Percutaneous renal denervation for the treatment of resistant essential hypertension; the first Dutch experience

Voskuil, Michiel; Verloop, Willemien L.; Blankestijn, Peter J.; Agostoni, P.; Stella, Pieter R.; Doevendans, P.A.F.M.

doi:10.1007/s12471-011-0143-z

Cited by 48 publications

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“…Different centres have published their first clinical experiences of this promising treatment modality. [19,[28][29][30][31][32] These analyses show a similar reduction in office BP as reported in the first clinical trials. However, the effect of pRDN on ambulatory BP measurements (ABPM) differed throughout the studies.…”

Section: Results Of Prdn In Daily Practicesupporting

confidence: 63%

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Renal denervation: a new treatment option in resistant arterial hypertension

2012

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Hypertension is one of the most prevalent cardiovascular risk factors. Despite this high prevalence and a broad availability of effective pharmaceutical agents, a significant proportion of patients do not reach treatment goals. Partly this can be explained by secondary causes of hypertension or non-compliance of patients. Nevertheless, a subgroup of patients can be diagnosed with 'resistant hypertension'. Activation of the sympathetic nervous system is known to be an important factor in the development and progression of systemic hypertension. In this context, a percutaneous, catheter-based approach has been developed using radiofrequency energy to disrupt renal sympathetic nerves. The first studies have shown this technique to be safe, illustrated by a lack of vascular or renal injury. More importantly, catheter-based renal nerve ablation resulted in a significant reduction in blood pressure on top of traditional medical therapy. Additional to the encouraging effects shown on hypertension, a positive influence of this intervention in other conditions, characterised by sympathetic overactivation, may be expected. Though this technique seems promising, further studies are needed to address long-term safety and efficacy of renal denervation in hypertension and other disease states.Keywords Renal denervation . Sympathetic nervous system . Resistant hypertension . Sympathetic activity HypertensionHypertension is one of the most prevalent cardiovascular risk factors. Globally, 34 % of adults worldwide have hypertension and this number is rising.[1, 2] Despite a broad availability of effective pharmaceutical agents, only 32 % of treated men and 37 % of treated women achieve treatment goals.[3] This low success ratio can be caused by noncompliance of patients to medical therapy or secondary causes of hypertension (i.e., primary hyperaldosteronism). However, a subgroup of patients do fulfil the criteria of the phenomenon called 'resistant hypertension'. In 2008, the American Heart Association (AHA) defined resistant hypertension as a blood pressure (BP) that remains above treatment goals despite the concurrent use of medication from three different antihypertensive classes, including a diuretic, with all agents prescribed at doses that provide optimal benefit.[4] Data indicate that patients with resistant hypertension have an approximately threefold increased risk for adverse cardiovascular outcome compared with patients with well-controlled hypertension.[5] To address problems associated with a rising prevalence of (resistant) hypertension, the sympathetic nervous system (SNS) has gained renewed interest as a therapeutic target. The sympathetic nervous systemAlthough the exact pathogenesis of an elevated BP remains unclear, it has become clear that (over)activation of the SNS is an important factor in the development and progression of systemic hypertension.[6] The SNS is known to be responsible for the homeostasis mechanism of multiple organ systems. Anderson et al. measured noradrenalin spillover and muscle ...

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Section: Results Of Prdn In Daily Practicesupporting

confidence: 63%

“…In preclinical studies this has shown to be effective, reducing norepinephrine levels by 80-90 %, without adverse effects on the vessel wall (Ardian Inc, unpublished). [19] Clinical studies…”

Section: The Sympathetic Nervous Systemmentioning

confidence: 99%

Renal denervation: a new treatment option in resistant arterial hypertension

2012

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Acute epinephrine test after renal sympathetic denervation in uncontrolled hypertensive patients

Kiuchi¹,

Chen²

2017

J Integr Cardiol

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Studies employing percutaneous renal sympathetic denervation (RSD) [1][2][3][4] showed a reduction in both systolic and diastolic blood pressure (BP) among refractory hypertensive patients. As we described previously [5,6], the reduction in office BP was evident from the 1st month until one year after RSD in refractory hypertensive patients. A recent study in animals showed the pathology of radiofrequencyderived RSD during the time and provided important knowledge of the mechanisms resulting in sustained BP reduction, and reported that the nerve damage post radiofrequency ablation was greatest at 7 days, with maximum functional nerve damage sustained ≤30 days. Focal terminal nerve regeneration was observed only at the sites of ablation as early as 2 months and continued to 6 months [7]. Another study reported a substantial decrease in office systolic BP in relation to the number of ablation points at 6 months [8]. To date, there is no test to prove the acute efficacy of RSD.As a hormone, epinephrine plays on closely all body tissues. Its actions vary by tissue kind and tissue manifestation of adrenergic receptors. Epinephrine acts by binding to a diversity of adrenergic receptors. Epinephrine is a nonselective agonist of altogether adrenergic receptors, comprising the major subtype's α 1 , α 2 , β 1 , β 2 , and β 3 . Its activities are to increase peripheral resistance via α1 receptordependent vasoconstriction and to growth cardiac output via its binding to β1 receptors. Based on this information, we believe that epinephrine can be used to evaluate the acute response of BP and heart rate (HR) to RSD in uncontrolled hypertensive patients.This transversal study involved 25 uncontrolled hypertensive subjects, was conducted in agreement with the Helsinki declaration and approved by the ethics committee of our institution. All subects sign up the informed consent term before inclusion. This study was piloted at the Hospital e Clínica São Gonçalo, Rio de Janeiro, Brazil. Patients were recruited from January 2015 to December 2016 from the Arrhythmias and Artificial Cardiac Pacing Service of the same hospital. Patients with the mixture of the subsequent criteria were successively enrolled: (i) mean 24-hour systolic ambulatory BP measurements (ABPM) of >130 mmHg and mean 24-hour diastolic ambulatory BP >80 mmHg, in use of at least 3 antihypertensive agents in the maximum doses prescribed or tolerated, being one of them a diuretic; (ii) a physically normal heart with an ejection fraction of >50% (Simpson's method) to CRM, without ischemia, fibrosis area, or any other disease; (iii) age of 18 to 80 years, (iv) estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m 2 estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation [9] (without microalbuminuria), and (vi) the capacity to read, understand, and sign the informed consent form and go to the clinical tests. The patients that presented any of the subsequent criteria were excluded: (i) pregnancy; (ii) valvular disease with significant ad...

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“…Среди побочных эффектов наблюда-лось в одном случае прогрессирование атероскле-ротического поражения почечных артерий, но не потребовавшее инвазивного вмешательства. Тем не менее, настороженность в отношении безопа-сности процедуры и отдаленных последствий по-прежнему остается.Недавно [66] были опубликованы данные о пер-вом применении данной технологии группой авторов в Дании. В 2010г было прооперировано 11 пациентов с резистентной АГ без развития каких-либо осложне-ний.…”

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“…Недавно [66] были опубликованы данные о пер-вом применении данной технологии группой авторов в Дании. В 2010г было прооперировано 11 пациентов с резистентной АГ без развития каких-либо осложне-ний.…”

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Autonomic nervous system in arterial hypertension and heart failure: current understanding of its pathophysiologic role and innovative treatment approaches

Конради¹

2013

Russ J Cardiol

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Роль ВНС в становлении артериальной гипертензии и ее осложнений. Инновации в лечении Понимание роли СНС в становлении и поддержа-нии АГ существенно изменилось за последние 50 лет. Ранее считалось, что барорефлекторная регуляция и соответствующее изменение активности СНС уча-ствуют лишь в краткосрочной регуляции уровня АД. Благодаря внедрению новых методологических под-ходов, сегодня стало очевидным, что дисбаланс ВНС, повышение симпатической импульсации, прежде всего, в почке, играет важнейшую роль в патогенезе ВЕГЕТАТИВНАЯ НЕРВНАЯ СИСТЕМА ПРИ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ И СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ: СОВРЕМЕННОЕ ПОНИМАНИЕ ПАТОФИЗИОЛОГИЧЕСКОЙ РОЛИ И НОВЫЕ ПОДХОДЫ К ЛЕЧЕНИЮКонради А. О.В обзоре представлено современное состояние понимания проблемы роли веге-тативной дисфункции в развитии артериальной гипертензии и сердечной недоста-точности и инновационные методы воздействия на различные компоненты вегета-тивной нервной системы с целью лечения сердечно-сосудистых заболеваний. Российский кардиологический журнал 2013, 4 (4 (102): 52-63Ключевые слова: вегетативная нервная система, артериальная гипертензия, сердечная недостаточность, барорефлекс.ФГБУ Федеральный Центр сердца, крови и эндокринологии им. В. А. Алма-зова, Минздрава России, Санкт-Петербург, Россия.Конради А. О. -д. м.н., профессор, заместитель директора по научно-иссле-довательской работе, заведующая НИО артериальных гипертензий.Автор, ответственный за переписку (Corresponding author): konradi@almazovcentre.ru АГ -артериальная гипертензия, АД -артериальное давление, АДМА -ассиметричный диметиларгинина, ВНС -вегетативная нервная система, ГЛЖ -гипертрофия левого желудочка, ИСАГ -изолированная систоличе-ская артериальная гипертензия, ЛЖ -левый желудочек, МРТ -магниторе-зонансная томография, РАС -ренин-ангиотензиновая система, СОАГС -синдром обструктивного апноэ во сне, СС -симпатическая нервная система, ХСН -хроническая сердечная недостаточность, ЦНС -централь-ная нервная система.Рукопись получена 16.08.2013 Принята к публикации 20.08.2013 53 К 50-ЛЕТИЮ РОССИЙСКОГО КАРДИОЛОГИЧЕСКОГО ОБЩЕСТВА эссенциальной АГ. В таблице 1 представлен перечень состояний и последствий АГ, при которых доказано повышение активности СНС.Наличие активации СНС при различных стадиях АГ известно достаточно давно [3][4]. К новым науч-ным данным последних лет можно отнести: 1) рас-шифровку некоторых механизмов, ответственных за повышение активности СНС, 2) установление взаимосвязи между активацией СНС и метаболиче-скими нарушениями при АГ, 3) уточнение роли акти-вации СНС в стимулировании поражения органов-мишеней, 4) уточнение роли автономной дисфунк-ции в нарушении циркадного ритма АД, 5) роль СНС в развитии АГ при ряде сопутствующих состояний, в частности, при синдроме сонного апноэ [5].Что касается понимания новых механизмов акти-вации СНС, это было продиктовано отсутствием убедительных данных в пользу изменения барореф-лекторной функции при АГ. Помимо классических барорефлекторных влияний все большее внимание уделяется дисфункции кардиопульмонального реф-лекса, роли артериальных хе...

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Percutaneous renal denervation for the treatment of resistant essential hypertension; the first Dutch experience

Cited by 48 publications

References 14 publications

Renal denervation: a new treatment option in resistant arterial hypertension

Renal denervation: a new treatment option in resistant arterial hypertension

Acute epinephrine test after renal sympathetic denervation in uncontrolled hypertensive patients

Autonomic nervous system in arterial hypertension and heart failure: current understanding of its pathophysiologic role and innovative treatment approaches

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