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

Bergo, Kaja Knudsen; Larstorp, Anne Cecilie K.; Hoffmann, Pavel; Hjørnholm, Ulla; Cataliotti, Alessandro; Høieggen, Aud; Rostrup, Morten; Elmula, Fadl Elmula M. Fadl

doi:10.1080/08037051.2020.1789446

Cited by 5 publications

(5 citation statements)

References 33 publications

(64 reference statements)

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“…However, RDN did not result in a significant change in endogenous catecholamines or in renin-angiotensin-aldosterone system hormones at 6 months [45]. RDN lowers BP by reducing systemic vascular resistance and stroke volume in patients with resistant hypertension [46, 47]. Furthermore, RDN may have additional effects on reducing arterial stiffness and cardiovascular risk [48].…”

Section: Discussionmentioning

confidence: 99%

Intravascular Renal Denervation Reduces Ambulatory and Office Blood Pressure in Patients with Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Trials

Yang

Liu

Chen

et al. 2022

Kidney Blood Press Res

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Background: This meta-analysis was designed to evaluate the antihypertensive efficacy of intravascular renal denervation (RDN) in patients with essential hypertension, especially to determine the magnitude of blood pressure (BP) reduction with RDN therapy using second-generation catheters. Methods: PubMed was searched to identify randomized sham-controlled trials from inception through August 2021. The endpoints were changes in 24-hours (24-h) ambulatory BP or office BP (OBP). This meta-analysis was performed by calculating the weighted mean difference (WMD) with 95% confidence interval (CI) using the random-effects model when the I2 index was < 50%. Fixed-effects model was used when the I2 index was ≥ 50%. Results: A total of 1297 patients were included in 8 randomized, sham-controlled trials in this meta-analysis. Intravascular RDN reduced 24-h ambulatory systolic BP (SBP) −3.02 (WMD, 95% CI, −4.95, −1.10, p <0.01,) and diastolic BP (DBP) −1.66 (WMD, 95% CI, −2.44, −0.88, p<0.001) mm Hg, respectively. In the studies using first-generation catheters, the WMD of 24-h ambulatory SBP and DBP changes between intravascular RDN and sham-control were −2.67 (95% CI, −5.08, -0.27; P<0.05) and −0.82 (95% CI, −2.19, 0.56; P>0.05) mm Hg. In the studies using second-generation catheters, the WMD of 24-h ambulatory SBP and DBP changes between intravascular RDN and sham-control were −3.14 (95% CI, −5.94, −0.33, p<0.05) and –2.06 (95% CI, −3.02, −1.11, p<0.001) mm Hg. Intravascular RDN using second-generation catheters reduced office SBP −6.30 (WMD, 95% CI, −7.67, −4.93, p<0.001) and DBP −3.88 (WMD, 95% CI, −4.44, −3.33, p<0.001) mm Hg, respectively. Conclusions: Intravascular RDN using second-generation catheters reduces ambulatory and office BP in patients with essential hypertension. The selection of appropriate hypertensive patients may be the major challenge for the performance of intravascular RDN in routine clinical practice.

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Section: Discussionmentioning

confidence: 99%

Intravascular Renal Denervation Reduces Ambulatory and Office Blood Pressure in Patients with Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Trials

Yang

Liu

Chen

et al. 2022

Kidney Blood Press Res

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“…First of all, patients with severe hypertension or hypertension refractory to antihypertensive therapy can be referred to this treatment [5]. Pressure reduction during treatment with the described devices depends on the level of initial hypertension [10,16].…”

Section: What Patients Should Get What Device?mentioning

confidence: 99%

“…Other studies show that 50% of patients do not use all the prescribed antihypertensive drugs despite intensive convincing about the need for treatment [4]. Finally, in a certain percentage of patients, despite the use of all drugs, blood pressure normalization cannot be achieved [1,5]. Therefore, new methods of treating arterial hypertension are being searched for.…”

Section: Introductionmentioning

confidence: 99%

Devices for the treatment of arterial hypertension

Głuszek

Kosicka

2023

Postępy Higieny I Medycyny Doświadczalnej

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Hypertension is still the cause of many cardiovascular complications and the premature death of a large number of patients despite the use of increasingly effective pharmacological drugs. Most patients with therapy-resistant hypertension show excessive activity of the sympathetic system. In the last two decades, there have been successful attempts at nonpharmacological reduction of this activity. The earliest method for this purpose is the denervation of the renal arteries by using devices specially designed for this purpose. Other methods of lowering blood pressure are the electrical activation of baroreceptors, which increases the tone of the parasympathetic system, and special pacemaker software to lower blood pressure. The paper discusses the studies assessing the effectiveness and safety of these methods, and on the basis of the current research results, predictions are made concerning which patients with arterial hypertension would be the most appropriate for these treatment methods.

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“…More than 9 million annual deaths can be related to complications of SAH, such as myocardial infarction, stroke and renal failure (WEBER M.A. et al, 2019;BERGO K.K. et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…In these cases, device-based blood pressurelowering therapy such as renal denervation may be a valuable additive or alternative treatment option (AHMAD Y. et al, 2021;SIMONETTI F. et al, 2023;MESSERLI F.H. et al, 2022;BERGO K.K. et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Renal Sympathetic Denervation in the Management of Resistant Hypertension: A Review of Current Evidence

Ferri,

Golart,

Neto

et al. 2023

JHS

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Goal: To evaluate the efficacy and safety of Renal Sympathetic Denervation (RSD) as a therapeutic approach in the management of resistant hypertension, through the analysis of recent clinical and experimental studies. Additionally, it aims to examine current evidence supporting its clinical use, discuss indications and contraindications, and identify areas where further research is needed to improve understanding and clinical practice. Methodology: A bibliographic review was carried out through searches in the PubMed Central (PMC) and SciELO (Scientific Electronic Library Online) databases. 196 articles were found and, after applying the inclusion criteria, 24 studies were selected to compose the collection. Results: Several types of studies reviewed indicate that Renal Sympathetic Denervation (RSD) is effective and safe in the management of resistant hypertension, both as a stand-alone treatment and as adjunctive therapy. The effects of this treatment demonstrated a reduction in blood pressure for at least 6 months after the procedure, with no complications and no kidney damage for at least 7 years after the intervention. Final considerations: Although more research is needed to confirm the longterm results, it is possible to associate Renal Sympathetic Denervation not only as an effective and safe procedure, but also as a relevant intervention for the improvement of cardiovascular morbidity and mortality.

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

Cited by 5 publications

References 33 publications

Intravascular Renal Denervation Reduces Ambulatory and Office Blood Pressure in Patients with Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Trials

Intravascular Renal Denervation Reduces Ambulatory and Office Blood Pressure in Patients with Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Trials

Devices for the treatment of arterial hypertension

Renal Sympathetic Denervation in the Management of Resistant Hypertension: A Review of Current Evidence

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