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Mahfoud F, Azizi M, Daemen J, Sharp ASP, Patak A, Iglesias JF, Kirtane A, Fisher NDL, Scicli A, Lobo MD. Real-world experience with ultrasound renal denervation utilizing home blood pressure monitoring: the Global Paradise System registry study design. Clin Res Cardiol 2024; 113:1375-1383. [PMID: 37943324 DOI: 10.1007/s00392-023-02325-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Hypertension is a major public health issue due to its association with cardiovascular disease risk. Despite the availability of effective antihypertensive drugs, rates of blood pressure (BP) control remain suboptimal. Renal denervation (RDN) has emerged as an effective non-pharmacological, device-based treatment option for patients with hypertension. The multicenter, single-arm, observational Global Paradise™ System (GPS) registry has been designed to examine the long-term safety and effectiveness of ultrasound RDN (uRDN) with the Paradise System in a large population of patients with hypertension. METHODS The study aims to enroll up to 3000 patients undergoing uRDN in routine clinical practice. Patients will be recruited over a 4-year period and followed for 5 years (at 3, 6, and 12 months after the uRDN procedure and annually thereafter). Standardized home BP measurements will be taken every 3 months with automatic upload to the cloud. Office and ambulatory BP and adverse events will be collected as per routine clinical practice. Quality-of-Life questionnaires will be used to capture patient-reported outcomes. CONCLUSIONS This observational registry will provide real-world information on the safety and effectiveness of uRDN in a large population of patients treated during routine clinical practice, and also allow for a better understanding of responses in prespecified subgroups. The focus on home BP in this registry is expected to improve completeness of long-term follow-up and provide unique insights into BP over time.
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Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany.
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Michel Azizi
- Université Paris Cité, 75006, Paris, France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, 75015, Paris, France
- INSERM, CIC1418, 75015, Paris, France
| | - Joost Daemen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff and Cardiff University, Cardiff, UK
| | - Atul Patak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco and University of Toulouse, Toulouse, France
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Ajay Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| | - Naomi D L Fisher
- Division of Endocrinology, Diabetes and Hypertension, The Brigham and Women's Hospital, Boston, MA, USA
| | | | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
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Chattranukulchai P, Roubsanthisuk W, Kunanon S, Kotruchin P, Satirapoj B, Wongpraparut N, Sunthornyothin S, Sukonthasarn A. Resistant hypertension: diagnosis, evaluation, and treatment a clinical consensus statement from the Thai hypertension society. Hypertens Res 2024; 47:2447-2455. [PMID: 39014113 PMCID: PMC11374717 DOI: 10.1038/s41440-024-01785-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/03/2024] [Accepted: 06/15/2024] [Indexed: 07/18/2024]
Abstract
Resistant hypertension (RH) includes hypertensive patients with uncontrolled blood pressure (BP) while receiving ≥3 BP-lowering medications or with controlled BP while receiving ≥4 BP-lowering medications. The exact prevalence of RH is challenging to quantify. However, a reasonable estimate of true RH is around 5% of the hypertensive population. Patients with RH have higher cardiovascular risk as compared with hypertensive patients in general. Standardized office BP measurement, confirmation of medical adherence, search for drug- or substance-induced BP elevation, and ambulatory or home BP monitoring are mandatory to exclude pseudoresistance. Appropriate further investigations, guided by clinical data, should be pursued to exclude possible secondary causes of hypertension. The management of RH includes the intensification of lifestyle interventions and the modification of antihypertensive drug regimens. The essential aspects of lifestyle modification include sodium restriction, body weight control, regular exercise, and healthy sleep. Step-by-step adjustment of the BP-lowering drugs based on the available evidence is proposed. The suitable choice of diuretics according to patients' renal function is presented. Sacubitril/valsartan can be carefully substituted for the prior renin-angiotensin system blockers, especially in those with heart failure with preserved ejection fraction. If BP remains uncontrolled, device therapy such as renal nerve denervation should be considered. Since device-based treatment is an invasive and costly procedure, it should be used only after careful and appropriate case selection. In real-world practice, the management of RH should be individualized depending on each patient's characteristics.
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Affiliation(s)
- Pairoj Chattranukulchai
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Weranuj Roubsanthisuk
- Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Sirisawat Kunanon
- Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Bancha Satirapoj
- Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Nattawut Wongpraparut
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sarat Sunthornyothin
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Apichard Sukonthasarn
- Department of Medicine, Cardiovascular Unit, Faculty of Medicine, Chiang Mai University, and Thai Hypertension Society, Bangkok, Thailand
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Azeez GA, Thirunagari M, Fatima N, Anand A, Palvia AR, Kaur A, Nassar ST. The Efficacy of Renal Denervation in Treating Resistant Hypertension: A Systematic Review. Cureus 2024; 16:e67007. [PMID: 39286705 PMCID: PMC11403650 DOI: 10.7759/cureus.67007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 08/16/2024] [Indexed: 09/19/2024] Open
Abstract
Resistant hypertension is blood pressure (BP) that is persistently above target in spite of the maximally tolerated usage of at least three anti-hypertensives simultaneously. The sympathetic nervous system is instrumental in blood pressure (BP) regulation. Renal (sympathetic) denervation involves using ablative energy to disrupt the sympathetic nerves in renal arteries. This systematic review examines the efficacy of this treatment modality. Abiding by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we conducted an extensive literature search in five databases, Cochrane Library, Google Scholar, PubMed, PubMed Central (PMC), and ScienceDirect, to retrieve studies that are free, open access, and published in English done within the past four years. Nineteen articles passed critical appraisal. These articles were randomized controlled trials (RCT), a case report, a cross-sectional study, a cohort study, and previous reviews. Renal denervation (RDN) was generally superior to sham control in patients with resistant hypertension for reducing various systolic blood pressure (SBP) measures, including 24-hour ambulatory, daytime, and nighttime SBP. The efficacy was highest in patients whose baseline SBP was higher. BP reduction was sustained for years post-procedure. The procedure had a good safety profile with no severe complications. Future studies should compare the efficacy of different types of renal denervation, such as ethanol ablation versus radiofrequency ablation, and renal denervation against other procedure-based treatment modalities, such as carotid baroreceptor stimulation and transcranial direct current stimulation.
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Affiliation(s)
- Gibran A Azeez
- Department of Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Department of Pathophysiology, St. George's University, St. George's, GRD
| | - Mounika Thirunagari
- Department of Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Department of Internal Medicine, Davao Medical School Foundation, Davao City, PHL
| | - Nazeefa Fatima
- Department of Clinical Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Abhinav Anand
- Department of Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Aadi R Palvia
- Department of Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Department of Internal Medicine, Kharghar Medicity Hospital, Navi Mumbai, IND
| | - Avneet Kaur
- Department of Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sondos T Nassar
- Department of Medicine and Surgery, Jordan University of Science and Technology, Amman, JOR
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4
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Taylor RS, Bentley A, Metcalfe K, Lobo MD, Kirtane AJ, Azizi M, Clark C, Murphy K, Boer JH, van Keep M, Ta AT, Barman NC, Schwab G, Akehurst R, Schmieder RE. Cost Effectiveness of Endovascular Ultrasound Renal Denervation in Patients with Resistant Hypertension. PHARMACOECONOMICS - OPEN 2024; 8:525-537. [PMID: 38289517 PMCID: PMC11252101 DOI: 10.1007/s41669-024-00472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Resistant hypertension (rHTN) is defined as blood pressure (BP) of ≥ 140/90 mmHg despite treatment with at least three antihypertensive medications, including a diuretic. Endovascular ultrasound renal denervation (uRDN) aims to control BP alongside conventional BP treatment with antihypertensive medication. This analysis assesses the cost effectiveness of the addition of the Paradise uRDN System compared with standard of care alone in patients with rHTN from the perspective of the United Kingdom (UK) health care system. METHODS Using RADIANCE-HTN TRIO trial data, we developed a state-transition model. Baseline risk was calculated using Framingham and Prospective Cardiovascular Münster (PROCAM) risk equations to estimate the long-term cardiovascular risks in patients treated with the Paradise uRDN System, based on the observed systolic BP (SBP) reduction following uRDN. Relative risks sourced from a meta-analysis of randomised controlled trials were then used to project cardiovascular events in patients with baseline SBP ('control' patients); utility and mortality inputs and costs were derived from UK data. Costs and outcomes were discounted at 3.5% per annum. Modelled outcomes were validated against trial meta-analyses and the QRISK3 algorithm and real-world evidence of RDN effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty surrounding the model inputs and sensitivity of the model results to changes in parameter inputs. Results were reported as incremental cost-effectiveness ratios (ICERs). RESULTS A mean reduction in office SBP of 8.5 mmHg with uRDN resulted in an average improvement in both absolute life-years (LYs) and quality-adjusted life-years (QALYs) gained compared with standard of care alone (0.73 LYs and 0.67 QALYs). The overall base-case ICER with uRDN was estimated at £5600 (€6500) per QALY gained (95% confidence interval £5463-£5739 [€6341-€6661]); modelling demonstrated > 99% probability that the ICER is below the £20,000-£30,000 (€23,214-€34,821) per QALYs gained willingness-to-pay threshold in the UK. Results were consistent across sensitivity analyses and validation checks. CONCLUSIONS Endovascular ultrasound RDN with the Paradise system offers patients with rHTN, clinicians, and healthcare systems a cost-effective treatment option alongside antihypertensive medication.
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Affiliation(s)
- Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit and Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, 90 Byres Rd, Glasgow, G12 8TB, UK.
| | | | | | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Ajay J Kirtane
- Columbia University Irving Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| | - Michel Azizi
- Université de Paris, Paris, France
- Hypertension Department and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
- INSERM, CIC1418, Paris, France
| | - Christopher Clark
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | | | | | | | - An Thu Ta
- BresMed Netherlands, Utrecht, The Netherlands
| | | | | | - Ron Akehurst
- BresMed Health Solutions, Sheffield, UK
- University of Sheffield, Sheffield, UK
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
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Chinitz L, Böhm M, Evonich R, Saba S, Sangriogoli R, Augostini R, O'Neill PG, Fellows C, Kim MY, Hettrick DA, Viktorova E, Ukena C. Long-Term Changes in Atrial Arrhythmia Burden After Renal Denervation Combined With Pulmonary Vein Isolation: SYMPLICITY-AF. JACC Clin Electrophysiol 2024:S2405-500X(24)00383-9. [PMID: 38934973 DOI: 10.1016/j.jacep.2024.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/22/2024] [Accepted: 04/27/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The autonomic nervous system plays an important role in atrial fibrillation (AF) and hypertension. Renal denervation (RDN) lowers blood pressure (BP), but its role in AF is poorly understood. OBJECTIVES The purpose of this study was to investigate whether RDN reduces AF recurrence after pulmonary vein isolation (PVI). METHODS This study randomized patients from 8 centers (United States, Germany) with drug-refractory AF for treatment with PVI+RDN vs PVI alone. A multielectrode radiofrequency Spyral catheter system was used for RDN. Insertable cardiac monitors were used for continuous rhythm monitoring. The primary efficacy endpoint was ≥2 minutes of AF recurrence or repeat ablation during all follow-up. The secondary endpoints included atrial arrhythmia (AA) burden, discontinuation of class I/III antiarrhythmic drugs, and BP changes from baseline. RESULTS A total of 70 patients with AF (52 paroxysmal, 18 persistent) and uncontrolled hypertension were randomized (RDN+PVI, n = 34; PVI, n = 36). At 3.5 years, 26.2% and 21.4% of patients in RDN+PVI and PVI groups, respectively, were free from the primary efficacy endpoint (log rank P = 0.73). Patients with mean ≥1 h/d AA had less daily AA burden after RDN+PVI vs PVI (4.1 hours vs 9.2 hours; P = 0.016). More patients discontinued class I/III antiarrhythmic drugs after RDN+PVI vs PVI (45% vs 14%; P = 0.040). At 1 year, systolic BP changed by -17.8 ± 12.8 mm Hg and -13.7 ± 18.8 mm Hg after RDN+PVI and PVI, respectively (P = 0.43). The composite safety endpoint was not significantly different between groups. CONCLUSIONS In patients with AF and uncontrolled BP, RDN+PVI did not prevent AF recurrence more than PVI alone. However, RDN+PVI may reduce AF burden and antiarrhythmic drug usage, but this needs further prospective validation.
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Affiliation(s)
- Larry Chinitz
- New York University Langone Medical Center, New York, New York, USA.
| | - Michael Böhm
- Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | | | - Samir Saba
- University of Pittsburgh Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | | | - Ralph Augostini
- The Ohio State University Wexner, Medical Center, Columbus, Ohio, USA
| | | | | | | | | | | | - Christian Ukena
- Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany; Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
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6
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Sesa-Ashton G, Nolde JM, Muente I, Carnagarin R, Macefield VG, Dawood T, Lambert EA, Lambert GW, Walton A, Esler MD, Schlaich MP. Long-Term Blood Pressure Reductions Following Catheter-Based Renal Denervation: A Systematic Review and Meta-Analysis. Hypertension 2024; 81:e63-e70. [PMID: 38506059 DOI: 10.1161/hypertensionaha.123.22314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Renal denervation is a recognized adjunct therapy for hypertension with clinically significant blood pressure (BP)-lowering effects. Long-term follow-up data are critical to ascertain durability of the effect and safety. Aside from the 36-month follow-up data available from randomized control trials, recent cohort analyses extended follow-up out to 10 years. We sought to analyze study-level data and quantify the ambulatory BP reduction of renal denervation across contemporary randomized sham-controlled trials and available long-term follow-up data up to 10 years from observational studies. METHODS A systematic review was performed with data from 4 observational studies with follow-up out to 10 years and 2 randomized controlled trials meeting search and inclusion criteria with follow-up data out to 36 months. Study-level data were extracted and compared statistically. RESULTS In 2 contemporary randomized controlled trials with 36-month follow-up, an average sham-adjusted ambulatory systolic BP reduction of -12.7±4.5 mm Hg from baseline was observed (P=0.05). Likewise, a -14.8±3.4 mm Hg ambulatory systolic BP reduction was found across observational studies with a mean long-term follow-up of 7.7±2.8 years (range, 3.5-9.4 years; P=0.0051). The observed reduction in estimated glomerular filtration rate across the long-term follow-up was in line with the predicted age-related decline. Antihypertensive drug burden was similar at baseline and follow-up. CONCLUSIONS Renal denervation is associated with a significant and clinically meaningful reduction in ambulatory systolic BP in both contemporary randomized sham-controlled trials up to 36 months and observational cohort studies up to 10 years without adverse consequences on renal function.
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Affiliation(s)
- Gianni Sesa-Ashton
- Human Neurotransmitter and Neurovascular Hypertension & Kidney Diseases Laboratories (G.S.-A., E.A.L., G.W.L., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne Australia
- Human Autonomic Neurophysiology Laboratory (G.S.-A., V.G.M., T.D.), Baker Heart and Diabetes Institute, Melbourne Australia
- Department of Neuroscience, Monash University, Melbourne Australia (G.S.-A., V.G.M., T.D.)
| | - Janis M Nolde
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Australia (J.M.N., I.M., R.C., M.P.S.)
| | - Ida Muente
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Australia (J.M.N., I.M., R.C., M.P.S.)
| | - Revathy Carnagarin
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Australia (J.M.N., I.M., R.C., M.P.S.)
| | - Vaughan G Macefield
- Human Autonomic Neurophysiology Laboratory (G.S.-A., V.G.M., T.D.), Baker Heart and Diabetes Institute, Melbourne Australia
- Department of Neuroscience, Monash University, Melbourne Australia (G.S.-A., V.G.M., T.D.)
| | - Tye Dawood
- Human Autonomic Neurophysiology Laboratory (G.S.-A., V.G.M., T.D.), Baker Heart and Diabetes Institute, Melbourne Australia
- Department of Neuroscience, Monash University, Melbourne Australia (G.S.-A., V.G.M., T.D.)
| | - Elisabeth A Lambert
- Human Neurotransmitter and Neurovascular Hypertension & Kidney Diseases Laboratories (G.S.-A., E.A.L., G.W.L., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne Australia
- Iverson Health Innovation Research Institute & School of Health Sciences, Swinburne University of Technology, Melbourne, Australia (E.A.L., G.W.L.)
| | - Gavin W Lambert
- Human Neurotransmitter and Neurovascular Hypertension & Kidney Diseases Laboratories (G.S.-A., E.A.L., G.W.L., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne Australia
- Iverson Health Innovation Research Institute & School of Health Sciences, Swinburne University of Technology, Melbourne, Australia (E.A.L., G.W.L.)
| | - Antony Walton
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia (A.W., M.D.E.)
| | - Murray D Esler
- Human Neurotransmitter and Neurovascular Hypertension & Kidney Diseases Laboratories (G.S.-A., E.A.L., G.W.L., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne Australia
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia (A.W., M.D.E.)
| | - Markus P Schlaich
- Human Neurotransmitter and Neurovascular Hypertension & Kidney Diseases Laboratories (G.S.-A., E.A.L., G.W.L., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne Australia
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Australia (J.M.N., I.M., R.C., M.P.S.)
- Department of Cardiology and Department of Nephrology, Royal Perth Hospital, WA, Australia (M.P.S.)
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Esler MD, Osborn JW, Schlaich MP. Sympathetic Pathophysiology in Hypertension Origins: The Path to Renal Denervation. Hypertension 2024; 81:1194-1205. [PMID: 38557153 DOI: 10.1161/hypertensionaha.123.21715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The importance of the sympathetic nervous system in essential hypertension has been recognized in 2 eras. The first was in early decades of the 20th century, through to the 1960s. Here, the sympathetic nervous system was identified as a target for the treatment of hypertension, and an extensive range of antiadrenergic therapies were developed. Then, after a period of lapsed interest, in a second era from 1985 on, the development of precise measures of human sympathetic nerve firing and transmitter release allowed demonstration of the importance of neural mechanisms in the initiation and maintenance of the arterial blood pressure elevation in hypertension. This led to the development of a device treatment of hypertension, catheter-based renal denervation, which we will discuss.
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Affiliation(s)
- Murray D Esler
- Human Neurotransmitter Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (M.D.E., M.P.S.)
| | - John W Osborn
- Department of Surgery, Medical School, University of Minnesota, Minneapolis (J.W.O.)
| | - Markus P Schlaich
- Human Neurotransmitter Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (M.D.E., M.P.S.)
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia (M.P.S.)
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Wang L, Li C, Li Z, Li Q, Liu C, Sun X, He Q, Xia DS, Xia D, Lu C. Ten-year follow-up of very-high risk hypertensive patients undergoing renal sympathetic denervation. J Hypertens 2024; 42:801-808. [PMID: 38164953 PMCID: PMC10990013 DOI: 10.1097/hjh.0000000000003650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/16/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Renal denervation (RDN) has been proven to be effective in lowering blood pressure (BP) in patients, but previous studies have had short follow-ups and have not examined the effects of RDN on major cardiovascular outcomes. This study aimed to demonstrate the effectiveness and safety of RDN in the long-term treatment of hypertension and to determine if it has an effect on cardiovascular outcomes. METHODS All patients with resistant hypertension who underwent RDN between 2011 and 2015 at Tianjin First Central Hospital were included in the study. Patients were followed up at 1,5 and 10 years and the longest follow-up was 12 years. Data were collected on office BP, home BP, ambulatory BP monitoring (ABPM), renal function, antihypertensive drug regimen, major adverse events (including acute myocardial infarction, stroke, cardiovascular death and all cause death) and safety events. RESULTS A total of 60 participants with mean age 50.37 ± 15.19 years (43.33% female individuals) completed long-term follow-up investigations with a mean of 10.02 ± 1.72 years post-RDN. Baseline office SBP and DBP were 179.08 ± 22.05 and 101.17 ± 16.57 mmHg under a mean number of 4.22 ± 1.09 defined daily doses (DDD), with a reduction of -35.93/-14.76 mmHg as compared with baseline estimates ( P < 0.0001). Compared with baseline, ambulatory SBP and DBP after 10-years follow-up were reduced by 14.31 ± 10.18 ( P < 0.001) and 9 ± 4.35 ( P < 0.001) mmHg, respectively. In comparison to baseline, participants were taking fewer antihypertensive medications ( P < 0.001), and their mean heart rate had decreased ( P < 0.001). Changes in renal function, as assessed by estimated glomerular filtration rate (eGFR) and creatinine, were within the expected rate of age-related decline. No major adverse events related to the RDN procedure were observed in long-term consequences. All-cause mortality and cardiovascular mortality rates were 10 and 8.34%, respectively, for the 10-year period. CONCLUSION The BP-lowering effect of RDN was safely sustained for at least 10 years post-procedure. More importantly, to the best of my knowledge, this is the first study to explore cardiovascular and all-cause mortality at 10 years after RDN.
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Affiliation(s)
- Li Wang
- Department of Cardiology, Tianjin First Central Hospital
| | - Chao Li
- Department of Cardiology, Tianjin First Central Hospital
| | - Zhuqing Li
- Department of Cardiology, Tianjin First Central Hospital
| | - Qi Li
- School of Medicine, Nankai University, Tianjin, China
| | - Chunlei Liu
- School of Medicine, Nankai University, Tianjin, China
| | - Xiaoqiang Sun
- Department of Cardiology, Tianjin First Central Hospital
| | - Qiang He
- Department of Cardiology, Tianjin First Central Hospital
| | - Da-sheng Xia
- Department of Cardiology, Tianjin First Central Hospital
| | - Dachuan Xia
- Department of Cardiology, Tianjin First Central Hospital
| | - Chengzhi Lu
- Department of Cardiology, Tianjin First Central Hospital
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Sesa-Ashton G, Nolde JM, Muente I, Carnagarin R, Lee R, Macefield VG, Dawood T, Sata Y, Lambert EA, Lambert GW, Walton A, Kiuchi MG, Esler MD, Schlaich MP. Catheter-Based Renal Denervation: 9-Year Follow-Up Data on Safety and Blood Pressure Reduction in Patients With Resistant Hypertension. Hypertension 2023; 80:811-819. [PMID: 36762561 DOI: 10.1161/hypertensionaha.122.20853] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Recent sham-controlled randomized clinical trials have confirmed the safety and efficacy of catheter-based renal denervation (RDN). Long-term safety and efficacy data beyond 3 years are scarce. Here, we report on outcomes after RDN in a cohort of patients with resistant hypertension with an average of ≈9-year follow-up (FU). METHODS We recruited patients with resistant hypertension who were previously enrolled in various RDN trials applying radiofrequency energy for blood pressure (BP) lowering. All participants had baseline assessments before RDN and repeat assessment at long-term FU including medical history, automated office and ambulatory BP measurement, and routine blood and urine tests. We analyzed changes between baseline and long-term FU. RESULTS A total of 66 participants (mean±SD, 70.0±10.3 years; 76.3% men) completed long-term FU investigations with a mean of 8.8±1.2 years post-procedure. Compared with baseline, ambulatory systolic BP was reduced by -12.1±21.6 (from 145.2 to 133.1) mm Hg (P<0.0001) and diastolic BP by -8.8±12.8 (from 81.2 to 72.7) mm Hg (P<0.0001). Mean heart rate remained unchanged. At long-term FU, participants were on one less antihypertensive medication compared with baseline (P=0.0052). Renal function assessed by estimated glomerular filtration rate fell within the expected age-associated rate of decline from 71.1 to 61.2 mL/min per 1.73 m2. Time above target was reduced significantly from 75.0±25.9% at baseline to 47.3±30.3% at long-term FU (P<0.0001). CONCLUSIONS RDN results in a significant and robust reduction in both office and ambulatory systolic and diastolic BP at ≈9-year FU after catheter-based RDN on less medication and without evidence of adverse consequences on renal function.
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Affiliation(s)
- Gianni Sesa-Ashton
- Human Neurotransmitter and Neurovascular Hypertension and Kidney Diseases Laboratories (G.S.-A., R.L., Y.S., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne, Australia.,Human Autonomic Neurophysiology Laboratory (G.S.-A., V.G.M., T.D.), Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Janis M Nolde
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia (J.M.N., I.M., R.C., M.G.K., M.P.S.)
| | - Ida Muente
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia (J.M.N., I.M., R.C., M.G.K., M.P.S.)
| | - Revathy Carnagarin
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia (J.M.N., I.M., R.C., M.G.K., M.P.S.)
| | - Rebecca Lee
- Human Neurotransmitter and Neurovascular Hypertension and Kidney Diseases Laboratories (G.S.-A., R.L., Y.S., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Vaughan G Macefield
- Human Autonomic Neurophysiology Laboratory (G.S.-A., V.G.M., T.D.), Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Tye Dawood
- Human Autonomic Neurophysiology Laboratory (G.S.-A., V.G.M., T.D.), Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Yusuke Sata
- Human Neurotransmitter and Neurovascular Hypertension and Kidney Diseases Laboratories (G.S.-A., R.L., Y.S., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia (Y.S., A.W., M.D.E.)
| | - Elisabeth A Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia (E.A.L., G.W.L.)
| | - Gavin W Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia (E.A.L., G.W.L.)
| | - Antony Walton
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia (Y.S., A.W., M.D.E.)
| | - Marcio G Kiuchi
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia (J.M.N., I.M., R.C., M.G.K., M.P.S.)
| | - Murray D Esler
- Human Neurotransmitter and Neurovascular Hypertension and Kidney Diseases Laboratories (G.S.-A., R.L., Y.S., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia (Y.S., A.W., M.D.E.)
| | - Markus P Schlaich
- Human Neurotransmitter and Neurovascular Hypertension and Kidney Diseases Laboratories (G.S.-A., R.L., Y.S., M.D.E., M.P.S.), Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia (J.M.N., I.M., R.C., M.G.K., M.P.S.).,Departments of Cardiology (M.P.S.), Royal Perth Hospital, Western Australia.,Nephrology (M.P.S.), Royal Perth Hospital, Western Australia
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Zeijen VJ, Hirsch A, Betjes MG, Daemen J. Unilateral renal atrophy 4 years after renal sympathetic denervation: a case report. J Hypertens 2023; 41:516-519. [PMID: 36728602 PMCID: PMC9894127 DOI: 10.1097/hjh.0000000000003350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Renal sympathetic denervation (RDN) carries a low risk of renal artery stenosis, and most cases occur within the first year. However, limited data are available on long-term incidence. Here, we present a case of a 68-year-old woman who underwent radiofrequency RDN for resistant hypertension. Ambulatory blood pressure improved following RDN and uptitration of antihypertensive drugs. Between year 3 and 4 after RDN, eGFR reduced from 87 to 50 ml/min per 1.73 m 2 . Ultrasound imaging revealed left renal atrophy, while subsequent magnetic resonance angiography showed a haemodynamically significant stenosis of the left renal artery. The patient remained in good clinical condition with stable blood pressure, while eGFR mildly deteriorated during a 6-year follow-up period. This case of renal artery stenosis occurred in a patient with multiple risk factors. A causal relationship to the RDN procedure cannot be confirmed nor ruled out. Long-term surveillance for adverse events should be considered in all RDN patients.
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Affiliation(s)
| | - Alexander Hirsch
- Department of Cardiology
- Department of Radiology and Nuclear Medicine
| | - Michiel G.H. Betjes
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus University Medical Center, Rotterdam, the Netherlands
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11
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Zeijen VJM, Kroon AA, van den Born BH, Blankestijn PJ, Meijvis SCA, Nap A, Lipsic E, Elvan A, Versmissen J, van Geuns RJ, Voskuil M, Tonino PAL, Spiering W, Deinum J, Daemen J. The position of renal denervation in treatment of hypertension: an expert consensus statement. Neth Heart J 2023; 31:3-11. [PMID: 36001280 PMCID: PMC9807711 DOI: 10.1007/s12471-022-01717-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 01/07/2023] Open
Abstract
Hypertension is an important risk factor for cardiovascular disease. In the Netherlands, there are approximately 2.8 million people with hypertension. Despite treatment recommendations including lifestyle changes and antihypertensive drugs, most patients do not meet guideline-recommended blood pressure (BP) targets. In order to improve BP control and lower the risk of subsequent cardiovascular events, renal sympathetic denervation (RDN) has been introduced and studied as a non-pharmacological approach. While early data on the efficacy of RDN showed conflicting results, improvements in treatment protocols and study design resulted in robust new evidence supporting the potential of the technology to improve patient care in hypertensive subjects. Recently, 5 randomised sham-controlled trials demonstrated the safety and efficacy of the technology. Modelling studies have further shown that RDN is cost-effective in the Dutch healthcare setting. Given the undisputable disease burden along with the shortcomings of current therapeutic options, we postulate a new, clearly framed indication for RDN as an adjunct in the treatment of hypertension. The present consensus statement summarises current guideline-recommended BP targets, proposed workup and treatment for hypertension, and position of RDN for those patients with primary hypertension who do not meet guideline-recommended BP targets (see central illustration).
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Affiliation(s)
- V J M Zeijen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A A Kroon
- Department of Internal Medicine, Maastricht University Medical Center & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - B H van den Born
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - P J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S C A Meijvis
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Nap
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - E Lipsic
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - A Elvan
- Department of Cardiology, Isala Heart Center, Zwolle, The Netherlands
| | - J Versmissen
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - R J van Geuns
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - W Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Deinum
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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12
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Long-term reduction in morning and nighttime blood pressure after renal denervation: 36-month results from SPYRAL HTN-ON MED trial. Hypertens Res 2023; 46:280-288. [PMID: 36241705 PMCID: PMC9747613 DOI: 10.1038/s41440-022-01042-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 02/03/2023]
Abstract
Elevated morning and nighttime blood pressures (BP) are associated with increased risk of cardiovascular events such as stroke and myocardial infarction. We compared the long-term changes in morning and nighttime BP in patients with uncontrolled hypertension (office systolic BP between 150 and <180 mmHg/diastolic BP ≥ 90 mmHg; mean ambulatory systolic BP (SBP) between 140 and <170 mmHg; 1-3 prescribed antihypertensive medications). Eighty patients were randomized to RDN or sham control. In patients taking at least 3 antihypertensive medications at 36 months (N = 23 RDN group; N = 23 sham group), the 24 h ambulatory SBP as well as morning (7:00-9:00AM) and nighttime (1:00-6:00AM) ambulatory SBP were significantly lower for the RDN group compared to sham control (24 h SBP: -20.2 vs. -10.2, p = 0.0087; morning SBP: -23.9 vs. -8.0 mmHg, p = 0.029; nighttime SBP: -20.8 vs. -7.2 mmHg, p = 0.0011). At 36 months, 24 h SBP was controlled to <130 mmHg in 40% of RDN patients in the morning compared to 6% for the sham group; P = 0.021 and in 80% of the RDN patients at night compared to 39% in the sham group; P = 0.019. Major adverse events through 36 months were rare in both groups, and there were no renal artery re-interventions or vascular complications. Morning and nighttime SBP were significantly lower in patients prescribed at least 3 antihypertensive medications at 36 months in the SPYRAL HTN-ON MED trial for RDN compared with sham control. The results suggest RDN has significant benefit when the risk of cardiovascular events is highest.
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