Renal Denervation as a Therapeutic Approach for Hypertension

Schlaich, Markus P.; Sobotka, Paul; Krum, Henry; Whitbourn, Robert; Walton, A.; Esler, Murray

doi:10.1161/hypertensionaha.109.138610

Cited by 231 publications

(184 citation statements)

References 64 publications

(72 reference statements)

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“…31,32 There was a trend toward reduction of urinary albumin excretion after renal denervation, which may represent additional beneficial effects of direct sympathetic modulation beyond BP reduction alone. 9,19,33 We also observed a trend toward reduction in plasma circulating BNP concentrations after renal denervation. Clinically, our patients were euvolemic and had no clinical history of heart failure or cardiac dysfunction.…”

Section: Discussionsupporting

confidence: 58%

Renal Denervation in Moderate to Severe CKD

Hering

Mahfoud

Walton

et al. 2012

Journal of the American Society of Nephrology

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Sympathetic activation contributes to the progression of CKD and is associated with adverse cardiovascular outcomes. Ablation of renal sympathetic nerves reduces sympathetic nerve activity and BP in patients with resistant hypertension and preserved renal function, but whether this approach is safe and effective in patients with an estimated GFR (eGFR) , 45 ml/min per 1.73 m 2 is unknown. We performed bilateral renal denervation in 15 patients with resistant hypertension and stage 3-4 CKD (mean eGFR, 31 ml/min per 1.73 m 2 ). We used CO 2 angiography in six patients to minimize exposure to contrast agents.Estimated GFR remained unchanged after the procedure, irrespective of the use of CO 2 angiography. Mean baseline BP 6 SD was 174622/91616 mmHg despite the use of 5.661.3 antihypertensive drugs. Mean changes in office systolic and diastolic BP at 1, 3, 6, and 12 months were 234/214, 225/211, 232/215, and 233/219 mmHg, respectively. Night-time ambulatory BP significantly decreased (P,0.05), restoring a more physiologic dipping pattern. In conclusion, this study suggests a favorable short-term safety profile and beneficial BP effects of catheter-based renal nerve ablation in patients with stage 3-4 CKD and resistant hypertension.

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Section: Discussionsupporting

confidence: 58%

Renal Denervation in Moderate to Severe CKD

Hering

Mahfoud

Walton

et al. 2012

Journal of the American Society of Nephrology

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322

224

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“…19 Furthermore, nephrectomy or renal denervation has been shown to correct blood pressure and sympathetic nerve activity. 6,7,20 Collectively, these data are consistent with the concept that the increase in renal afferent inputs to the CNS from the diseased kidney, leading to systemic sympathetic nerve overactivity and the development of hypertension in patients with chronic kidney disease. Central Ang II has been implicated as a factor for the development and maintenance of hypertension.…”

Section: Wky Rats Shrssupporting

confidence: 83%

Roles of central renin-angiotensin system and afferent renal nerve in the control of systemic hemodynamics in rats

et al. 2011

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Afferent renal nerves (ARNs) convey signals generated by physiological changes in the kidney to the central nervous system. The aim of this study was to determine whether ARNs contribute to cardiovascular regulation through central renin-angiotensin system (RAS)-dependent pathways. Blood pressure and renal sympathetic nerve activity (RSNA) were monitored during elevations in pelvic pressure in anesthetized Wistar-Kyoto Izm (WKY) rats and spontaneously hypertensive Izm rats (SHRs). In both groups of rats, blood pressure and RSNA were significantly increased in response to elevations in renal pelvic pressure in a pressure-dependent fashion, which were prevented by renal denervation. Injection of an angiotensin II type I receptor blocker (CV-11974, 10 lg) into the intracerebroventricular region significantly suppressed the vasopressor and sympathoexcitatory responses to the increases in pelvic pressure in both WKY rats and SHRs, although these inhibitory effects of CV-11974 in SHRs appeared to be weaker than in WKY rats. These results indicate that signals transmitted by ARNs have an important role in the control of systemic hemodynamics through regulating central RAS-mediated changes in sympathetic nerve activity.

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“…[6] The SNS is known to be responsible for the homeostasis mechanism of multiple organ systems. Anderson et al measured noradrenalin spillover and muscle sympathetic nerve activity (MSNA) in normotensive and hypertensive subjects.…”

Section: The Sympathetic Nervous Systemmentioning

confidence: 99%

“…Efferent renal sympathetic nerves originate from the thoracic and lumbar sympathetic trunk, and terminate in the blood vessels, the juxtaglomerular apparatus, and the renal tubules. [6,9] When stimulated, these nerves achieve an increased sodium reabsorption, increased renin release leading to antinatriuresis, and a decreased renal blood flow. [10][11][12] Communication from the kidneys into the central nervous system drives through the renal afferent nerves.…”

Section: The Sympathetic Nervous Systemmentioning

confidence: 99%

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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Renal Denervation as a Therapeutic Approach for Hypertension

Cited by 231 publications

References 64 publications

Renal Denervation in Moderate to Severe CKD

Renal Denervation in Moderate to Severe CKD

Roles of central renin-angiotensin system and afferent renal nerve in the control of systemic hemodynamics in rats

Renal denervation: a new treatment option in resistant arterial hypertension

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