Renal Sympathetic Denervation Therapy for Resistant Hypertension

Myat, Aung; Redwood, Simon; Qureshi, Ayesha C.; Thackray, Simon; Cleland, John G.F.; Bhatt, Deepak L.; Williams, Bryan; Gersh, Bernard J.

doi:10.1161/circinterventions.112.000037

Cited by 33 publications

(20 citation statements)

References 96 publications

(116 reference statements)

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“…Renal denervation has emerged as a potential treatment strategy for true resistant hypertension 233 234. Data on the safety and efficacy of this technique suggest that the initial findings relating to efficacy may have been exaggerated.…”

Section: 2 Blood Pressurementioning

confidence: 99%

Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3)

Board¹

2014

Heart

461

196

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Section: 2 Blood Pressurementioning

confidence: 99%

Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3)

Board¹

2014

Heart

461

196

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“…Increased sympathetic outflow has been implicated in resistant hypertension and renal denervation has been proposed as an effective method of interrupting sympathetic supply to the kidney resulting in reduced blood pressure 34. Renal denervation involves disruption of renal sympathetic nerves along the renal artery by radio-ablation catheters inserted through the femoral artery 34…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and management of resistant hypertension

Sheppard

Martin

McManus

2017

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“…Poor concordance with treatment is considered to be one of the major causes of inadequate response to blood pressure (BP) lowering treatment in patients diagnosed with ‘resistant hypertension’ (up to 10%–20% of patients with high BP) 2. This issue has recently come to the fore because of the availability of new non-drug therapies, that is, percutaneous radiofrequency, catheter-based renal sympathetic denervation (renal denervation) for patients with suspected resistance to antihypertensive treatment 2 3. Furthermore, patients with undeclared/unrecognised non-adherence frequently undergo numerous additional (sometimes invasive and often expensive) diagnostic tests in specialist centres to identify causes of their apparent poor response to antihypertensive medications.…”

mentioning

confidence: 99%

High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS) urine analysis

Tomaszewski

White

Patel

et al. 2014

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ObjectivesNon-adherence to therapy is an important cause of suboptimal blood pressure control but few practical tools exist to accurately and routinely detect it. We used a simple urine-based assay to evaluate the prevalence of antihypertensive treatment non-adherence and its impact on blood pressure in a specialist hypertension centre.Methods208 hypertensive patients (125 new referrals, 66 follow-up patients with inadequate blood pressure control and 17 renal denervation referrals) underwent assessment of antihypertensive drug intake using high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS) urine analysis at the time of clinical appointment. A total of 40 most commonly prescribed antihypertensive medications (or their metabolites) were screened for in spot urine samples.ResultsOverall, 25% of patients were totally or partially non-adherent to antihypertensive treatment (total non-adherence 10.1%, partial non-adherence 14.9%). The highest prevalence of partial and total non-adherence was among follow-up patients with inadequate blood pressure control (28.8%) and those referred for consideration of renal denervation (23.5%), respectively. There was a linear relationship between blood pressure and the numerical difference in detected/prescribed antihypertensive medications—every unit increase in this difference was associated with 3.0 (1.1) mm Hg, 3.1 (0.7) mm Hg and 1.9 (0.7) mm Hg increase in adjusted clinic systolic blood pressure, clinic diastolic blood pressure (DBP) and 24 h mean daytime DBP (p=0.0051, p=8.62×10−6, p=0.0057), respectively.ConclusionsNon-adherence to blood pressure lowering therapy is common, particularly in patients with suboptimal blood pressure control and those referred for renal denervation. HP LC-MS/MS urine analysis could be used to exclude non-adherence and better stratify further investigations and intervention.

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Renal Sympathetic Denervation Therapy for Resistant Hypertension

Cited by 33 publications

References 96 publications

Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3)

Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3)

Diagnosis and management of resistant hypertension

High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS) urine analysis

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