Arterial Destiffening Starts Early after Renal Artery Denervation

Berūkštis, Andrius; Navickas, Rokas; Neverauskaite-Piliponiene, Gintarė; Ryliškytė, Ligita; Misiūra, Jonas; Vajauskas, Donatas; Misonis, Nerijus; Laucevičius, Aleksandras

doi:10.1155/2019/3845690

Cited by 9 publications

(11 citation statements)

References 36 publications

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“…In our previous study, we also observed a significant reduction in blood pressure and AoPWV that was sustained for up to 12 months after the RDN procedure [ 12 ].…”

Section: Introductionmentioning

confidence: 80%

“…A prospective single arm interventional study was conducted between March 2012 and December 2016, and a total of 243 patients with suspected resistant hypertension were referred to university hospital hypertension specialist. They went through a detailed examination according to local hospital protocol, which contained magnetic resonance tomography (MRT) of whole aorta, renal arteries and adrenal glands to rule out secondary hypertension [ 12 ]. If MRT was unable to be performed, a computed tomography scan was conducted.…”

Section: Methodsmentioning

confidence: 99%

“…The measurement and processing technique is described in detail in our group’s previous publication [ 12 ]. Briefly, the parameters of arterial stiffness and wave reflection were estimated by applanation tonometry and analysed according to European expert consensus (SphygmoCor v.8.0; AtCor Medical, Sydney, Australia) [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

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Long-Term Effects of Renal Artery Denervation

et al. 2021

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Background and Objectives: Renal artery denervation (RDN) procedure is a broadly discussed method in the treatment of resistant hypertension. Many studies report short-term (3–12 months) results for blood pressure and arterial stiffness. The primary endpoints were changes in 24 h mean systolic blood pressure (BP) and office systolic BP 48 months after RDN. The secondary endpoints were changes in aortic pulse wave velocity and impact of polypharmacy on these variables. Materials and Methods: Renal artery denervation was performed in 73 patients treated for resistant hypertension; 49 patients remained in final analysis. Patient examination was carried out before the procedure, and subsequently at 3, 6, 12, 24, and 48 months later. Patients’ antihypertensive and overall medication regimens were carefully analysed. Results: Mean 24 h arterial blood pressure lowered and was sustained at lower levels for up to 48 months; median (interequartile range—IQR) from 158(23.5)/100(14.2) to 140(26.5)/86(16.2) mmHg. Mean reduction in 24 h ambulatory systolic BP was −11 ± 25 mmHg (95% CI, −20 to −2; p < 0.001), while office systolic BP reduced by −7 ± 23 mmHg (95%CI, −24 to −1; p < 0.02). A significant reduction in median aortic pulse wave velocity 12 months after the procedure (drop from baseline 11.2 [3.15] m/s (95%CI 6.1 to 16.2) to 9.8 [2.1] m/s (95%CI 6.1 to 13.7; p = 0.002)). After 48 months, there was no worsening compared to the baseline level of 10.3 [4.0] m/s (95% CI 6.9 to 17.8) (p > 0.05). The total mean number of antihypertensive drugs remained unchanged: 5.97(±1.1) vs. 5.24 (±1.45). A higher number of pills after 48 months was associated with higher aortic pulse wave velocity (1–5 pill group: 8.1 ± 1.6 m/s; 6–10 pill group: 10.9 ± 1.8 m/s; >11 pill group: 15.1 ± 2.6 m/s) (p = 0.003). Conclusions: Antihypertensive effect after renal denervation lasts up to 48 months with no worsening of arterial stiffness compared to baseline. In our study, polypharmacy was associated with increased arterial stiffness 48 months after the procedure.

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“…In our previous study, we also observed a significant reduction in blood pressure and AoPWV that was sustained for up to 12 months after the RDN procedure [ 12 ].…”

Section: Introductionmentioning

confidence: 80%

Section: Methodsmentioning

confidence: 99%

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Long-Term Effects of Renal Artery Denervation

et al. 2021

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“…One study showed a rapid, and sustained, drop in cfPWV of 1 m/s after RDN which persisted over a year. This fall in cfPWV preceded and appeared to be independent of changes in office blood pressure [29]. Other studies, however, have found no changes in PWV after RDN [30].…”

Section: Antidiabetic Medicationsmentioning

confidence: 64%

Large Artery Stiffness: A Companion to the 2015 AHA Science Statement on Arterial Stiffness

Rey-García¹,

Townsend²

2021

Pulse

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Large artery stiffness (LAS) has proven to be an independent risk factor for cardiovascular disease and mortality. Nevertheless, the position of current hypertension guidelines regarding the usefulness of assessing LAS differs across different continents. In general, European Guidelines recognize pulse wave velocity (PWV) as a marker of target organ damage but do not recommend its systematic use in general population. Asian guidelines consider PWV as a recommended test at diagnosis of hypertension, in contrast to North American guidelines that do not state any position about its usefulness. However, PWV predicts cardiovascular events, and several studies have shown that it improves risk classification adjusting for established risk factors especially for intermediate-risk patients. Finally, some advances have been made related to treatments affecting LAS. Dietary interventions such as sodium restriction and exercise-based interventions have a modest effect in reducing LAS. Pharmacological interventions, such as statins, or more recent advances with mineralocorticoid blocker seem to have a beneficial effect. Last, controversial effects of renal denervation on LAS have been found. Our goal here is to update the reader on LAS on these areas since the 2015 American Heart Association Scientific Statement.

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“…RDN lowers BP by reducing systemic vascular resistance and stroke volume in patients with resistant hypertension [46, 47]. Furthermore, RDN may have additional effects on reducing arterial stiffness and cardiovascular risk [48].…”

Section: Discussionmentioning

confidence: 99%

Intravascular Renal Denervation Reduces Ambulatory and Office Blood Pressure in Patients with Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Trials

Yang

Liu

Chen

et al. 2022

Kidney Blood Press Res

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Background: This meta-analysis was designed to evaluate the antihypertensive efficacy of intravascular renal denervation (RDN) in patients with essential hypertension, especially to determine the magnitude of blood pressure (BP) reduction with RDN therapy using second-generation catheters. Methods: PubMed was searched to identify randomized sham-controlled trials from inception through August 2021. The endpoints were changes in 24-hours (24-h) ambulatory BP or office BP (OBP). This meta-analysis was performed by calculating the weighted mean difference (WMD) with 95% confidence interval (CI) using the random-effects model when the I2 index was < 50%. Fixed-effects model was used when the I2 index was ≥ 50%. Results: A total of 1297 patients were included in 8 randomized, sham-controlled trials in this meta-analysis. Intravascular RDN reduced 24-h ambulatory systolic BP (SBP) −3.02 (WMD, 95% CI, −4.95, −1.10, p <0.01,) and diastolic BP (DBP) −1.66 (WMD, 95% CI, −2.44, −0.88, p<0.001) mm Hg, respectively. In the studies using first-generation catheters, the WMD of 24-h ambulatory SBP and DBP changes between intravascular RDN and sham-control were −2.67 (95% CI, −5.08, -0.27; P<0.05) and −0.82 (95% CI, −2.19, 0.56; P>0.05) mm Hg. In the studies using second-generation catheters, the WMD of 24-h ambulatory SBP and DBP changes between intravascular RDN and sham-control were −3.14 (95% CI, −5.94, −0.33, p<0.05) and –2.06 (95% CI, −3.02, −1.11, p<0.001) mm Hg. Intravascular RDN using second-generation catheters reduced office SBP −6.30 (WMD, 95% CI, −7.67, −4.93, p<0.001) and DBP −3.88 (WMD, 95% CI, −4.44, −3.33, p<0.001) mm Hg, respectively. Conclusions: Intravascular RDN using second-generation catheters reduces ambulatory and office BP in patients with essential hypertension. The selection of appropriate hypertensive patients may be the major challenge for the performance of intravascular RDN in routine clinical practice.

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Arterial Destiffening Starts Early after Renal Artery Denervation

Cited by 9 publications

References 36 publications

Long-Term Effects of Renal Artery Denervation

Long-Term Effects of Renal Artery Denervation

Large Artery Stiffness: A Companion to the 2015 AHA Science Statement on Arterial Stiffness

Intravascular Renal Denervation Reduces Ambulatory and Office Blood Pressure in Patients with Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Trials

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