (n=18) were referred for a thorough clinical and laboratory work-up. Treat...

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