Effects of renal sympathetic denervation on cardiac sympathetic activity and function in patients with therapy resistant hypertension

Brussel, Peter M. van; Schattenkerk, Daan W. Eeftinck; Dobrowolski, Linn C.; Winter, Robbert J. de; Reekers, Jim A.; Verberne, Hein J.; Vogt, Liffert; Born, Bert‐Jan H. van den

doi:10.1016/j.ijcard.2015.09.025

Cited by 13 publications

(5 citation statements)

References 25 publications

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“…Monitoring revealed a high level of renal sympathetic outflow activation, indicating renal sympathetic hyperactivity, which is the core mechanism of hypertension. Enhanced renal afferent nerve activity can increase the central sympathetic nervous system signal efflux, through the RAAS system mechanism to promote blood pressure [16,[21][22][23]. Renal efferent nerves enhance the activity of the RAAS system and promote blood pressure by increasing sodium and water retention, increasing renal blood flow and glomerular filtration rate and further increasing renin release.…”

Section: Discussionmentioning

confidence: 99%

Clinical Effect of Renal Arterial Sympathetic Radiofrequency Ablation on Secondary Hypertension

Zhang

Huang

Shen

et al. 2022

Computational and Mathematical Methods in Medicine

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Sympathetic hyperactivity is one of the main mechanisms of secondary hypertension. Reducing renal sympathetic activity through surgery can effectively reduce blood pressure. Many cases have shown that renal denervation (RDN) can selectively block renal artery sympathetic nerve activity to control refractory hypertension. This surgery is a minimally invasive surgery, and the risk of surgery-related adverse events is significantly reduced compared with surgery. Therefore, the purpose of this study is to explore the efficacy of radiofrequency ablation of renal artery sympathetic nerve in the treatment of secondary hypertension. Eight patients with secondary hypertension diagnosed by the cardiovascular department of our hospital and treated with RDN were followed up for 3-18 months, of which 5 cases were followed up for more than 12 months and 8 cases were followed up for more than 3 months. Eight patients were treated with radiofrequency ablation of renal artery catheter. The parameters such as preoperative blood pressure, antihypertensive drugs, organ function, intraoperative ablation resistance, power, time, and temperature were determined. The related changes of blood pressure, antihypertensive drugs, and visceral function and the occurrence of side effects at 1 week and 1, 3, 6, and 12 months after operation were related to the operation. In conclusion, RDN has a significant clinical effect in the treatment of refractory hypertension, with stable postoperative blood pressure drop, reduced drug dosage, and less side effects.

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Section: Discussionmentioning

confidence: 99%

Clinical Effect of Renal Arterial Sympathetic Radiofrequency Ablation on Secondary Hypertension

Zhang

Huang

Shen

et al. 2022

Computational and Mathematical Methods in Medicine

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“…6) Recently, many clinical studies have verified that RDN is associated with a reduction in excessive sympathetic activity [7][8][9] by measuring norepinephrine (NE) spillover, muscle sympathetic nerve activity (MSNA), and 123 I-MIBG cardiac scintigraphy. A series of studies have been shown to significantly improve HF outcomes in both HF animal models and patients.…”

mentioning

confidence: 99%

Influence of Renal Sympathetic Denervation in Patients with Early-Stage Heart Failure Versus Late-Stage Heart Failure

et al. 2018

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SummaryRenal sympathetic denervation (RDN) is currently being investigated in multiple studies of heart failure (HF). Our aim was to assess the safety and effectiveness of RDN in patients with HF, and determine which patients could achieve more beneficial effects of RDN. A total of 17 consecutive patients with HF were enrolled in the study. Clinical symptoms, office blood pressure, and laboratory results were obtained and echocardiography was performed before and 12 months after RDN. Changes from baseline to 12 months were analyzed for all patients and for two subgroups based on HF duration (group 1: HF duration !3 years, n = 9; group 2: HF duration > 3 years, n = 8). The RDN procedure was successful in all patients and no procedure-related complications were documented. In comparison to baseline, there was a significant increase in left ventricular ejection fraction (LVEF) in all patients and group 1 (P < 0.05 for both), which did not happen in group 2. LAD, LVDs, and RVD also showed a significant reduction in group 1 (P < 0.05 for both). At 12 months, the reductions in TNF-α and CRP were significant for all patients and for patients in group 1 separately. No obvious changes in echocardiographic parameters, 6-minute walking distance, TNF-α, or CRP were recorded in group 2. No changes in BNP in either group were observed at the 12th month of follow-up. RDN could improve cardiac function and led to a significant drop in inflammatory markers in patients with HF. We also found that patients in early-stage HF could benefit more from RDN.(Int Heart J 2018; 59: 99-104)

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“…One study with a short follow-up of only six weeks did not find any changes in systemic vascular resistance or other hemodynamic parameters except office BP [31]. One previous study demonstrated reduced systemic vascular resistance and 24 hour ambulatory BP after six months, while heart rate and cardiac output remained unchanged [32].…”

Section: Previous Knowledge Of Changes In Systemic Vascular Resistance After Rdnmentioning

confidence: 94%

“…We have identified three previous studies examining hemodynamic changes after RDN in patients with apparent TRH, all were uncontrolled, neither excluded patients with poor adherence before inclusion [31][32][33], and one study did not require elevated ambulatory BP levels prior to inclusion [32].…”

Section: Previous Knowledge Of Changes In Systemic Vascular Resistance After Rdnmentioning

confidence: 99%

Renal sympathetic denervation lowers systemic vascular resistance in true treatment-resistant hypertension

et al. 2020

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Renal sympathetic denervation (RDN) is again gaining interest as recent well-designed trials have demonstrated reduced ambulatory blood pressure (BP) after RDN. However, the hemodynamic mechanisms have not been elucidated. We aimed for the first time to investigate the effect of RDN on the "Hallmark of Hypertension" namely increased systemic vascular resistance index (SVRI). Materials and methods:We investigated SVRI change in patients with true treatment-resistant hypertension randomized to RDN (n=9) or drug adjusted control (n=9). Treatment-resistant hypertension was defined as office systolic BP ≥ 140 mmHg despite ≥ 3 antihypertensive drugs including a diuretic. True treatment-resistant hypertension was confirmed prior to inclusion with ambulatory daytime systolic BP ≥ 135 mmHg immediately after witnessed intake of antihypertensive drugs. Hemodynamic variables were recorded with thoracic impedance cardiography at baseline and at three and six months follow-up after RDN. This non-invasive method also guided further tailoring of drug treatment in the control group aiming to normalize hemodynamic variables and BP. Results: From three to six months follow-up after RDN, SVRI decreased with a median of -611 dyn*s*m 2 /cm 5 [IQR -949 to -267] (p<0.01), while supine mean BP decreased with a median of -11 mmHg [IQR -21 to -3] (p=0.02). In the same period, SVRI in the control group was reduced with -674 dyn*s*m 2 /cm 5 [IQR -1,309 to -340] (p<0.01), while supine mean BP decreased with -15 mmHg [IQR -29 to -6] (p=0.01). Thus, hemodynamic variables and BP in the two groups normalized in parallel. Conclusion:Our data suggest that in patients with true treatment-resistant hypertension, renal sympathetic denervation lowers BP by reducing systemic vascular resistance of similar size as in the control group with careful individual selection of antihypertensive drugs and dose titration.

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Effects of renal sympathetic denervation on cardiac sympathetic activity and function in patients with therapy resistant hypertension

Cited by 13 publications

References 25 publications

Clinical Effect of Renal Arterial Sympathetic Radiofrequency Ablation on Secondary Hypertension

Clinical Effect of Renal Arterial Sympathetic Radiofrequency Ablation on Secondary Hypertension

Influence of Renal Sympathetic Denervation in Patients with Early-Stage Heart Failure Versus Late-Stage Heart Failure

Renal sympathetic denervation lowers systemic vascular resistance in true treatment-resistant hypertension

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