Resistant Hypertension in People With CKD: A Review

Fay, Kevin; Cohen, Debbie L.

doi:10.1053/j.ajkd.2020.04.017

Cited by 43 publications

(30 citation statements)

References 102 publications

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“…Nevertheless, delineating the clinical benefit of renal nerve ablation for the treatment of hypertension has proved to be surprisingly difficult over the last decade (3,20,29,41,48,54). Furthermore, a role of renal nerve ablation in patients with renal disease and hypertension has not yet been established (19,51). Sympathetic efferent and primary afferent sensory neurons are also key players in the regulation of inflammation and immune responses in various organs, including the kidney (52); therefore, it is difficult to separate the effects of renal denervation on hypertension from those on inflammation in kidney disease.…”

Section: Introductionmentioning

confidence: 99%

Afferent renal innervation in anti-Thy1.1 nephritis in rats

Rodionova

Veelken

Hilgers

et al. 2020

American Journal of Physiology-Renal Physiology

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Afferent renal nerves exhibit a dual function controlling central sympathetic outflow via afferent electrical activity and influencing intrarenal immunological processes by releasing peptides such as calcitonin-gene-related peptide (CGRP). We tested the hypothesis that increased afferent (ARNA) and efferent renal nerve activity (RSNA) occur with augmented release of CGRP in anti-Thy1.1 nephritis, in which enhanced CGRP release exacerbates inflammation. Nephritis was induced in Sprague-Dawley rats by intravenous injection of OX-7 antibody (1.75 mg/kg), animals were investigated neurophysiologically, electrophysiologically and pathomorphologically six days later. Nephritic rats exhibited proteinuria (169.3±10.2 mg/24 h), with increased RSNA (14.7±0.9 bursts/s vs. control 11.5±0.9 bursts/s; n = 11, P < 0.05). However, ARNA (spikes/s) decreased in nephritis (8.0±1.8 Hz vs. control 27.4±4.1 Hz, n = 11, P < 0.05). In patch-clamp recordings neurons with renal afferents from nephritic rats showed a lower frequency of high activity following electrical stimulation (43.4% vs. 66.4% in controls, P < 0.05). In vitro assays showed that renal tissue from nephritic rats exhibited increased CGRP release via spontaneous (14±3 pg/ml vs. 6.8±2.8 pg/ml in controls; P < 0.05, n = 7) and stimulated mechanisms. In nephritic animals, marked infiltration of macrophages in the interstitium (26±4 cells/mm2) and glomeruli (3.7±0.6 cells/glomerular cross-section) occurred. Pretreatment with the CGRP receptor antagonist CGRP8-37 reduced proteinuria, infiltration and proliferation. In nephritic rats, it can be speculated that afferent renal nerves lose their ability to properly control efferent sympathetic nerve activity while influencing renal inflammation through increased CGRP release.

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Section: Introductionmentioning

confidence: 99%

Afferent renal innervation in anti-Thy1.1 nephritis in rats

Rodionova

Veelken

Hilgers

et al. 2020

American Journal of Physiology-Renal Physiology

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“…At present, although many studies have found that age, diabetes, and blood pressure are risk factors affecting the prognosis of elderly RAS patients ( 14 – 17 ), no previous study had established a model to predict the risk of RFD in RAS patients ( 19 ). Based on a total of five risk factors such as age, diabetes, hypertension, RAS, and AUCi, we established a nomogram of the CEUS+ scoring system.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Prognostic Nomogram for Prognosis in Patients With Renal Artery Stenosis

Zhang

et al. 2022

Front. Med.

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Background and ObjectiveRenal artery stenosis (RAS) is associated with an increased risk of renal function deterioration (RFD). Our previous study showed that renal cortical blood perfusion assessed by contrast-enhanced ultrasound (CEUS) was an important related factor for RFD in RAS patients. Based on several conventional related factors confirmed by previous studies, we aimed to establish and verify a CEUS+ scoring system to evaluate the risk of RFD at 1 year of follow-up in RAS patients.MethodsThis study was a single-center retrospective study. A total of 497 elderly RAS patients (247 in the training group and 250 in the verification group) admitted to the Beijing Hospital from January 2016 to December 2019 were included. The baseline characteristics of the patients on admission (including general conditions, previous medical history, blood pressure, blood creatinine, RAS, and cortical blood perfusion in the affected kidney) and renal function [glomerular filtration rate (GFR)] at 1-year of follow-up were collected. We used the univariate and multivariate logistic regressions to establish a CEUS+ scoring system model, the receiver operating characteristic (ROC) curve and area under the curve (AUC) to evaluate prediction accuracy, and the decision curve analysis and nomogram to evaluate the clinical application value of CEUS+ scoring system model.ResultsAmong the 497 patients enrolled, 266 (53.5%) were men, with an average age of (51.7 ± 19.3) years. The baseline clinical-radiomic data of the training group and the verification group were similar (all p > 0.05). Multivariate logistic regression analysis results showed that age [Odds ratio (OR) = 1.937, 95% confidence interval (CI): 1.104–3.397), diabetes (OR = 1.402, 95% CI: 1.015–1.938), blood pressure (OR = 1.575, 95% CI: 1.138–2.182), RAS (OR = 1.771, 95% CI: 1.114–2.816), and area under ascending curve (AUCi) (OR = 2.131, 95% CI: 1.263–3.596) were related factors for the renal function deterioration after 1 year of follow-up (all p < 0.05). The AUC of the ROC curve of the CEUS+ scoring system model of the training group was 0.801, and the Youden index was 0.725 (specificity 0.768, sensitivity 0.813); the AUC of the ROC curve of the validation group was 0.853, Youden index was 0.718 (specificity 0.693, sensitivity 0.835). There was no significant difference in ROC curves between the two groups (D = 1.338, p = 0.325). In addition, the calibration charts of the training and verification groups showed that the calibration curve of the CEUS+ scoring system was close to the standard curve (p = 0.701, p = 0.823, both p > 0.10).ConclusionThe CEUS+ scoring system model is helpful in predicting the risk of worsening renal function in elderly RAS patients.

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“…The longer half-life of chlorthalidone and indapamide results in increased and potent natriuresis, which prevents blood pressure elevation. Furthermore, the restriction of dietary sodium intake by 1 g has shown a decrease in blood pressure by 2.1 mmHg, which would be beneficial in addition to the recommended therapy [12]. It is advised that blood pressure in TRH patients should be maintained at 130/80 mmHg or lower [13].…”

Section: Managementmentioning

confidence: 99%

Etiology and Management of Treatment-Resistant Hypertension in African American Adults ≥18 Years: A Literature Review

Odion-Omonhimin¹,

Marwizi²,

Chive³

et al. 2022

Cureus

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Treatment-resistant hypertension (TRH) is defined as blood pressure levels that remain above the therapeutic goal despite concurrent use of three or more antihypertensive medications taken at maximally tolerated doses, one of which should be a diuretic. Additionally, individuals on four or more antihypertensive agents regardless of blood pressure are also considered to have TRH. Amongst people diagnosed with TRH, African American adults face a huge management gap, resulting in increased cardiovascular disease risk. The primary objective of this review was to identify the commonly encountered etiologies and extensively discuss the current management strategies of TRH with a particular focus on African Americans. Relevant studies were identified by analyzing scientific databases and journals such as PubMed, Cochrane, MEDLINE, Cureus, and American Heart Association (AHA). The studies identified and examined common causes of TRH, describing their pathophysiology and highlighting different treatment options for the respective etiologies. The most prevalent etiologies of TRH amongst African Americans were chronic kidney disease (CKD), renal artery stenosis (RAS), fibromuscular dysplasia, obstructive sleep apnea (OSA), endocrine causes (Conn syndrome, Cushing syndrome, etc.), sympathetic nervous system overactivity, lifestyle factors, inaccurate blood pressure measurement, and inappropriate treatment. Of the etiologies reviewed, OSA, lifestyle factors, and CKD exhibited a striking prevalence among the subpopulation studied. Unfortunately, there was a paucity of articles addressing this topic amongst African Americans, and therefore there was not a substantial appreciation of the prevalence of some of the identified etiologies in the population of interest. Thorough diagnostic testing for associated or underlying conditions provides a basis for successful management. This review brought to the fore the need for doctors and patients to collaborate in order to improve TRH management and help patients lead healthier lives.

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Resistant Hypertension in People With CKD: A Review

Cited by 43 publications

References 102 publications

Afferent renal innervation in anti-Thy1.1 nephritis in rats

Afferent renal innervation in anti-Thy1.1 nephritis in rats

Development and Validation of a Prognostic Nomogram for Prognosis in Patients With Renal Artery Stenosis

Etiology and Management of Treatment-Resistant Hypertension in African American Adults ≥18 Years: A Literature Review

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