Reduction of left ventricular hypertrophy detected by cardiac magnetic resonance in a patient after renal denervation

Daniele, Nicola Di; Rovella, Valentina; Violo, Leano; Francesco, M. De; Sperandio, Massimiliano; Spinelli, Alessio; Tesauro, Manfredi; Romeo, Francesco; Simonetti, Giovanni

doi:10.2459/jcm.0000000000000131

Cited by 3 publications

(7 citation statements)

References 19 publications

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“…[13][14][15][16][17][18][19] Nevertheless, few data on the safety and efficacy of renal denervation in patients with ESRD and uncontrolled hypertension have been reported. [20][21][22][23][24] Renal denervation also appears to reduce left ventricular hypertrophy in patients with ESRD who are on hemodialysis. 24 The most important limitation of our study was that although we investigated a large number of renal nerves, the number of cases in some subgroups was limited.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22][23][24] Renal denervation also appears to reduce left ventricular hypertrophy in patients with ESRD who are on hemodialysis. 24 The most important limitation of our study was that although we investigated a large number of renal nerves, the number of cases in some subgroups was limited. In particular, we were unable to examine the renal arteries of a larger group of patients with ESRD and hemodialysis without arteriolar damage.…”

Section: Discussionmentioning

confidence: 99%

“…12 Currently, renal denervation represents an emerging treatment for resistant hypertension in patients with preserved renal function, as demonstrated by most randomized controlled trials. [13][14][15][16][17][18][19] Recent promising studies have reported a significant reduction in blood pressure in patients with chronic kidney disease at different stages of chronic kidney disease up to ESRD after renal denervation, [20][21][22][23][24] but data about the anatomic substrate of this surgical procedure are lacking.…”

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confidence: 99%

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Increased Sympathetic Renal Innervation in Hemodialysis Patients Is the Anatomical Substrate of Sympathetic Hyperactivity in End‐Stage Renal Disease

Mauriello

Rovella

Anemona

et al. 2015

JAHA

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BackgroundRenal denervation represents an emerging treatment for resistant hypertension in patients with end‐stage renal disease, but data about the anatomic substrate of this treatment are lacking. Therefore, the aim of this study was to investigate the morphological basis of sympathetic hyperactivity in the setting of hemodialysis patients to identify an anatomical substrate that could warrant the use of this new therapeutic approach.Methods and ResultsThe distribution of sympathetic nerves was evaluated in the adventitia of 38 renal arteries that were collected at autopsy or during surgery from 25 patients: 9 with end‐stage renal disease on dialysis (DIAL group) and 16 age‐matched control nondialysis patients (CTRL group). Patients in the DIAL group showed a significant increase in nerve density in the internal area of the peri‐adventitial tissue (within the first 0.5 mm of the beginning of the adventitia) compared with the CTRL group (4.01±0.30 versus 2.87±0.28×mm2, P=0.01). Regardless of dialysis, hypertensive patients with signs of severe arteriolar damage had a greater number of nerve endings in the most internal adventitia, and this number was significantly higher than in patients without hypertensive arteriolar damage (3.90±0.36 versus 2.87±0.41×mm2, P=0.04), showing a correlation with hypertensive arteriolar damage rather than with hypertensive clinical history.ConclusionsThe findings from this study provide a morphological basis underlying sympathetic hyperactivity in patients with end‐stage renal disease and might offer useful information to improve the use of renal denervation in this group of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Increased Sympathetic Renal Innervation in Hemodialysis Patients Is the Anatomical Substrate of Sympathetic Hyperactivity in End‐Stage Renal Disease

Mauriello

Rovella

Anemona

et al. 2015

JAHA

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“…11 Data from the initial clinical trials applying catheter-based RDN found a substantial BP reduction and attenuation of target organ damage in patients with RH. 8,[12][13][14][15][16][17][18][19] While relatively small in size, with a total of 45 RH patients (baseline mean BP of 177/101 mm Hg) undergoing RDN in an initial nonblinded proof-of-concept study (Symplicity HTN-1), 12,14 the tolerability of the procedure could be reported, along with clear evidence of efficacy with a reduction in office BP of À22/À11 mm Hg and À27/À17 mm Hg at 6 and 12 months after the procedure, respectively. Initial concerns about the durability of the BP reduction were addressed by subsequent longer-term follow-up out to 36 months post-procedure, finding a sustained office BP reduction of À32/À14 mm Hg.…”

Section: Renal Denervationmentioning

confidence: 99%

Device Therapies for Resistant Hypertension

Hering

Schultz

Schlaich

2016

Clinical Therapeutics

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“…[73][74][75][76] The BP lowering following RDN has been linked to attenuation of hypertension -induced organ damage in RH patients. [77][78][79][80][81] Although expectations were high for the first prospective randomized double--blind sham -controlled Symplicity HTN -3 study designed for assessing true ambulatory BP lowering effects, unexpectedly this trial failed to meet its primary and secondary efficacy endpoints. 82 The negative results surrounding the Symplicity HTN -3 trial triggered preclinical and clinical studies for further exploration of the RDN technique, including both procedural and anatomical factors.…”

Section: 59mentioning

confidence: 99%

Recent advances in the pathophysiology of arterial hypertension - potential implications for clinical practice

Hering¹,

Trzebski²

2017

Polish Archives of Internal Medicine

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REVIEW ARTICLE Advances in pathophysiology of arterial hypertension 195 population. Notably, only 46.5% of participants were aware of their hypertension, with less than half (40.6%) medically treated and BP levels less than 140/90 mm Hg achieved in 1 in 3 individuals (13.2%).1 The global disparities in the prevalence, awareness, treatment, and control of hypertension have also been indicated in a recent meta -analysis of 135 population -based studies from 90 countries.2 Globally, the number of individuals with hypertension increased, reaching an estimated total of 1.39 billion adults with hypertension, including 349 million in high -income countries and 1.04 billion in low-and middle -income countries by 2010. The increased and highest prevalence of raised BP has been particularly noted in East Europe, Asia, Africa, and Latin America. 2 Introduction Despite the well -recognized benefits of reducing major cardiovascular events and mortality through the control of blood pressure (BP), detection rates and control of hypertension remain low across all countries. Even though therapy is initiated in the vast majority of patients diagnosed with hypertension, treatment is suboptimal with a declined use of antihypertensive drugs over time. A large gap between the prevalence, awareness, treatment, and control of hypertension has been addressed in the multinational Prospective Urban Rural Epidemiology (PURE) study conducted in 628 communities, including high -income, upper -middle -income, low -middle -income and low -income countries. KEY WORDShypertension, interventional therapies, neural reflexes, neuroplasticity, sympathetic nervous system ABSTRACT Hypertension remains a major and growing public health problem associated with the greatest global rate of cardiovascular morbidity and mortality. Although numerous factors contribute to poor control of blood pressure (BP) and to pseudo resistance (eg, unawareness, lifestyle habits, nonadherence to medication, insufficient treatment, drug -induced hypertension, undiagnosed secondary causes), true resistant hypertension (RH) is reported in 10.1% of patients treated for elevated BP. While the mechanisms underlying RH remain complex and not entirely understood, sympathetic activation involved in the pathophysiology of hypertension, disease progression, and adverse complications is further augmented in patients with drug -resistant hypertension. The well -established contribution of neurogenic component of hypertension has led to the introduction of new alternative therapies aimed specifically at modulating central and neural reflexes mechanisms involved in BP control. Although clinical benefits of lowering BP with renal denervation, baroreflex activation therapy, carotid body denervation, central arteriovenous anastomosis, and deep brain stimulation have advanced our knowledge on uncontrolled hypertension, the variable BP response has prompted extensive ongoing research to define predictors of treatment effectiveness and further investigation of pathophysiology of RH. Very rec...

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Reduction of left ventricular hypertrophy detected by cardiac magnetic resonance in a patient after renal denervation

Cited by 3 publications

References 19 publications

Increased Sympathetic Renal Innervation in Hemodialysis Patients Is the Anatomical Substrate of Sympathetic Hyperactivity in End‐Stage Renal Disease

Increased Sympathetic Renal Innervation in Hemodialysis Patients Is the Anatomical Substrate of Sympathetic Hyperactivity in End‐Stage Renal Disease

Device Therapies for Resistant Hypertension

Recent advances in the pathophysiology of arterial hypertension - potential implications for clinical practice

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