The randomised Oslo study of renal denervation
            <i>vs.</i>
            Antihypertensive drug adjustments: efficacy and safety through 7 years of follow-up

Bergland, Ola Undrum; Søraas, Camilla Lund; Larstorp, Anne Cecilie K.; Halvorsen, Lene Vernås; Hjørnholm, Ulla; Hoffman, Pavel; Høieggen, Aud; Elmula, Fadl Elmula M. Fadl

doi:10.1080/08037051.2020.1828818

Cited by 13 publications

(8 citation statements)

References 34 publications

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“…The efficacy-and safety of RDN after three years have been previously described, along with our own, recently published seven year follow-up data (7,8). Although available data indicate that RDN is a safe procedure, proper selection of patients who are likely to respond to the procedure beforehand would be of advantage.…”

Section: Introductionmentioning

confidence: 89%

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Changes in sympathetic nervous system activity after renal denervation: results from the randomised Oslo RDN study

et al. 2021

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Purpose: Sympathetic nervous system (SNS) over-activity is associated with essential hypertension.Renal sympathetic denervation (RDN) possibly lowers office-and ambulatory blood pressure (BP) in patients with treatment-resistant hypertension (TRH). We aimed to assess the effect of RDN compared to drug adjustment on SNS activity among patients with TRH by measuring plasma catecholamines and heart rate variability (HRV) during stress tests. Materials and methods:Patients with TRH were randomized to RDN (n=9) or Drug Adjustment (DA) (n=10). We measured continuous HRV and beat-to-beat-BP using FinaPres® and obtained plasma catecholamines during standardized orthostatic-and cold-pressor stress tests (CPT) before-and six months after randomization.Results: CPT revealed no differences between groups at baseline in peak adrenaline concentration (69.3pg/mL in the DA group vs. 70.0pg/mL in the RDN group, p=0.38) or adrenaline reactivity (∆23.1pg/mL in the DA group vs. ∆29.3pg/mL in the RDN group, p=0.40). After six months, adrenaline concentrations were statistically different between groups after one minute (66.9pg/mL in the DA group vs. 55.3pg/mL in the RDN group, p=0.03), and six minutes (62.4pg/mL in the DA group vs. 50.1pg/mL in the RDN group, p=0.03). There was a tendency of reduction in adrenaline reactivity after six months in the RDN group (∆26.3pg/mL at baseline vs. ∆12.8pg/ml after six months, p=0.08), while it increased in the DA group (∆13.6pg/mL at baseline vs. ∆19.9pg/mL after six months, p=0.53).We also found a difference in the Low Frequency band at baseline following the CPT (667µs 2 in the DA group vs. 1628µs 2 in the RDN group, p=0.03) with a clear tendency of reduction in the RDN group to 743µs 2 after six months (p=0.07), compared to no change in the DA group (1052µs 2, p=0.39). Conclusion:Our data suggest that RDN reduces SNS activity after six months. This finding warrants investigation in a larger study.

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Section: Introductionmentioning

confidence: 89%

“…The biochemical assays and BP measurements have previously been published and are detailed in Appendix 5a (baseline) and Appendix 5b (6 months) in the Online Supplement (8).…”

Section: Characteristics and Biochemistrymentioning

confidence: 99%

Changes in sympathetic nervous system activity after renal denervation: results from the randomised Oslo RDN study

et al. 2021

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“…However, the small Oslo RDN study, that has reported the longest follow-up so far, indicates that BP lowering may not endure after longer follow-up. In this randomized study, including very carefully selected treatment resistant hypertension patients, daytime ambulatory BP increased again at 7 years follow-up after an initial decrease that sustained for 3 years, while BP was better controlled during the 7 years of follow-up in the drug treated as compared to the RDN patients [38]. These long-term findings provide important information in line with the concept that complete and persistent denervation may be crucial for BP control after RDN, but other factors including adjustments in BP-lowering medication deserve consideration.…”

Section: Duration Of the Bp-lowering Effect: Do Nerves Regenerate Aft...mentioning

confidence: 89%

Renal denervation in the antihypertensive arsenal – knowns and known unknowns

Messerli

Bavishi

Brguljan

et al. 2022

Journal of Hypertension

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Even though it has been more than a decade since renal denervation (RDN) was first used to treat hypertension and an intense effort on researching this therapy has been made, it is still not clear how RDN fits into the antihypertensive arsenal. There is no question that RDN lowers blood pressure (BP), it does so to an extent at best corresponding to one antihypertensive drug. The procedure has an excellent safety record. However, it remains clinically impossible to predict whose BP responds to RDN and whose does not. Long-term efficacy data on BP reduction are still unconvincing despite the recent results in the SPYRAL HTN-ON MED trial; experimental studies indicate that reinnervation is occurring after RDN. Although BP is an acceptable surrogate endpoint, there is complete lack of outcome data with RDN. Clear indications for RDN are lacking although patients with resistant hypertension, those with documented increase in activity of the sympathetic system and perhaps those who desire to take fewest medication may be considered.

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“…The combined effect of enhanced sympathetic nerve germination and electrical remodelling of the myocardium is a possible cause of ventricular tachycardia, ventricular brillation and sudden cardiac death [12]. RDN damages renal sympathetic nerves, reduces sympathetic nerve activity and inhibits the RAAS system; it is widely used to treat clinical cardiovascular diseases, including hypertension and heart failure [13,14]. Previous studies have found that RDN can inhibit myocardial remodelling and cardiac electrical remodelling after AMI [15] and can reduce arrhythmias during myocardial ischaemia [7].…”

Section: Discussionmentioning

confidence: 99%

Effects and mechanism of renal denervation on ventricular arrhythmia after acute myocardial infarction in rats

Ye¹,

Xiao

Wang³

et al. 2022

Preprint

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Background: Renal denervation (RDN) can reduce ventricular arrhythmia after acute myocardial infarction(AMI), but the mechanism is not clear. The purpose of this study is to study its mechanism. Methods: Thirty-two Sprague-Dawley rats were divided into four groups: control group, AMI group, RDN-1d+AMI group, RDN-2w+AMI group. The AMI model was established 1 day after RDN in the RDN-1d+AMI group and 2 weeks after RDN in the RDN-2w+AMI group. At the same time, 8 normal rats were subjected to AMI modelling (the AMI group). The control group consisted of 8 rats without RDN intervention or AMI modelling. Results：The study confirmed that RDN can reduce the occurrence of ventricular tachycardia in AMI rats, reduce renal sympathetic nerve discharge, and inhibit the activity of local sympathetic nerves and cell growth factor (NGF) protein expression in the heart after AMI. In addition, RDN decreased the expression of norepinephrine (NE) and glutamate in the hypothalamus ,and NE in cerebrospinal fluid, and increased the expression level of γ -aminobutyric acid (GABA) in the hypothalamus after AMI. Conclusion: RDN can effectively reduce the occurrence of ventricular arrhythmia after AMI, and its main mechanism may be via the inhibition of central sympathetic nerve discharge.

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The randomised Oslo study of renal denervation vs. Antihypertensive drug adjustments: efficacy and safety through 7 years of follow-up

Cited by 13 publications

References 34 publications

Changes in sympathetic nervous system activity after renal denervation: results from the randomised Oslo RDN study

Changes in sympathetic nervous system activity after renal denervation: results from the randomised Oslo RDN study

Renal denervation in the antihypertensive arsenal – knowns and known unknowns

Effects and mechanism of renal denervation on ventricular arrhythmia after acute myocardial infarction in rats

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