Effects of renal denervation on blood pressures in patients with hypertension: a systematic review and meta-analysis of randomized sham-controlled trials

Ogoyama, Yukako; Tada, Kazuhiro; Abe, Makiko; Nanto, Shinsuke; Shibata, Hirotaka; Mukoyama, Masashi; Kai, Hisashi; Arima, Hisatomi; Kario, Kazuomi

doi:10.1038/s41440-021-00761-8

Cited by 48 publications

(29 citation statements)

References 60 publications

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“… 123 There were no significant differences in the 24‐hour BP‐lowering effects of RDN between patients who were versus were not receiving antihypertensive medication, or between radiofrequency and ultrasound RDN devices. 123 However, in certain cases whose BP could not be controlled in spite of receiving a huge amount of antihypertensive drugs, RDN can be considered.…”

Section: Other Considerationsmentioning

confidence: 85%

Seven‐action approaches for the management of hypertension in Asia – The HOPE Asia network

Kario

Chia

Siddique

et al. 2022

J of Clinical Hypertension

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Asia is a large continent and there is significant diversity between countries and regions. Over the last 30 years, absolute blood pressure (BP) levels in Asia have increased to a greater extent than those in other regions. In diverse Asia-Pacific populations, for choosing an Asia-specific approach to hypertension management is important to prevent target organ damage and cardiovascular diseases. In this consensus document of HOPE Asia Network, we introduce seven action approaches for management of hypertension in Asia.

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Section: Other Considerationsmentioning

confidence: 85%

Seven‐action approaches for the management of hypertension in Asia – The HOPE Asia network

Kario

Chia

Siddique

et al. 2022

J of Clinical Hypertension

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“…The prognosis of patients with RHT is ominous and associated with higher mortality, higher prevalence of end-organ damage and higher cardiovascular risk than in controlled hypertensive patients 23 . A few studies currently recommend invasive procedures, most notably renal denervation, with controversial results 24 but it is important to consider that an increasing number of cases occur in people with weight excess. Recent results from a randomized clinical trial demonstrated that diet and exercise training delivered in a cardiac rehabilitation setting could lower BP in patients with RHT, although the effectiveness of lifestyle modi cations is yet to be established 9,25,26 .…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary Lifestyle Interventions In The Management of Resistant Hypertension

Espinel

Azancot

Gómez

et al. 2022

Preprint

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Resistant hypertension renders patients refractory to pharmacological treatment and is closely associated with excess weight and high cardiovascular risk. Resistant hypertension and obesity-associated hypertension share highly interrelated and interacting pathogenic mechanisms exacerbated by adiposity that propagate end organ damage including chronic kidney disease and cardiovascular disease. Perhaps it is time to contemplate in the overall management of hypertension, invasive procedures focused on weight loss. Lifestyle interventions improved results from pharmacotherapy alone in a cohort of patients with resistant hypertension. After 6 months of intensive multidisciplinary care, we found significant reductions in blood pressure, body mass index, and antihypertensive medication burden with improvement in cardiovascular disease biomarkers. Increased physical activity and weight loss appeared to be significant factors. Weight-loss drugs are generally ineffective but the impact of laparoscopic sleeve gastrectomy in another cohort of patients with obesity grade 3 and hypertension, was relevant with hypertension remission in more than 50% of cases and significant reductions in blood pressure and medication burden in those who remained hypertensive. Our results suggest the need to define in future studies and selected patients the potential role of combining medical multidisciplinary care with surgical interventions in the management of patients with resistant hypertension and high cardiovascular risk.

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“…As discussed above, RDN has been introduced as a novel therapy to treat drug-resistant hypertension. 189,190 It is thought to be another approach to directly modulate the sympathetic nervous system. However, RDN interrupts both the afferent inputs to the CNS from the kidney and the efferent outputs from the CNS to the kidney, resulting in suppression of sympathetic outflow and eliciting beneficial effects in both hypertension and CHF.…”

Section: Renal Afferentsmentioning

confidence: 99%

Cardiorenal Syndrome: The Role of Neural Connections Between the Heart and the Kidneys

Patel

Katsurada

Zheng

2022

Circulation Research

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The maintenance of cardiovascular homeostasis is highly dependent on tightly controlled interactions between the heart and the kidneys. Therefore, it is not surprising that a dysfunction in one organ affects the other. This interlinking relationship is aptly demonstrated in the cardiorenal syndrome. The characteristics of the cardiorenal syndrome state include alterations in neurohumoral drive, autonomic reflexes, and fluid balance. The evidence suggests that several factors contribute to these alterations. These may include peripheral and central nervous system abnormalities. However, accumulating evidence from animals with experimental models of congestive heart failure and renal dysfunction as well as humans with the cardiorenal syndrome suggests that alterations in neural pathways, from and to the kidneys and the heart, including the central nervous system are involved in regulating sympathetic outflow and may be critically important in the alterations in neurohumoral drive, autonomic reflexes, and fluid balance commonly observed in the cardiorenal syndrome. This review focuses on studies implicating neural pathways, particularly the afferent and efferent signals from the heart and the kidneys integrating at the level of the paraventricular nucleus in the hypothalamus to alter neurohumoral drive, autonomic pathways, and fluid balance. Further, it explores the potential mechanisms of action for the known beneficial use of various medications or potential novel therapeutic manipulations for the treatment of the cardiorenal syndrome. A comprehensive understanding of these mechanisms will enhance our ability to treat cardiorenal conditions and their cardiovascular complications more efficaciously and thoroughly.

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Effects of renal denervation on blood pressures in patients with hypertension: a systematic review and meta-analysis of randomized sham-controlled trials

Cited by 48 publications

References 60 publications

Seven‐action approaches for the management of hypertension in Asia – The HOPE Asia network

Seven‐action approaches for the management of hypertension in Asia – The HOPE Asia network

Multidisciplinary Lifestyle Interventions In The Management of Resistant Hypertension

Cardiorenal Syndrome: The Role of Neural Connections Between the Heart and the Kidneys

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