Adequacy of blood pressure control in high-risk hypertensive patients: The DEGREE study

Zeijen, Victor; Lafeber, Melvin; Versmissen, Jorie; Boersma, Eric; Daemen, Joost

doi:10.1016/j.ijcard.2022.02.014

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…Hypertension affects over 1.3 billion people worldwide and poses an increased risk for cardiovascular morbidity and mortality [1][2][3]. Despite a broad armamentarium of pharmacological and non-pharmacological treatment options for hypertension, most patients do not reach blood pressure (BP) targets proposed in contemporary guidelines [2,[4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Long-term follow-up of patients undergoing renal sympathetic denervation

et al. 2022

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Objectives Renal denervation (RDN) proved to significantly lower blood pressure (BP) at 2–6 months in patients on and off antihypertensive drugs. Given a lack of longer-term follow-up data, our aim was to assess the safety and efficacy of RDN up to five years taking into account antihypertensive drug regimen changes over time. Methods In the present single-center study, patients underwent RDN for (therapy resistant) hypertension. Patients underwent protocolized yearly follow-up out to five years. Data were collected on 24-h ambulatory BP and office BP monitoring, renal function, antihypertensive drug regimen, and safety events, including non-invasive renal artery imaging at 6/12 months. Efficacy analyses were performed using linear mixed-effects models. Results Seventy-two patients with mean age 63.3 ± 9.5 (SD) years (51% female) were included. Median follow-up time was 3.5 years and Clark’s Completeness Index was 72%. Baseline ambulatory daytime BP was 146.1/83.7 ± 17.4/12.2 mmHg under a mean number of 4.9 ± 2.7 defined daily doses (DDD). At five years, ambulatory daytime systolic BP as calculated from the mixed model was 120.8 (95% CI 114.2–127.5) mmHg and diastolic BP was 73.3 (95% CI 69.4–77.3) mmHg, implying a reduction of -20.9/-8.3 mmHg as compared to baseline estimates (p < 0.0001). The number of DDDs remained stable over time (p = 0.87). No procedure-related major adverse events resulting in long-term consequences were observed. Conclusions The BP-lowering effect of RDN was safely maintained at least five years post-procedure as reflected by a significant decrease in ambulatory daytime BP in the absence of escalating antihypertensive drug therapy over time. Graphical abstract

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Section: Introductionmentioning

confidence: 99%

Long-term follow-up of patients undergoing renal sympathetic denervation

et al. 2022

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“…Hypertension is a major public health problem prevalent in 18% (2.8 million people) of all Dutch adults [1,2]. Previous studies showed that guideline-recommended blood pressure (BP) targets were only achieved in 28.4 to 41.8% of all patients [3][4][5]. As a result, hypertension accounts for 6.7% of all disability-adjusted life years (DALYs) in the Netherlands [6].…”

Section: Clinical Relevancementioning

confidence: 99%

The position of renal denervation in treatment of hypertension: an expert consensus statement

et al. 2022

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Hypertension is an important risk factor for cardiovascular disease. In the Netherlands, there are approximately 2.8 million people with hypertension. Despite treatment recommendations including lifestyle changes and antihypertensive drugs, most patients do not meet guideline-recommended blood pressure (BP) targets. In order to improve BP control and lower the risk of subsequent cardiovascular events, renal sympathetic denervation (RDN) has been introduced and studied as a non-pharmacological approach. While early data on the efficacy of RDN showed conflicting results, improvements in treatment protocols and study design resulted in robust new evidence supporting the potential of the technology to improve patient care in hypertensive subjects. Recently, 5 randomised sham-controlled trials demonstrated the safety and efficacy of the technology. Modelling studies have further shown that RDN is cost-effective in the Dutch healthcare setting. Given the undisputable disease burden along with the shortcomings of current therapeutic options, we postulate a new, clearly framed indication for RDN as an adjunct in the treatment of hypertension. The present consensus statement summarises current guideline-recommended BP targets, proposed workup and treatment for hypertension, and position of RDN for those patients with primary hypertension who do not meet guideline-recommended BP targets (see central illustration).

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“…hereas adequate antihypertensive therapy has demonstrated to reduce cardiovascular risk in hypertensive patients, blood pressure (BP) control is achieved in merely 40% of all patients receiving medical treatment [1][2][3][4].…”

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Association between renal sympathetic denervation and arterial stiffness: the ASORAS study

Zeijen¹,

Feyz²,

Kardys³

et al. 2023

Journal of Hypertension

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Objectives: Renal sympathetic denervation (RDN) reduces blood pressure (BP). However, one out of three patients does not exhibit a significant BP response to the therapy. This study investigates the association between noninvasive vascular stiffness indices and RDN-mediated BP reduction. Methods:In this prospective, single-arm pilot study, patients with systolic office BP at least 140 mmHg, mean 24-h systolic ambulatory blood pressure (ABP) at least 130 mmHg and at least three prescribed antihypertensive drugs underwent radiofrequency RDN. The primary efficacy endpoint was temporal evolution of mean 24-h systolic ABP throughout 1-year post RDN (measured at baseline and 3-6-12 months). Effect modification was studied for baseline ultrasound carotid-femoral and magnetic resonance (MR) pulse wave velocity (PWV), MR aortic distensibility, cardiac MR left ventricular parameters and clinical variables. Statistical analyses were performed using linear mixed-effects models, and effect modification was assessed using interaction terms.Results: Thirty patients (mean age 62.5 AE 10.7 years, 50% women) with mean 24-h ABP 146.7/80.8 AE 13.7/ 12.0 mmHg were enrolled. Following RDN, mean 24-h systolic ABP changed with À8.4 (95% CI: À14.5 to À2.3) mmHg/year (P ¼ 0.007). Independent effect modifiers were CF-PWV [R2.7 (0.3 to 5.1) mmHg/year change in outcome for every m/s increase in CF-PWV; P ¼ 0.03], daytime diastolic ABP [À0.4 (À0.8 to 0.0) mmHg/year per mmHg; P ¼ 0.03], age [R0.6 (0.2 to 1.0) mmHg/year per year of age; P ¼ 0.006], female sex [À14.0 (À23.1 to À5.0) mmHg/year as compared with men; P ¼ 0.003] and BMI [R1.2 (0.1 to 2.2) mmHg/year per kg/m 2 ; P ¼ 0.04]. Conclusion:Higher CF-PWV at baseline was associated with a smaller reduction in systolic ABP following RDN. These findings could contribute to improve identification of RDN responders.

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Adequacy of blood pressure control in high-risk hypertensive patients: The DEGREE study

Cited by 4 publications

References 29 publications

Long-term follow-up of patients undergoing renal sympathetic denervation

Long-term follow-up of patients undergoing renal sympathetic denervation

The position of renal denervation in treatment of hypertension: an expert consensus statement

Association between renal sympathetic denervation and arterial stiffness: the ASORAS study

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