Renal Sympathetic Denervation Reduces Left Ventricular Hypertrophy and Improves Cardiac Function in Patients With Resistant Hypertension

Brandt, Mathias C.; Mahfoud, Felix; Reda, Sara; Schirmer, Stephan H.; Erdmann, Erland; Böhm, Michael; Hoppe, Uta C.

doi:10.1016/j.jacc.2011.11.034

Cited by 455 publications

(305 citation statements)

References 41 publications

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“…Echocardiographic data also revealed a decrease in left ventricular (LV) thickness -substantiated in other studies as well. 37,38 In this setting, the freedom from AF was 69 % at one-year in the RDN group, versus 29 % in the PVI only group. 36 However, because there was also a substantial decrease in blood pressure in the denervation group, these results beg the question: did blood pressure control alone account for the decrease in AF, or was it also influenced by decreased afferent renal sympathetic output?…”

Section: Renal Denervation Renal Denervation and Atrial Electrophysiomentioning

confidence: 84%

Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology

Hucker

Singh

Parks

et al. 2014

Arrhythm Electrophysiol Rev

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The interplay between the central nervous system and cardiac electrophysiology is fundamental, and becomes obvious each time one's pulse quickens in response to stress. Normally, cardiac neurohormonal regulation is accomplished through the balanced effects of sympathetic and parasympathetic autonomic stimulation, along with the hormonal regulation of the renin-angiotensinaldosterone system (RAAS). Autonomic and hormonal input modulate multiple facets of cellular electrophysiology -action potential duration, ion channel kinetics and intracellular calcium dynamics (just to name a few) -which translate into macroscopic manifestations of autonomic modulation such as heart rate variability, atrioventricular (AV) conduction time and QT interval variability.1 Therefore, it is no surprise that neurohormonal regulation of cardiac electrophysiology is an area of active investigation for its potential antiarrhythmic effects. Recent reviews have focused on the efficacy of neurohormonal modulation, via non-pharmacological methods, to enhance heart failure treatment. 2,3 This review will attempt to provide a state-of-the-art on the potential antiarrhythmic efficacy of renal artery denervation, spinal cord stimulation and direct vagal stimulation. Neurohormonal Control in the Normal and Failing HeartAutonomic control of cardiac physiology is often conceptualised as parasympathetic (cholinergic) and sympathetic (adrenergic) innervation existing in a 'yin and yang' balance under normal circumstances; however, this concept may be over-simplified. 4 In reality, the intrinsic cardiac nervous system, composed of several ganglia located primarily posterior to the atria, likely acts as a 'little brain' of the heart -it provides efferent input to the myocardium, collects afferent signals on a beat-to-beat basis and performs some integrative functions on its own, all under the tonic modulation of extrinsic sympathetic and parasympathetic input (see Figure 1). 4-8The ganglia are predominantly composed of cholinergic neurons; however, sympathetic efferent neurons are also present. Due to the complex interconnectivity between the ganglia, afferent mechanosensory, nociceptive and chemosensory signals from all four chambers of the heart may be processed within a single ganglion. 4 Such interconnectivity implies that predicting the effect of stimulation or ablation of a particular ganglion may be difficult, because each ganglion performs multiple functions. 7,9Abstract Alterations in resting autonomic tone can be pathogenic in many cardiovascular disease states, such as heart failure and hypertension.Indeed, autonomic modulation by way of beta-blockade is a standard treatment of these conditions. There is a significant interest in developing non-pharmacological methods of autonomic modulation as well. For instance, clinical trials of vagal stimulation and spinal cord stimulation in the treatment of heart failure are currently underway, and renal denervation has been studied recently in the treatment of resistant hypertension. Notably, autonom...

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Section: Renal Denervation Renal Denervation and Atrial Electrophysiomentioning

confidence: 84%

Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology

Hucker

Singh

Parks

et al. 2014

Arrhythm Electrophysiol Rev

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“…However, there is accumulating evidence on intermediate endpoints, such as left ventricular hypertrophy, which might have important prognostic implications in patients with resistant hypertension. 18 Furthermore, RDN was recently shown to have a favorable safety profile and beneficial effects on BP in patients with stage 3-4 chronic kidney disease. 19 Endovascular radiofrequency renal denervation in resistant hypertension amination to confirm treatment resistance and exclude pseudo-resistance, for instance from a white-coat effect; particularly, persisting high clinic BP in spite of multidrug treatment should be confirmed by 24-h ABPM.…”

Section: Discussionmentioning

confidence: 99%

Endovascular radiofrequency renal denervation in resistant hypertension: a single center experience

et al. 2013

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Eight patients with office blood pressure >140/90 mmHg, despite being treated with at least three antihypertensive drugs, underwent catheter-based renal denervation. Secondary hypertension was excluded in all patients. Every patient underwent follow-up at 30 days, and then every 3 months. At 6 and 12 months the median value of systolic clinic blood pressure decreased from 161 mmHg (25 th -75 th percentiles: 158-191 mmHg) at baseline to 144 mmHg (25 th -75 th percentiles: 136-153 mmHg) at follow up (P=0.012), and the median value of diastolic clinic blood pressure decreased from 102 mmHg (25 th -75 th percentiles: 94-122 mmHg) at baseline to 90 mmHg (25 th -75 th percentiles: 78-99 mmHg) at follow-up (P=0.012). The number of medications decreased from 5 (range, 2-8) at baseline to 3.3 (range, 0-6) at follow up. There was a significant decrease of left ventricular mass index from a median of 160 g/m 2 (25 th -75 th percentiles: 147-151 g/m 2 ) at baseline to 126 g/m 2 (25 th -75 th percentiles 107-151 g/m 2 ) at follow-up (P=0.043) was detected. The renal function, and metabolic and neurohumoral parameters, did not change significantly. No complications were observed.

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“…This includes heart failure, sleep apnoea, insulin resistance and even metabolic changes in polycystic ovary syndrome. [23][24][25][26][27] Obviously, these preliminary results have to be confirmed in larger prospective controlled trials.…”

Section: The Sympathetic Nervous Systemmentioning

confidence: 92%

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 Sympathetic Denervation Reduces Left Ventricular Hypertrophy and Improves Cardiac Function in Patients With Resistant Hypertension

Abstract: Besides the known effect on blood pressure, our study showed for the first time that RD significantly reduces LV mass and improves diastolic function, which might have important prognostic implications in patients with resistant hypertension at high cardiovascular risk.

Cited by 455 publications

References 41 publications

Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology

Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology

Endovascular radiofrequency renal denervation in resistant hypertension: a single center experience

Renal denervation: a new treatment option in resistant arterial hypertension

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