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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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Jami O, Oussama EA, Mohammed Z, Soulaymane I, Ilhaam BS, Tijani Y, Aziz E. Device's design and clinical perspectives for resistant hypertension therapy. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 20:200240. [PMID: 38352851 PMCID: PMC10862014 DOI: 10.1016/j.ijcrp.2024.200240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/13/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024]
Abstract
Introduction Hypertension is the leading cause of death in the cardiovascular system. Indeed, untreated hypertension can affect one's general health, but medicine can help hypertensive people reduce their chance of developing high blood pressure. However, secondary hypertension remains an unresolved illness. Areas covered This review will go through the typical and unusual device-based therapies for resistant hypertension that have arisen in recent years. Further to that, the innovations developed in device-based RH treatment will be covered, as well as the research and studies assessing these novel technologies. Expert opinion The innovative device-based techniques that target resistant hypertension provide a potential therapy that has been backed by a number of studies and clinical trials, whereas pharmacological non-adherence and increased sympathetic activity are recognized to be the primary causes of resistant hypertension. Nevertheless, some limitations will be critical for the future of these RH systems, with the device's design and larger RCTs playing a significant role in determining whether a position in routine treatment could be warranted.
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Affiliation(s)
- Oussama Jami
- Mohammed V University in Rabat, High School of Technology in Salé; Materials, Energy and Acoustics Team, Rabat, Morocco
- Mohammed VI University of Health Sciences, Biomedical Engineering Department, Casablanca, Morocco
| | - El Allam Oussama
- National High School of Arts and Crafts of Casablanca, Hassan II University of Casablanca, Morocco
| | - Zaki Mohammed
- Mohammed VI University of Health Sciences, Biomedical Engineering Department, Casablanca, Morocco
| | - Imai Soulaymane
- Mohammed VI University of Health Sciences, Biomedical Engineering Department, Casablanca, Morocco
| | - Ben Sahi Ilhaam
- Mohammed VI University of Health Sciences, Faculty of Medicine, Casablanca, Morocco
| | - Youssef Tijani
- Mohammed VI University of Health Sciences, Faculty of Medicine, Casablanca, Morocco
| | - Ettahir Aziz
- Mohammed V University in Rabat, High School of Technology in Salé; Materials, Energy and Acoustics Team, Rabat, Morocco
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3
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Gosse P, Sentilhes L, Boulestreau R, Doublet J, Gaudissard J, Azizi M, Cremer A. Endovascular ultrasound renal denervation to lower blood pressure in young hypertensive women planning pregnancy: study protocol for a multicentre randomised, blinded and sham controlled proof of concept study. BMJ Open 2023; 13:e071164. [PMID: 37775290 PMCID: PMC10546167 DOI: 10.1136/bmjopen-2022-071164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/08/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION A major issue confronting clinicians treating hypertension in pregnancy is the limited number of pharmacological options. Endovascular catheter-based renal denervation (RDN) is a new method to lower blood pressure (BP) in patients with hypertension by reducing the activity of the renal sympathetic nervous system. Drugs that affect this system are safe in pregnant women. So there is reasonable evidence that RDN performed before pregnancy should not have deleterious effects for the fetus. Because the efficacy of RDN may be greater in younger patients and in women, we may expect a larger proportion of BP normalisation in young hypertensive women, but this remains to be proven. Our primary objective is to quantify the proportion of BP normalisation with RDN in this population. METHODS AND ANALYSIS WHY-RDN is a multicentre randomised sham-controlled trial conducted in six French hypertension centres that will include 80 women with essential hypertension treated or untreated, who are planning a pregnancy in the next 2 years and will be randomly assigned to RDN or classic renal arteriography and sham RDN in a ratio of 1:1. The primary outcome is the normalisation of 24-hour BP (<130/80 mm Hg) at 2-month post procedure off treatment. Sample size is calculated with the following assumptions: 5% one-sided significance level (α), 80% power (1-β), expected responder rates of 24% and 3% in the treatment and control group, respectively. Secondary outcomes include the absence of adverse outcomes for a future pregnancy, the variations of BP in ambulatory and home BP measurements and the evaluation of treatment prescribed. ETHICS AND DISSEMINATION WHY-RDN has been approved by the French Ethics Committee (Tours, Region Centre, Ouest 1- number 2021T1-28 HPS). This project is being carried out in accordance with national and international guidelines. The findings of this study will be disseminated by publication. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT05563337.
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Affiliation(s)
- Philippe Gosse
- Department of Cardiology/Hypertension, University Hospital Centre Bordeaux, Bordeaux, France
| | - Loïc Sentilhes
- University Hospital Centre Bordeaux, Bordeaux, France
- University of Bordeaux, Bordeaux, France
| | - Romain Boulestreau
- Cardiologie/Hypertension arterielle, University Hospital Centre Bordeaux, Bordeaux, France
| | - Julien Doublet
- Cardiologie/Hypertension arterielle, University Hospital Centre Bordeaux, Bordeaux, France
| | - Julie Gaudissard
- Cardiologie/Hypertension arterielle, University Hospital Centre Bordeaux, Bordeaux, France
| | - Michel Azizi
- Department of Hypertension, Hopital Europeen Georges Pompidou, Paris, France
| | - Antoine Cremer
- Cardiologie/Hypertension arterielle, University Hospital Centre Bordeaux, Bordeaux, France
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4
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Wagener M, Dolan E, Arnous S, Galvin J, Murphy AW, Casserly I, Eustace J, O’Connor S, McCreery C, Shand J, Wall C, Matiullah S, Sharif F. Renal Denervation as a Complementary Treatment Option for Uncontrolled Arterial Hypertension: A Situation Assessment. J Clin Med 2023; 12:5634. [PMID: 37685701 PMCID: PMC10488551 DOI: 10.3390/jcm12175634] [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: 07/23/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Uncontrolled arterial hypertension is a major global health issue. Catheter-based renal denervation has shown to lower blood pressure in sham-controlled trials and represents a device-based, complementary treatment option for hypertension. In this situation assessment, the authors, who are practicing experts in hypertension, nephrology, general practice and cardiology in the Republic of Ireland, discuss the current evidence base for the BP-lowering efficacy and safety of catheter-based renal denervation with different modalities. Although important questions remain regarding the identification of responders, and long-term efficacy and safety of the intervention, renal denervation has the potential to provide much-needed help to address hypertension and its adverse consequences. The therapeutic approach needs to be multidisciplinary and personalised to take into account the perspective of patients and healthcare professionals in a shared decision-making process.
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Affiliation(s)
- Max Wagener
- University Hospital Galway, University of Galway, H91 TK33 Galway, Ireland
| | - Eamon Dolan
- Stroke and Hypertension Unit, Connolly Hospital, D15 X40D Dublin, Ireland
| | - Samer Arnous
- University Hospital Limerick, V94 F858 Limerick, Ireland
| | - Joseph Galvin
- The Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
| | - Andrew W. Murphy
- Turloughmore Medical Centre, University of Galway, H91 TK33 Galway, Ireland
| | - Ivan Casserly
- The Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
| | | | | | | | - James Shand
- St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | | | | | - Faisal Sharif
- University Hospital Galway, University of Galway, H91 TK33 Galway, Ireland
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5
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Tsioufis PA, Theofilis P, Vlachakis PK, Dimitriadis K, Tousoulis D, Tsioufis K. Novel Invasive Methods as the Third Pillar for the Treatment of Essential Uncontrolled Hypertension. Curr Pharm Des 2023; 29:2780-2786. [PMID: 37641987 DOI: 10.2174/1381612829666230828142346] [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: 05/24/2023] [Revised: 07/16/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023]
Abstract
Pharmacologic therapies remain the treatment of choice for patients with essential hypertension, as endorsed by international guidelines. However, several cases warrant additional modalities, such as invasive antihypertensive therapeutics. The major target of these interventions is the modulation of the sympathetic nervous system, which is a common pathophysiologic mechanism in essential hypertension. In this narrative review, we elaborate on the role of invasive antihypertensive treatments with a focus on renal denervation, stressing their potential as well as the drawbacks that prevent their widespread implementation in everyday clinical practice. In the field of renal denervation, several trials have shown significant and sustained reductions in the level of office and ambulatory blood pressure, regardless of the type of energy that was used (radiofrequency or ultrasound). Critically, renal denervation is considered a safe intervention, as evidenced by follow-up data from large clinical trials. Baroreflex activation therapy may result in enhanced parasympathetic nervous system activation, thus lowering blood pressure levels. Along the same lines, carotid body ablation could also produce a significant antihypertensive effect, which has not been tested in appropriately designed randomized trials. Moreover, cardiac neuromodulation therapy could prove efficacious by altering the duration of the atrioventricular interval in order to regulate the preload of the left ventricle and, therefore, lower blood pressure.
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Affiliation(s)
| | - Panagiotis Theofilis
- First Department of Cardiology, "Hippocration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Panayotis K Vlachakis
- First Department of Cardiology, "Hippocration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Kyriakos Dimitriadis
- First Department of Cardiology, "Hippocration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, "Hippocration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, "Hippocration" General Hospital, University of Athens Medical School, Athens, Greece
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6
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Messerli FH, Bavishi C, Brguljan J, Burnier M, Dobner S, Elijovich F, Ferdinand KC, Kjeldsen S, Laffer CL, S Ram CV, Rexhaj E, Ruilope LM, Shalaeva EV, Siontis GC, Staessen JA, Textor SC, Vongpatanasin W, Vogt L, Volpe M, Wang J, Williams B. Renal denervation in the antihypertensive arsenal - knowns and known unknowns. J Hypertens 2022; 40:1859-1875. [PMID: 36052518 PMCID: PMC10010701 DOI: 10.1097/hjh.0000000000003171] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 01/21/2023]
Abstract
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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Affiliation(s)
- Franz H. Messerli
- Department of BioMedical Research, University of Bern, Bern, Switzerland
- Jagiellonian University Krakow, Krakow, Poland
| | - Chirag Bavishi
- Department of Cardiology, University of Missouri, Columbia, Missouri, USA
| | - Jana Brguljan
- University Medical Centre Ljubljana, Department of Hypertension, Medical University Ljubljana, Slovenia
| | - Michel Burnier
- University of Lausanne. Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Stephan Dobner
- Department of Cardiology, Bern University Hospital University of Bern, Bern, Switzerland
| | - Fernando Elijovich
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, USA
| | | | - Sverre Kjeldsen
- Department of Cardiology, University of Oslo Hospital, Oslo, Norway
| | - Cheryl L. Laffer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - C. Venkata S Ram
- Apollo Hospitals and Medical College, Hyderabad, Telangana, India
| | - Emrush Rexhaj
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Luis M. Ruilope
- Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research i+12, CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Evgeniya V. Shalaeva
- Division of Public Health Science, Westminster International University in Tashkent, Tashkent, Uzbekistan
- Department of Cardiology, Tashkent Medical Academy, Tashkent, Uzbekistan
| | - George C.M. Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan A. Staessen
- NPO Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
- Biomedical Science Group, Faculty of Medicine, Leuven, Belgium
| | - Stephen C. Textor
- Division of Hypertension and Nephrology, Mayo Clinic, Rochester, Minnesota, USA
| | - Wanpen Vongpatanasin
- Hypertension Section, Cardiology Division, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Liffert Vogt
- Department of Internal Medicine, section Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome, Italy
| | - Jiguang Wang
- The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, London, United Kingdom
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7
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Arunothayaraj S, Whitbourn R, Barlis P, Mahfoud F. Renal Denervation for Resistant Hypertension. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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8
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Yamamoto E, Sueta D, Tsujita K. Renal denervation in resistant hypertension: a review of clinical trials and future perspectives. Cardiovasc Interv Ther 2022; 37:450-457. [PMID: 35474179 DOI: 10.1007/s12928-022-00854-2] [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: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022]
Abstract
A previous report using the National Health and Nutrition Examination Survey demonstrated an increase in the prevalence of resistant hypertension, which does not respond to traditional therapy and medication. Studies using various animal hypertensive models have demonstrated significant blood pressure (BP) reduction following renal artery denervation (RDN). Catheter-based RDN became available in clinical trials as a possible treatment option for resistant hypertension. Although first clinical trials of RDN have demonstrated the efficacy and safety of this treatment mortality for lowering BP in patients with resistant hypertension, the role of RDN has been questioned since the results of the Symplicity HTN-3 trial. Considering the ethnic differences demonstrated in the Symplicity HTN-Japan and Global Symplicity registry, by contrast, RDN might be an effective for resistant hypertension in Asian population. Here, we discuss RDN applications and technology, the old and new clinical evidence of RDN, patients' selection of RDN responder, and optimization of RDN procedure in this review. The available evidence demonstrates that RDN could be effective in carefully selected patients with resistant hypertension, paving the way for future research in this area.
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Affiliation(s)
- Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science and Center for Metabolic Regulation of Healthy Aging (CMHA), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science and Center for Metabolic Regulation of Healthy Aging (CMHA), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science and Center for Metabolic Regulation of Healthy Aging (CMHA), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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9
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Kandzari DE, Mahfoud F, Weber MA, Townsend R, Parati G, Fisher NDL, Lobo MD, Bloch M, Böhm M, Sharp ASP, Schmieder RE, Azizi M, Schlaich MP, Papademetriou V, Kirtane AJ, Daemen J, Pathak A, Ukena C, Lurz P, Grassi G, Myers M, Finn AV, Morice MC, Mehran R, Jüni P, Stone GW, Krucoff MW, Whelton PK, Tsioufis K, Cutlip DE, Spitzer E. Clinical Trial Design Principles and Outcomes Definitions for Device-Based Therapies for Hypertension: A Consensus Document From the Hypertension Academic Research Consortium. Circulation 2022; 145:847-863. [PMID: 35286164 PMCID: PMC8912966 DOI: 10.1161/circulationaha.121.057687] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The clinical implications of hypertension in addition to a high prevalence of both uncontrolled blood pressure and medication nonadherence promote interest in developing device-based approaches to hypertension treatment. The expansion of device-based therapies and ongoing clinical trials underscores the need for consistency in trial design, conduct, and definitions of clinical study elements to permit trial comparability and data poolability. Standardizing methods of blood pressure assessment, effectiveness measures beyond blood pressure alone, and safety outcomes are paramount. The Hypertension Academic Research Consortium (HARC) document represents an integration of evolving evidence and consensus opinion among leading experts in cardiovascular medicine and hypertension research with regulatory perspectives on clinical trial design and methodology. The HARC document integrates the collective information among device-based therapies for hypertension to better address existing challenges and identify unmet needs for technologies proposed to treat the world’s leading cause of death and disability. Consistent with the Academic Research Consortium charter, this document proposes pragmatic consensus clinical design principles and outcomes definitions for studies aimed at evaluating device-based hypertension therapies.
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Affiliation(s)
| | - Felix Mahfoud
- Piedmont Heart Institute, Atlanta, GA (D.E.K.).,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (F.M.)
| | - Michael A Weber
- State University of New York, Downstate Medical College, New York (M.A.W.)
| | - Raymond Townsend
- University of Pennsylvania, Perelman School of Medicine, Philadelphia (R.T.)
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.).,Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere scientifico (IRCCS), Ospedale San Luca, Milan, Italy (G.P.)
| | | | - Melvin D Lobo
- Barts National Institute for Health Research Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.D.L.)
| | - Michael Bloch
- University of Nevada/Reno School of Medicine (M. Bloch).,Renown Institute for Heart and Vascular Health, Reno, NV (M. Bloch)
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany (F.M., M. Böhm, C.U.)
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff and University of Exeter, United Kingdom (A.S.P.S.)
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University Erlangen/Nürnberg, Germany (R.E.S.)
| | - Michel Azizi
- University of Paris, Institut national de la santé et de la recherche médicale (INSERM), Centre d'investigation clinique 418, Assistance Publique-Hôpitaux de Paris Hypertension Department and Département médico-universitaire Cardiologie Rein Transplantation Neurovasculaire, Georges Pompidou European Hospital, France (M.A.)
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit and Research Foundation, University of Western Australia (M.P.S.)
| | - Vasilios Papademetriou
- Department of Veterans Affairs and Georgetown University Medical Centers, Washington, DC (V.P.)
| | - Ajay J Kirtane
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York' NY (A.J.K.).,Cardiovascular Research Foundation, New York (A.J.K., R.M., G.W.S.)
| | - Joost Daemen
- Thoraxcenter, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands (J.D., E.S.)
| | - Atul Pathak
- Department of Cardiovasculaire Medicine, European Society of Hypertension Excellence Center, Princess Grace Hospital, Monaco (A.P.).,Centre for Anthropobiology and Genomics of Toulouse, Toulouse, France (A.P.)
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany (F.M., M. Böhm, C.U.)
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Germany (P.L.)
| | - Guido Grassi
- Clinica Medica University Milano-Bicocca, Milan, Italy (G.G.)
| | - Martin Myers
- Division of Cardiology, Sunnybrook Health Sciences Centre (M.M.), University of Toronto, Canada
| | | | | | - Roxana Mehran
- Cardiovascular Research Foundation, New York (A.J.K., R.M., G.W.S.).,Mount Sinai Hospital, New York (R.M., G.W.S.)
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation (P.J.), University of Toronto, Canada
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York (A.J.K., R.M., G.W.S.)
| | | | - Paul K Whelton
- Departments of Epidemiology and Medicine, Tulane University Health Sciences Center, New Orleans, LA (P.K.W.)
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Hippocratio Hospital, Greece (K.T.)
| | - Donald E Cutlip
- Baim Institute for Clinical Research, Boston, MA (D.E.C.).,Beth Israel Deaconess Medical Center, Boston, MA (D.E.C.)
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10
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Kandzari DE. Catheter-Based Renal Denervation Therapy: Evolution of Evidence and Future Directions. Circ Cardiovasc Interv 2021; 14:e011130. [PMID: 34903035 DOI: 10.1161/circinterventions.121.011130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Motivated by the persistence of uncontrolled blood pressure and its public health impact, the development and evaluation of device-based therapies for hypertension has advanced at an accelerated pace to complement pharmaceutical and lifestyle intervention strategies. Countering widespread interest from early studies, the lack of demonstrable efficacy for renal denervation (RDN) in a large, sham-controlled randomized trial motivated revision of trial design and conduct to account for confounding variables of procedural technique, medication variability, and selection of both patients and end points. Now amidst varied trial design and methods, several sham-controlled, randomized trials have demonstrated clinically meaningful reductions in blood pressure with RDN. With this momentum, additional studies are underway to position RDN as a potential part of standard therapy for the world's leading cause of death and disability. In parallel, further studies will address unresolved issues including durability of blood pressure lowering and reduction in antihypertensive medications, late-term safety, and impact on clinical outcomes. Identifying predictors of treatment effect and surveys of patient-reported outcomes and treatment preferences are also evolving areas of investigation. Aside from confirmatory studies of safety and effectiveness, these additional studies will further inform patient selection, expand experience with RDN in broader populations with hypertension, and provide guidance to how RDN may be incorporated into treatment pathways.
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Li L, Hu Z, Xiong Y, Yao Y. Device-Based Sympathetic Nerve Regulation for Cardiovascular Diseases. Front Cardiovasc Med 2021; 8:803984. [PMID: 34957267 PMCID: PMC8695731 DOI: 10.3389/fcvm.2021.803984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/22/2021] [Indexed: 12/05/2022] Open
Abstract
Sympathetic overactivation plays an important role in promoting a variety of pathophysiological processes in cardiovascular diseases (CVDs), including ventricular remodeling, vascular endothelial injury and atherosclerotic plaque progression. Device-based sympathetic nerve (SN) regulation offers a new therapeutic option for some CVDs. Renal denervation (RDN) is the most well-documented method of device-based SN regulation in clinical studies, and several large-scale randomized controlled trials have confirmed its value in patients with resistant hypertension, and some studies have also found RDN to be effective in the control of heart failure and arrhythmias. Pulmonary artery denervation (PADN) has been clinically shown to be effective in controlling pulmonary hypertension. Hepatic artery denervation (HADN) and splenic artery denervation (SADN) are relatively novel approaches that hold promise for a role in cardiovascular metabolic and inflammatory-immune related diseases, and their first-in-man studies are ongoing. In addition, baroreflex activation, spinal cord stimulation and other device-based therapies also show favorable outcomes. This review summarizes the pathophysiological rationale and the latest clinical evidence for device-based therapies for some CVDs.
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Affiliation(s)
| | | | | | - Yan Yao
- National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China
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Gao JQ, Zhang H, Li LY, Wang X, Ye J, Liu ZJ. Comparison of a 5 F Microtube-Irrigated Ablation Catheter and a General Ablation Catheter in the Treatment of Resistant Hypertension with Renal Denervation. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2021. [DOI: 10.15212/cvia.2021.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To assess the effectiveness of catheter-based renal denervation for reducing blood pressure in patients with resistant hypertension using a 5 F microtube-irrigated ablation catheter.Methods: Sixty patients with resistant hypertension were divided into two
groups: a microtube-irrigated ablation catheter group and a general ablation catheter group. We conducted 12-month follow-up of all patients and recorded clinical blood pressure, ambulatory blood pressure, medication use, and biochemistry test results in both groups at the baseline and at
the 12-month follow-up.Results: All patients underwent renal denervation. At the 6-month follow-up, ambulatory blood pressure in the microtube-irrigated ablation catheter group was significantly lower than in the general ablation catheter group (systolic blood pressure 142.0 ±
14.4 mmHg vs. 150.8 ± 17.9 mmHg, P=0.04; diastolic blood pressure 81.2 ± 7.0 mmHg vs. 87.6 ± 8.0 mmHg, P=0.002). At the 12-month follow-up, the between-group difference in ambulatory blood pressure was not statistically significant. At the 12-month follow-up, the number
of antihypertensive drugs and diuretics used in the microtube-irrigated ablation catheter group was less than in the general ablation catheter group (P=0.043). There was no statistical difference between the two groups in the results of biochemistry tests and echocardiography.Conclusion:
The microtube-irrigated ablation catheter is more effective in treating hypertension than the general ablation catheter at the 6-month follow up and thus fewer antihypertensive drugs were used in the microtube-irrigated ablation catheter group than in the general ablation catheter group.
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Affiliation(s)
- Jun-Qing Gao
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 200069 Shanghai, People’s Republic of China
| | - Hong Zhang
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 200069 Shanghai, People’s Republic of China
| | - Ling-Yan Li
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 200069 Shanghai, People’s Republic of China
| | - Xu Wang
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 200069 Shanghai, People’s Republic of China
| | - Jian Ye
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 200069 Shanghai, People’s Republic of China
| | - Zong-Jun Liu
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 200069 Shanghai, People’s Republic of China
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Choi KH, Choi SH. Current Status and Future Perspectives of Renal Denervation. Korean Circ J 2021; 51:717-732. [PMID: 34227270 PMCID: PMC8424450 DOI: 10.4070/kcj.2021.0175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 12/05/2022] Open
Abstract
Despite the availability of numerous antihypertensive medications, hypertension treatment and control rates remain low, and uncontrolled hypertension is well-known to be one of the most important cardiovascular risk factors. Endovascular catheter-based renal denervation (RDN) has been developed to be a complementary or alternative treatment option for patients who cannot take medication, poor adherence, or have resistant hypertension despite the use of maximal doses of medications. Recently, several randomized trials for evaluating the efficacy and safety of second-generation RDN devices consistently show solid evidence for their blood pressure-lowering efficacy. This review summarizes the current evidence and future perspectives of RDN. Catheter-based renal denervation (RDN) therapy, a new procedure that uses radiofrequency ablation to interrupt efferent and afferent renal sympathetic nerve fibers, is a complementary or alternative treatment to antihypertensive medications for optimal control of blood pressure (BP). Although several single-arm early proof-of-concept studies showed significant BP reduction, the largest sham-controlled study using the first-generation RDN device (SYMPLICITY HTN-3) failed to significantly reduce BP in patients with resistant hypertension who were taking the guideline-based combination of antihypertensive medications. Since then, new devices and techniques have been developed to improve the efficacy and safety of RDN procedures. Sham-controlled trials using second-generation RDN devices (radiofrequency- and ultrasound-based) have provided solid evidence for their BP-lowering efficacy with and without the use of concomitant antihypertensive medication. Moreover, the safety profile of RDN in several registries and clinical trials appears to be excellent. This review summarizes the current evidence for RDN and discusses its current issues, future trials, Asian perspectives, and potential roles in both hypertension and other morbidities.
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Liang B, Liang Y, Li R, Gu N. Effect of renal denervation on long-term outcomes in patients with resistant hypertension. Cardiovasc Diabetol 2021; 20:117. [PMID: 34090434 PMCID: PMC8180124 DOI: 10.1186/s12933-021-01309-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 05/28/2021] [Indexed: 12/13/2022] Open
Abstract
Increasing studies strongly prove that renal denervation, a minimally invasive surgery, is a promising new non-drug treatment method that can effectively control blood pressure in patients with resistant hypertension, but the evaluation of the long-term blood pressure control effect of renal denervation for resistant hypertension is still lacking. Here, we critically review current long-term follow-up data about the use of renal denervation for RH to comprehensively evaluate the effectiveness of renal denervation for RH, and to provide practical guidance for practitioners who are establishing a renal denervation service. Limited by the current research, many problems need to be solved before renal denervation is applied to RH. In addition, ambulatory blood pressure should be the first choice for the evaluation of blood pressure. Finally, the continuous antihypertensive effect of renal denervation in different renal denervation systems also needs to be strictly compared.
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Affiliation(s)
- Bo Liang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Yi Liang
- Southwest Medical University, Luzhou, China
| | - Rui Li
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Ning Gu
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China.
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Kim CJ, Chang K, Kim BK, Park CG, Jang Y. An Open-label, Single-arm, Multicenter Feasibility Study Evaluating the Safety of Catheter-based Renal Denervation with DENEX™ in Patients with Uncontrolled Hypertension on Standard Medical Therapy. Korean Circ J 2021; 51:43-55. [PMID: 33377328 PMCID: PMC7779817 DOI: 10.4070/kcj.2020.0391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background and Objectives DENEX™ is a novel renal sympathetic denervation (RDN) system that is equipped with 3 electrodes that deliver radiofrequency energy to the renal nerves along renal arteries. The purpose of this study was to evaluate the safety and efficacy of RDN with DENEX™ in resistant hypertension. Methods This was an open-label, single-arm, multicenter, first-in-man pilot study. Between November 2016 and May 2018, a total of 16 patients were enrolled at 4 centers in South Korea. The inclusion criteria were systolic blood pressure (SBP) ≥150 mmHg and use of 3 or more antihypertensive medications, including diuretics. The primary objective was the safety outcome of RDN with the DENEX™ system. The secondary objective was efficacy outcome based on changes of office, and 24-hour ambulatory SBP from baseline to 3 months. The patients underwent abdominal computed tomography (CT) or duplex ultrasonogram before and 6 months after RDN. Results No major adverse events occurred after RDN for 6 month of follow-up period. There was no vascular complication either by CT or duplex ultrasonogram. The office SBP was significantly reduced from 164.6±11.6 mmHg at baseline to 142.0±20.4 mmHg (−24.4±24.4 mmHg, p=0.003) at 3 months. The ambulatory SBP was reduced from 151.44±12.85 mmHg at baseline to 140.0±16.5 mmHg (−13.1±18.9 mmHg, p=0.056) at 3 months. Conclusion RDN with the DENEX™ system showed a favorable safety profile in resistant hypertension. A significant reduction in office SBP and a borderline reduction in ambulatory SBP were observed. Trial Registration ClinicalTrials.gov Identifier: NCT04248530
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Affiliation(s)
- Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Kiyuk Chang
- Department of Cardiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Byeong Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Recent trends in renal denervation devices for resistant hypertension treatment. Ir J Med Sci 2020; 190:971-979. [PMID: 33111251 DOI: 10.1007/s11845-020-02421-1] [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: 06/05/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
Hypertension is one of the most important risk factors for cardiovascular disease, which is the leading cause of mortality. The World Health Organization (WHO) estimated that in 2019 more than 1.13 billion people worldwide were suffering from hypertension. In spite of the advances in new medical therapies, control of hypertension remains suboptimal. Renal denervation (RDN) neuromodulation treatment was primarily developed to treat resistant hypertension and is potentially a new method for treating congestive heart failure, diabetes, and chronic renal failure. RDN consists of passing a catheter into the renal arteries and ablating their sympathetic nerves using radiofrequency or ultrasound energy. Despite promising results in initial trials, RDN failed to achieve its efficacy endpoints as a treatment for resistant hypertension, but the recent series of successful trials show that RDN is back as a serious treatment alternative. This paper reviews the current state-of-the-art RDN devices including Symplicity Flex, Symplicity Spyral, Vessix, EnligHTN, Iberis, TIVUS system, and Paradise. The paper also provides an in-depth review of future RDN devices which include Cryo-RDN, Golden Leaf Catheter, Synaptic, SyMapCath, ConfidenHT System, and Grizzly Microwave Ablation system.
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Abstract
PURPOSE OF REVIEW To review the data about the use of renal denervation (RDN), a minimally invasive surgery, for resistant hypertension (RH) and to provide practical guidance for practitioners who are establishing an RDN service. RECENT FINDINGS RDN can selectively ablate renal sympathetic nerve fibres, block the transmission of nerve impulses between central sympathetic nerve and kidney, to control blood pressure to as a novel promising non-drug treatment option for RH. At present, there are many researches on the treatment of RH by RDN, but there are some controversies. This review summarises and critically examines the evidence for RDN in the treatment of RH and identifies areas for future research. With the development of RDN, the continuous innovation of RDN technology and methods, the development about better evaluating the real-time success of RDN and the improvement for identifying individuals who are most likely to benefit from RDN will ultimately determine whether RDN represents a feasible way to manage RH in the future.
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Delgado Silva J, Almeida JS, Rodrigues-Santos P, Santos Rosa M, Gonçalves L. Activated double-negative T cells (CD3 +CD4 -CD8 -HLA-DR +) define response to renal denervation for resistant hypertension. Clin Immunol 2020; 218:108521. [PMID: 32619647 DOI: 10.1016/j.clim.2020.108521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To explore the cellular immune response of patients with resistant hypertension treated with renal denervation (RDN). METHODS AND RESULTS Twenty-three patients were included and blood samples were obtained in six timings, pre and post procedure. Response was evaluated at six-months and one year and was observed in 69.6% and 82.6% of patients, respectively. Absolute values of HLA-DR+ double negative (DN) T cells were significantly lower in the group of 'responders' at one year, and interaction between the timings were found in three T cell subsets (T CD4, T CD8 and naïve T CD8 cells), with the 'responders' tending to present with lower absolute values and little inter-timing variation. CONCLUSIONS 'Responders' significantly present with lower absolute values of activated DN T cells and have lower and more stable values of total T CD8+, CD4+, and naïve T CD8+ cells. These cell types may be able to predict response to RDN.
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Affiliation(s)
- Joana Delgado Silva
- Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal; Department of Cardiology, Coimbra's Hospital and University Centre (CHUC), Coimbra, Portugal.
| | - Jani-Sofia Almeida
- Laboratory of Immunology and Oncology, Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal; Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Paulo Rodrigues-Santos
- Laboratory of Immunology and Oncology, Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal; Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Manuel Santos Rosa
- Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal; Department of Cardiology, Coimbra's Hospital and University Centre (CHUC), Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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20
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Akinseye OA, Ralston WF, Johnson KC, Ketron LL, Womack CR, Ibebuogu UN. Renal Sympathetic Denervation: A Comprehensive Review. Curr Probl Cardiol 2020; 46:100598. [PMID: 32448758 DOI: 10.1016/j.cpcardiol.2020.100598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/06/2020] [Indexed: 12/28/2022]
Abstract
In 2017, the American College of Cardiology and American Heart Association released its updated blood pressure guidelines, redefining hypertension to be any systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg. Among United States adults, these new parameters increased the prevalence of hypertension from 72.2 million (31.9%) to 103.3 million (45.6%) adults and decreased the rate of medication-controlled hypertension from 53.4% to 39% with the prevalence of resistant hypertension ranging from 12% to 18%. Results of the pivotal SPRINT trial showed that more intensive blood pressure control in diabetic patients decreased both cardiovascular events and all-cause mortality. However, even with ideal goals in mind, compliance remains an issue due to multiple causes, and approximately half of study participants had stopped taking their antihypertensive drug within a year. Renal sympathetic denervation is a process in which catheter-based techniques are used to ablate specific portions of the renal artery nerves with the goal of decreasing sympathetic nerve activity and reducing blood pressure. Several studies using renal artery denervation have already shown benefit in patients with resistant hypertension, and now newer trials are beginning to focus on those with stage II hypertension as an additional potential treatment population. This review will seek to summarize the current evidence surrounding renal artery denervation and discuss some of its future trials, current issues, and potential roles both in hypertension and other comorbidities.
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Italian Society of Arterial Hypertension (SIIA) Position Paper on the Role of Renal Denervation in the Management of the Difficult-to-Treat Hypertensive Patient. High Blood Press Cardiovasc Prev 2020; 27:109-117. [DOI: 10.1007/s40292-020-00367-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/02/2020] [Indexed: 12/17/2022] Open
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Stavropoulos K, Patoulias D, Imprialos K, Doumas M, Katsimardou A, Dimitriadis K, Tsioufis C, Papademetriou V. Efficacy and safety of renal denervation for the management of arterial hypertension: A systematic review and meta‐analysis of randomized, sham‐controlled, catheter‐based trials. J Clin Hypertens (Greenwich) 2020; 22:572-584. [DOI: 10.1111/jch.13827] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Konstantinos Stavropoulos
- Veterans Affairs Medical Center Georgetown University District of Columbia Washington
- 2nd Propedeutic Department of Internal Medicine Aristotle University Thessaloniki Greece
| | - Dimitrios Patoulias
- 2nd Propedeutic Department of Internal Medicine Aristotle University Thessaloniki Greece
| | - Konstantinos Imprialos
- Veterans Affairs Medical Center Georgetown University District of Columbia Washington
- 2nd Propedeutic Department of Internal Medicine Aristotle University Thessaloniki Greece
| | - Michael Doumas
- 2nd Propedeutic Department of Internal Medicine Aristotle University Thessaloniki Greece
- Veterans Affairs Medical Center George Washington University District of Columbia Washington
| | - Alexandra Katsimardou
- 2nd Propedeutic Department of Internal Medicine Aristotle University Thessaloniki Greece
| | | | - Costas Tsioufis
- Veterans Affairs Medical Center Georgetown University District of Columbia Washington
- 1st Cardiology Department National and Kapodistrian University of Athens Greece
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Fontes MAP, Marzano LAS, Silva CC, Silva ACSE. Renal sympathetic denervation for resistant hypertension: where do we stand after more than a decade. ACTA ACUST UNITED AC 2020; 42:67-76. [PMID: 31939995 PMCID: PMC7213935 DOI: 10.1590/2175-8239-jbn-2018-0213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 08/18/2019] [Indexed: 01/11/2023]
Abstract
Despite the current availability of safe and efficient drugs for treating hypertension, a substantial number of patients are drug-resistant hypertensives. Aiming this condition, a relatively new approach named catheter-based renal denervation was developed. We have now a clinically relevant time window to review the efficacy of renal denervation for treating this form of hypertension. This short review addresses the physiological contribution of renal sympathetic nerves for blood pressure control and discusses the pros and cons of renal denervation procedure for the treatment of resistant hypertension.
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Affiliation(s)
| | | | - Carina Cunha Silva
- Departamento de Fisiologia e Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Ana Cristina Simões E Silva
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Abstract
Despite availability of effective drugs for hypertension therapy, significant numbers of hypertensive patients fail to achieve recommended blood pressure levels on ≥3 antihypertensive drugs of different classes. These individuals have a high prevalence of adverse cardiovascular events and are defined as having resistant hypertension (RHT) although nonadherence to prescribed antihypertensive medications is common in patients with apparent RHT. Furthermore, apparent and true RHT often display increased sympathetic activity. Based on these findings, technology was developed to treat RHT by suppressing sympathetic activity with electrical stimulation of the carotid baroreflex and catheter-based renal denervation (RDN). Over the last 15 years, experimental and clinical studies have provided better understanding of the physiological mechanisms that account for blood pressure lowering with baroreflex activation and RDN and, in so doing, have provided insight into which patients in this heterogeneous hypertensive population are most likely to respond favorably to these device-based therapies. Experimental studies have also played a role in modifying device technology after early clinical trials failed to meet key endpoints for safety and efficacy. At the same time, these studies have exposed potential differences between baroreflex activation and RDN and common challenges that will likely impact antihypertensive treatment and clinical outcomes in patients with RHT. In this review, we emphasize physiological studies that provide mechanistic insights into blood pressure lowering with baroreflex activation and RDN in the context of progression of clinical studies, which are now at a critical point in determining their fate in RHT management.
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Affiliation(s)
- Thomas E Lohmeier
- From the Department of Physiology and Biophysics (T.E.L., J.E.H.), University of Mississippi Medical Center, Jackson
| | - John E Hall
- From the Department of Physiology and Biophysics (T.E.L., J.E.H.), University of Mississippi Medical Center, Jackson.,Mississippi Center for Obesity Research (J.E.H.), University of Mississippi Medical Center, Jackson
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Renal Artery Denervation in Resistant Hypertension: The Good, The Bad and The Future. Heart Lung Circ 2020; 29:94-101. [DOI: 10.1016/j.hlc.2019.06.723] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/04/2019] [Accepted: 06/24/2019] [Indexed: 02/05/2023]
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Gupta A, Prince M, Bob-Manuel T, Jenkins JS. Renal denervation: Alternative treatment options for hypertension? Prog Cardiovasc Dis 2019; 63:51-57. [PMID: 31884099 DOI: 10.1016/j.pcad.2019.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 12/17/2022]
Abstract
Hypertension affects millions of Americans and has adverse long-term consequences increasing morbidity and mortality. Resistant hypertension (RH) continues to be difficult to treat with medications alone which may be associated with significant side effects. Alternate therapies have been evaluated for treating RH and renal denervation has been investigated extensively. We review the data from renal denervation trials and other novel technologies which are not FDA approved to date.
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Affiliation(s)
- Aashish Gupta
- Department of Cardiology at Ochsner Clinic Foundation, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America.
| | - Marloe Prince
- Department of Cardiology at Ochsner Clinic Foundation, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - Tamunoinemi Bob-Manuel
- Department of Cardiology at Ochsner Clinic Foundation, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - J Stephen Jenkins
- Department of Cardiology at Ochsner Clinic Foundation, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America
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Papademetriou V, Stavropoulos K, Imprialos K, Doumas M, Schmieder RE, Pathak A, Tsioufis C. New data, new studies, new hopes for renal denervation in patients with uncontrolled hypertension. INTERNATIONAL JOURNAL CARDIOLOGY HYPERTENSION 2019; 3:100022. [PMID: 33447752 PMCID: PMC7803019 DOI: 10.1016/j.ijchy.2019.100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/11/2019] [Accepted: 11/07/2019] [Indexed: 11/27/2022]
Abstract
Background following the publication of SYMPLICITY HTN-3 the field of renal of denervation was put on hold. Although SYMPLICITY HTN-3 was well-designed and sham-controlled trial it failed to show any meaningful reduction in office or 24 h ambulatory blood pressure. The procedure was however safe and allowed research to continue. Although several pitfalls of the study have been pointed out, incomplete renal denervation was also implicated. Since then, a great deal of basic and clinical research took place and will be briefly commented on in this article. Methods and results Before and after SYMPLICITY-HTN-3, numerous uncontrolled, single or unblinded studies have shown substantial office BP reduction ranging from -7.7 to -32 mmHg and ambulatory BP ranging from -2.2 to 10.2 mmHg. Average weighted office systolic BP reduction was -20.8 mmHg and weighted average 24 h ambulatory BPM reduction was -7.8 mmHg. National and international registries have shown similar BP reductions, but results remained unconvincing due to lack of reliable sham controls. In recent years, 5 well-designed sham - controlled studies (beyond, SYMPLICITY-HTN-3) have been published. Of those studies two were single center and three were multicenter international studies. Four studies used single tip or multi-electrode, radiofrequency catheters and one used focused ultrasound. The three multicenter studies reported positive-placebo subtracted results and established BP reductions measured both in the office and by ambulatory monitoring. No serious adverse events were reported. Conclusions It can therefore be concluded that the latest sham controlled studies established efficacy and safety of renal denervation.
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Affiliation(s)
| | - Konstantinos Stavropoulos
- Georgetown University and VA Medical Center, Washington DC, USA.,Aristotle University, Thessaloniki, Greece
| | - Kostas Imprialos
- Georgetown University and VA Medical Center, Washington DC, USA.,Aristotle University, Thessaloniki, Greece
| | | | - Roland E Schmieder
- University Hospital Erlangen, Friedrich Alexander University, Erlangen/Nuremberg, Germany
| | - Atul Pathak
- Clinique Pasteur, Hypertension, Risk Factors and Heart Failure Unit, INSERM 1048, Clinical Research Center, Toulouse, France
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Sharp TE, Polhemus DJ, Li Z, Spaletra P, Jenkins JS, Reilly JP, White CJ, Kapusta DR, Lefer DJ, Goodchild TT. Renal Denervation Prevents Heart Failure Progression Via Inhibition of the Renin-Angiotensin System. J Am Coll Cardiol 2019; 72:2609-2621. [PMID: 30466519 DOI: 10.1016/j.jacc.2018.08.2186] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/10/2018] [Accepted: 08/20/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previously, we have shown that radiofrequency (RF) renal denervation (RDN) reduces myocardial infarct size in a rat model of acute myocardial infarction (MI) and improves left ventricular (LV) function and vascular reactivity in the setting of heart failure following MI. OBJECTIVES The authors investigated the therapeutic efficacy of RF-RDN in a clinically relevant normotensive swine model of heart failure with reduced ejection fraction (HFrEF). METHODS Yucatan miniswine underwent 75 min of left anterior descending coronary artery balloon occlusion to induce MI followed by reperfusion (R) for 18 weeks. Cardiac function was assessed pre- and post-MI/R by transthoracic echocardiography and every 3 weeks for 18 weeks. HFrEF was classified by an LV ejection fraction <40%. Animals who met inclusion criteria were randomized to receive bilateral RF-RDN (n = 10) treatment or sham-RDN (n = 11) at 6 weeks post-MI/R using an RF-RDN catheter. RESULTS RF-RDN therapy resulted in significant reductions in renal norepinephrine content and circulating angiotensin I and II. RF-RDN significantly increased circulating B-type natriuretic peptide levels. Following RF-RDN, LV end-systolic volume was significantly reduced when compared with sham-treated animals, leading to a marked and sustained improvement in LV ejection fraction. Furthermore, RF-RDN improved LV longitudinal strain. Simultaneously, RF-RDN reduced LV fibrosis and improved coronary artery responses to vasodilators. CONCLUSIONS RF-RDN provides a novel therapeutic strategy to reduce renal sympathetic activity, inhibit the renin-angiotensin system, increase circulating B-type natriuretic peptide levels, attenuate LV fibrosis, and improve left ventricular performance and coronary vascular function. These cardioprotective mechanisms synergize to halt the progression of HFrEF following MI/R in a clinically relevant model system.
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Affiliation(s)
- Thomas E Sharp
- Cardiovascular Research Center, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - David J Polhemus
- Cardiovascular Research Center, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana; Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Zhen Li
- Cardiovascular Research Center, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana; Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Pablo Spaletra
- Cardiovascular Research Center, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - J Stephen Jenkins
- Department of Cardiology, Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana
| | - John P Reilly
- Department of Cardiology, Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana
| | - Christopher J White
- Department of Cardiology, Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana
| | - Daniel R Kapusta
- Cardiovascular Research Center, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana; Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - David J Lefer
- Cardiovascular Research Center, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana; Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana.
| | - Traci T Goodchild
- Cardiovascular Research Center, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana; Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana
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Carnagarin R, Lambert GW, Kiuchi MG, Nolde JM, Matthews VB, Eikelis N, Lambert EA, Schlaich MP. Effects of sympathetic modulation in metabolic disease. Ann N Y Acad Sci 2019; 1454:80-89. [DOI: 10.1111/nyas.14217] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 07/07/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine – Royal Perth Hospital Unit/Medical Research FoundationUniversity of Western Australia Perth Western Australia Australia
| | - Gavin W. Lambert
- Iverson Health Innovation Research InstituteSwinburne University of Technology Hawthorn Victoria Australia
- School of Health SciencesSwinburne University of Technology Hawthorn Victoria Australia
| | - Marcio G. Kiuchi
- Dobney Hypertension Centre, School of Medicine – Royal Perth Hospital Unit/Medical Research FoundationUniversity of Western Australia Perth Western Australia Australia
| | - Janis M. Nolde
- Dobney Hypertension Centre, School of Medicine – Royal Perth Hospital Unit/Medical Research FoundationUniversity of Western Australia Perth Western Australia Australia
| | - Vance B. Matthews
- Dobney Hypertension Centre, School of Medicine – Royal Perth Hospital Unit/Medical Research FoundationUniversity of Western Australia Perth Western Australia Australia
| | - Nina Eikelis
- Iverson Health Innovation Research InstituteSwinburne University of Technology Hawthorn Victoria Australia
- School of Health SciencesSwinburne University of Technology Hawthorn Victoria Australia
| | - Elisabeth A. Lambert
- Iverson Health Innovation Research InstituteSwinburne University of Technology Hawthorn Victoria Australia
- School of Health SciencesSwinburne University of Technology Hawthorn Victoria Australia
| | - Markus P. Schlaich
- Dobney Hypertension Centre, School of Medicine – Royal Perth Hospital Unit/Medical Research FoundationUniversity of Western Australia Perth Western Australia Australia
- Departments of Cardiology and NephrologyRoyal Perth Hospital Perth Western Australia Australia
- Neurovascular Hypertension and Kidney Disease LaboratoryBaker Heart and Diabetes Institute Melbourne Victoria Australia
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Lurz P, Fengler K. Lessons Learned from RADIOSOUND-HTN: Different Technologies and Techniques for Catheter-based Renal Denervation and Their Effect on Blood Pressure. Interv Cardiol 2019; 14:102-106. [PMID: 31178937 PMCID: PMC6545992 DOI: 10.15420/icr.2019.03.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/23/2019] [Indexed: 12/18/2022] Open
Abstract
The interest in renal denervation (RDN) as a treatment for arterial hypertension has returned with three proof of principle trials that have shown recently RDN to be superior to sham treatment. Nevertheless, many questions about this treatment remain open, including those around the optimal interventional technique and technology. To clarify this important question, the authors designed and conducted the Randomized Trial of Different Renal Denervation Devices and Techniques in Patients with Resistant Hypertension (RADIOSOUND-HTN) trial, which compared three RDN treatment arms in a prospective randomised clinical trial. In this article, they comment on the background and results of this trial, and discuss which conclusions can be drawn from the trial, and which questions remain open for future studies in this field.
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Affiliation(s)
- Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig Leipzig, Germany
| | - Karl Fengler
- Department of Cardiology, Heart Center Leipzig, University of Leipzig Leipzig, Germany
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Weber MA, Mahfoud F, Schmieder RE, Kandzari DE, Tsioufis KP, Townsend RR, Kario K, Böhm M, Sharp AS, Davies JE, Osborn JW, Fink GD, Euler DE, Cohen DL, Schlaich MP, Esler MD. Renal Denervation for Treating Hypertension. JACC Cardiovasc Interv 2019; 12:1095-1105. [DOI: 10.1016/j.jcin.2019.02.050] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/22/2019] [Accepted: 02/26/2019] [Indexed: 12/14/2022]
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Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, Egan BM, Flack JM, Gidding SS, Judd E, Lackland DT, Laffer CL, Newton-Cheh C, Smith SM, Taler SJ, Textor SC, Turan TN, White WB. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension 2019; 72:e53-e90. [PMID: 30354828 DOI: 10.1161/hyp.0000000000000084] [Citation(s) in RCA: 540] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the "white-coat effect" (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.
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Su E, Zhao L, Gao C, Zhao W, Wang X, Qi D, Zhu L, Yang X, Zhu B, Liu Y. Acute changes in morphology and renal vascular relaxation function after renal denervation using temperature-controlled radiofrequency catheter. BMC Cardiovasc Disord 2019; 19:67. [PMID: 30902047 PMCID: PMC6431051 DOI: 10.1186/s12872-019-1053-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Resistant hypertension and renal sympathetic hyperactivity are closely linked, and catheter-based renal denervation (RDN) is regarded as a new treatment strategy. However, the acute changes in vascular morphology and relaxation function have yet to be evaluated, and these may be important for the efficacy and safety of the procedure. In this study, we explored these questions by conventional temperature-controlled cardiac radiofrequency catheter-based RDN in a pig model. METHODS Six mini-pigs were randomly divided into the renal denervation (RDN) group (n = 3) and the Sham-RDN group (n = 3). Animals in the RDN group underwent unilateral radiofrequency ablation, and those in the Sham-RDN group underwent the same procedure except for the ablation. The pigs were examined by angiography pre- and post-RDN and were euthanized immediately thereafter. Renal arteries were processed for histological and molecular biology analyses as well as for in vitro vascular tension testing. RESULTS Compared with the Sham-RDN group, the RDN caused vascular intima and media injury, renal nerve vacuolization, mild collagen fiber hyperplasia and elastic fiber cleavage (all p < 0.05). The RDN group also significantly exhibited nitric oxide synthase pathway inhibition and decreased endothelium-independent vascular relaxation function Compared to the Sham-RDN group (all p < 0.05). CONCLUSIONS In this porcine model, renal artery denervation led to vascular wall injury and endothelial dysfunction in the acute phase, which negatively affected vascular relaxation function. Thus, this process may be detrimental to the prognosis and progress of hypertension patients.
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Affiliation(s)
- Enyong Su
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
| | - Linwei Zhao
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
| | - Chuanyu Gao
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China.
| | - Wen Zhao
- Zhengzhou University School of Pharmaceutical Sciences, Zhengzhou, 450003, Henan, China
| | - Xianpei Wang
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
| | - Datun Qi
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
| | - Lijie Zhu
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
| | - Xiaohang Yang
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
| | - Binbin Zhu
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
| | - Yahui Liu
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
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Wilson AL, Gandhi J, Suh Y, Joshi G, Smith NL, Khan SA. Renal Innervation in Resistant Hypertension: A Review of Pathophysiology and Renal Denervation as Potential Treatment. Curr Hypertens Rev 2019; 16:115-127. [PMID: 30827252 PMCID: PMC7527543 DOI: 10.2174/1573402115666190301154100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 12/30/2022]
Abstract
Background Advances in treatment and increased awareness have improved the prognosis for many patients with hypertension (HTN). Resistant hypertension (RH) refers to a subset of hypertensive individuals who fail to achieve a desired blood pressure (BP) despite concurrent use of 3 different classes antihypertensive agents, one being a diuretic, and proper lifestyle changes. The prevalence and prognosis of RH are unclear owing to its heterogeneous etiologies, risk factors, and secondary comorbidities. Previous research has provided evidence that increased renal sympathetic nerve activity (RSNA) within the renal artery contributes to RH development. Renal denervation (RDN) is a procedure that attempts to ameliorate the effects of heightened RSNA via ablation renal sympathetic fibers. BP reductions associated with RDN may be attributed to decreased norepinephrine spillover, restoration of natriuresis, increasing renal blood flow, and lowering plasma renin activity. Early clinical trials perpetuated positive results, and enthusiasm grew exponentially. However, recent clinical trials have called into question RDN's efficacy. Numerous limitations must be addressed to discern the true effectiveness of RDN as a therapeutic option for RH. Objective We aimed to review the current understanding of RH, the anatomy of renal arteries, physiology of RH on renal arteries, anatomical pathways of the sympathetic involved in RH, RDN as a treatment option, and all relevant clinical trials treating RH with RDN. Methods We piloted a MEDLINE® database search of literature extending from 1980 to 2017, with emphasis on the previous five years, combining keywords such as “resistant hypertension” and
“renal denervation.” Conclusion A plethora of information is available regarding heightened RSNA leading to RH. RDN as a possible treatment option has shown a range of results. Reconciling RDN's true efficacy requires future trials to increased sites of nerve ablation, standardized protocol, increased anatomical understanding per individual basis, stricter guidelines regarding study design, increased operator experience, and integrating the use of a multielectrode catheter.
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Affiliation(s)
- Anthony L Wilson
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, United States
| | - Jason Gandhi
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, United States
| | - Yiji Suh
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, United States
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, NY 11968, United States
| | - Noel L Smith
- Foley Plaza Medical, New York, NY 10007, United States
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, United States
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Renal Artery Denervation for Hypertension. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:7. [PMID: 30762119 DOI: 10.1007/s11936-019-0715-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW Hypertension (HTN) has a growing impact, already affecting over 1 billion people. An estimated 2-16% of those with HTN have resistant HTN. The sympathetic nervous system (SNS) is a recognized contributor to the pathophysiology of resistant HTN. Current hypertensive pharmacotherapy has not fully targeted the SNS; therefore, the SNS has become a prominent research therapeutic target. This review summarizes the evidence and rationale behind renal denervation (RDN) therapy and the technology available. RECENT FINDINGS Prior to the SYMPLICITY HTN-3 clinical trial, trials found RDN to be an effective procedure to control resistant hypertension. The failure of SYMPLICITY HTN-3 to meet its primary efficacy endpoint sparked further studies to address potential shortcomings. The subsequent SPYRAL program trials demonstrated efficacy of RDN therapy in a controlled manner; however, they were not adequately powered. Ongoing research is examining new, innovative RDN technology as well as defining appropriate patients to target for treatment. The data currently available for RDN in HTN and other states of SNS activation suffer from potential biases and limitations, highlighting the need for continued exploration. Contemporary studies are more promising and hypothesis-generating. Future trials and continued device innovation will be crucial for understanding the clinical applications of RDN therapy.
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Al Raisi SI, Pouliopoulos J, Qian P, King P, Byth K, Barry MT, Swinnen J, Thiagalingam A, Kovoor P. Comparison of two different radiofrequency ablation systems for renal artery denervation: Evaluation of short-term and long-term follow up. Catheter Cardiovasc Interv 2018; 93:E105-E111. [PMID: 30549404 PMCID: PMC6590350 DOI: 10.1002/ccd.28038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 11/06/2018] [Accepted: 12/02/2018] [Indexed: 12/05/2022]
Abstract
Objectives To assess the clinical efficacy of renal artery denervation (RAD) in our center and to compare the efficacy of two different radiofrequency (RF) systems. Background Several systems are available for RF renal denervation. Whether there is a difference in clinical efficacy among various systems remains unknown. Methods Renal artery denervation was performed on 43 patients with resistant hypertension using either the single electrode Symplicity Flex (n = 20) or the multi‐electrode EnligHTN system (n = 23). Median post‐procedural follow‐up was 32.93 months. The primary outcome was post‐procedural change in office blood pressure (BP) within 1 year (short‐term follow‐up). Secondary outcomes were change in office BP between 1 and 4 years (long‐term follow‐up) and the difference in office BP reduction between the two systems at each follow‐up period. Results For the total cohort, mean baseline office BP (systolic/diastolic) was 174/94 mmHg. At follow‐up, mean changes in office BP from baseline were −19.70/−11.86 mmHg (P < 0.001) and −21.90/−13.94 mmHg (P < 0.001) for short‐term and long‐term follow‐up, respectively. The differences in office BP reduction between Symplicity and EnligHTN groups were 8.96/1.23 mmHg (P = 0.42 for systolic BP, P = 0.83 for diastolic BP) and 9.56/7.68 mmHg (P = 0.14 for systolic BP, P = 0.07 for diastolic BP) for short‐term and long‐term follow‐up, respectively. Conclusions In our cohort, there was a clinically significant office BP reduction after RAD, which persisted up to 4 years. No significant difference in office BP reduction between the two systems was found.
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Affiliation(s)
- Sara I Al Raisi
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jim Pouliopoulos
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Pierre Qian
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Patricia King
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Karen Byth
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Research and Educational Network, Westmead Hospital, Sydney, New South Wales, Australia
| | - Michael T Barry
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - John Swinnen
- Department of Vascular Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Aravinda Thiagalingam
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Atrial fibrillation reduction by renal sympathetic denervation: 12 months' results of the AFFORD study. Clin Res Cardiol 2018; 108:634-642. [PMID: 30413869 PMCID: PMC6529371 DOI: 10.1007/s00392-018-1391-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/05/2018] [Indexed: 12/14/2022]
Abstract
Aim The purpose of this pilot study was to assess whether renal sympathetic denervation (RDN) decreases atrial fibrillation (AF) burden in hypertensive patients with symptomatic AF at 6- and 12-month follow-up, as measured using an implantable cardiac monitor (ICM). Methods and results A total of 20 patients with symptomatic paroxysmal or persistent AF (EHRA ≥ II) and primary hypertension with a mean office systolic blood pressure (BP) of > 140 mmHg were enrolled. After enrolment, an ICM was implanted 3 months pre-RDN to monitor AF burden. Quality of life (QOL) was assessed using the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. Mean age was 64 ± 7 years and 55% were females. AF burden in min/day decreased from a median (IQR) of 1.39 (0–11) pre-RDN to 0.67 (0–31.6) at 6 months (p = 0.64) and to 0.94 (0–6.0) at 12 months (pre-RDN vs. 12 months; p = 0.03). QOL improved significantly at both 6 months (+ 11 ± 15 points, p = 0.006) and 12 months (+ 10 ± 19, p = 0.04) as compared to pre-RDN. Office BP decreased significantly at 12-month follow-up (− 20 ± 19/− 7 ± 10 mmHg), p < 0.01) as compared to pre-RDN. Ambulatory BP decreased − 7 ± 16/− 3 ± 9 mmHg (p > 0.05) at 12-month follow-up as compared to pre-RDN. Conclusion This pilot study suggests that RDN might be able to decrease AF burden in min/day as measured using an ICM, with a positive effect on QOL. Large-scale randomized trials are needed to prove the definite value of RDN in hypertensive patients with atrial fibrillation. Electronic supplementary material The online version of this article (10.1007/s00392-018-1391-3) contains supplementary material, which is available to authorized users.
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Kataoka Y, Delacroix S, Sidharta S, Andrews J, Nicholls SJ, Tsioufis CP, Papademetriou V, Worthley SG. Serial changes in vessel walls of renal arteries after catheter-based renal artery denervation: insights from volumetric computed tomography analysis. Int J Nephrol Renovasc Dis 2018; 11:259-266. [PMID: 30310302 PMCID: PMC6166743 DOI: 10.2147/ijnrd.s161313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim Radiofrequency ablation of peri-arterial renal autonomic nerves has been studied as a potential therapeutic option for resistant hypertension. While recent clinical trials have reported its efficacy, there is paucity of data addressing the effects of the procedure on renal arteries, such as changes in vessel and lumen areas. Herein, the effect of atheroma burden on renal arteries after renal denervation was assessed using computed tomography (CT) imaging. Materials and methods Serial renal artery CT imaging was conducted in 38 patients from the EnligHTN™ I study, a prospective, multicenter study evaluating the efficacy of the EnligHTN multi-electrode radiofrequency ablation catheter in resistant hypertensive subjects. Cross-sectional images of renal arteries at 1 mm intervals were acquired using commercially available software (3mensio Structural Heart version 5.1). Vessel and lumen areas were manually traced in each image. Vessel wall volume (VWV) and percent vessel wall volume (P-VWV) were calculated. The measurements within the ablation (first 30 mm segments) and the non-ablation (subsequent 30 mm segment after the first bifurcation of renal arteries) zones were compared. Results On serial evaluation, greater increase in P-VWV and VWV was observed in the ablation zone (change in P-VWV, 6.7%±5.1% vs 3.6%±2.8%, P=0.001; change in VWV, 106.3±87.4 vs 23.0±18.2 mm3, P=0.001). Receiver-operating characteristic analysis demonstrated baseline P-VWV in the ablation zone >37.1% as an optimal cutoff value to predict its substantial progression after the procedure (area under the curve=0.88, sensitivity 89.8%, specificity 79.1%). Conclusion Change in vessel wall was greater within the segments receiving renal artery denervation. Baseline VWV predicted its substantial increase after the procedure. These observations suggest that atheroma burden within the renal arteries is a potential contributing factor to vascular changes after renal sympathetic denervation.
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Affiliation(s)
- Yu Kataoka
- Vascular Research Center, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Sinny Delacroix
- Department of Medicine, Cardiovascular Research Center, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia,
| | - Samuel Sidharta
- Department of Medicine, Cardiovascular Research Center, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia,
| | - Jordan Andrews
- Vascular Research Center, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Stephen J Nicholls
- Vascular Research Center, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Costas P Tsioufis
- 1st Department of Cardiology, University of Athens, Hippokration Hospital, Athens, Greece
| | - Vasilios Papademetriou
- Center for hypertension, kidney and vascular research, VA and Georgetown University Medical Centers, Washington DC, USA
| | - Stephen G Worthley
- Department of Medicine, Cardiovascular Research Center, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia,
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First-in-Man Experience with a Novel Catheter-Based Renal Denervation System of Ultrasonic Ablation in Patients with Resistant Hypertension. J Vasc Interv Radiol 2018; 29:1158-1166. [DOI: 10.1016/j.jvir.2018.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 11/21/2022] Open
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Intravascular imaging, histopathological analysis, and catecholamine quantification following catheter-based renal denervation in a swine model: the impact of prebifurcation energy delivery. Hypertens Res 2018; 41:708-717. [PMID: 30006641 DOI: 10.1038/s41440-018-0072-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/26/2018] [Accepted: 02/02/2018] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to evaluate the impact of prebifurcation renal denervation in a swine model and assess its safety through optical coherence tomography (OCT). Prebifurcation renal denervation with a multi-electrode catheter was performed in one renal artery of 12 healthy pigs, with the contralateral artery and kidney being used as controls. Angiograms and OCT pullbacks were obtained peri-procedurally and 1 month post procedure. Renal tissue catecholamines were quantified, and the arterial wall and peri-adventitial tissue were analyzed histologically. Intraluminal changes (endothelial swelling, spasm, and thrombus formation) were observed acutely by OCT in most of the treated arteries and were no longer visible at follow-up. Histology revealed a statistically significant accumulation of collagen (fibrosis) and a near absence of tyrosine hydroxylase labeling in the denervated artery, suggesting a clear reduction in nervous terminals. Renal tissue catecholamine levels were similar between both sides, probably due to the low number of ablation points and the renorenal reflex. The present study demonstrates that renal denervation is associated with acute intimal disruptions, areas of fibrosis, and a reduction in nervous terminals. The lack of difference in renal tissue catecholamine levels is indicative of the need to perform the highest and safest number of ablation points in both renal arteries. These findings are important because they demonstrate the histological consequences of radiofrequency energy application and its medium-term safety.
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Dai X, Hua L, Chen Y, Wang J, Li J, Wu F, Zhang Y, Su J, Wu Z, Liang C. Mechanisms in hypertension and target organ damage: Is the role of the thymus key? (Review). Int J Mol Med 2018; 42:3-12. [PMID: 29620247 PMCID: PMC5979885 DOI: 10.3892/ijmm.2018.3605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 03/27/2018] [Indexed: 12/23/2022] Open
Abstract
A variety of cells and cytokines have been shown to be involved in the whole process of hypertension. Data from experimental and clinical studies on hypertension have confirmed the key roles of immune cells and inflammation in the process. Dysfunction of the thymus, which modulates the development and maturation of lymphocytes, has been shown to be associated with the severity of hypertension. Furthermore, gradual atrophy, functional decline or loss of the thymus has been revealed to be associated with aging. The restoration or enhancement of thymus function via upregulation in the expression of thymus transcription factors forkhead box N1 or thymus transplantation may provide an option to halt or reverse the pathological process of hypertension. Therefore, the thymus may be key in hypertension and associated target organ damage, and may provide a novel treatment strategy for the clinical management of patients with hypertension in addition to different commercial drugs. The purpose of this review is to summarize and discuss the advances in our understanding of the impact of thymus function on hypertension from data from animal and human studies, and the potential mechanisms.
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Affiliation(s)
| | | | | | - Jiamei Wang
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
| | - Jingyi Li
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
| | - Feng Wu
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
| | - Yanda Zhang
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
| | - Jiyuan Su
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
| | - Zonggui Wu
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
| | - Chun Liang
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
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Tsioufis C, Dimitriadis K, Tsioufis P, Patras R, Papadoliopoulou M, Petropoulou Z, Konstantinidis D, Tousoulis D. ConfidenHT™ System for Diagnostic Mapping of Renal Nerves. Curr Hypertens Rep 2018; 20:49. [DOI: 10.1007/s11906-018-0847-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Delacroix S, Chokka RG, Nelson AJ, Wong DT, Pederson S, Nimmo J, Rajwani A, Williams K, Teo KS, Worthley SG. Effects of renal sympathetic denervation on myocardial structure, function and perfusion: A serial CMR study. Atherosclerosis 2018; 272:207-215. [DOI: 10.1016/j.atherosclerosis.2018.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 03/05/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022]
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Morganti A, Mancia G. Resistant hypertension: Renal denervation or intensified medical treatment? Eur J Intern Med 2018; 50:6-11. [PMID: 29287767 DOI: 10.1016/j.ejim.2017.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 12/27/2022]
Abstract
Resistant hypertension (RH) can be diagnosed if blood pressure (BP) is not controlled with the combination of three antihypertensive drugs, including a diuretic, all at effective doses. Patients affected by this condition exhibit a marked increase in the risk of cardiovascular and renal morbid and fatal events. They also exhibit an increased activity of the sympathetic nervous system which is likely to importantly contribute at the renal and other vascular levels to the hypertensive state. Almost 10years ago renal denervation (RDN) by radiofrequency thermal energy delivery to the walls of the renal arteries was proposed for the treatment of RH. Several uncontrolled studies initially reported that this procedure substantially reduced the elevated BP values but this conclusion has not been supported by a recent randomized control trial, which has almost marginalized this therapeutic approach. A revival, however, is under way because of recent positive findings and technical improvement that hold promise to make renal denervation more complete. The antihypertensive efficacy and overall validity of RDN will have to be tested against drug treatment of RH. Several studies indicate that an excess of aldosterone production contributes to RH and recent evidence documents indisputably that anti-aldosterone agents such as spironolactone can effectively control BP in many RH patients, although with some side effects that require close patients' monitoring. At present, it is advisable to treat RH with the addition of an anti-aldosterone agent. If BP control is not achieved or serious side effects become manifest RDN may then be considered.
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Affiliation(s)
- Alberto Morganti
- Centro Fisiologia Clinica e Ipertensione, Ospedale Policlinico, Università Milano, Milan, Italy
| | - Giuseppe Mancia
- Università degli Studi di Milano-Bicocca, Milano, Italy; Policlinico di Monza, Istituto di Ricovero e Cura ad Alta Specializzazione, Monza, Italy.
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Banek CT, Gauthier MM, Baumann DC, Van Helden D, Asirvatham-Jeyaraj N, Panoskaltsis-Mortari A, Fink GD, Osborn JW. Targeted afferent renal denervation reduces arterial pressure but not renal inflammation in established DOCA-salt hypertension in the rat. Am J Physiol Regul Integr Comp Physiol 2018. [PMID: 29513561 DOI: 10.1152/ajpregu.00416.2017] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent preclinical studies show renal denervation (RDNx) may be an effective treatment for hypertension; however, the mechanism remains unknown. We have recently reported total RDNx (TRDNx) and afferent-selective RDNx (ARDNx) similarly attenuated the development of deoxycorticosterone acetate (DOCA)-salt hypertension. Whereas TRDNx abolished renal inflammation, ARDNx had a minimal effect despite an identical antihypertensive effect. Although this study established that ARDNx attenuates the development of DOCA-salt hypertension, it is unknown whether this mechanism remains operative once hypertension is established. The current study tested the hypothesis that TRDNx and ARDNx would similarly decrease mean arterial pressure (MAP) in the DOCA-salt hypertensive rat, and only TRDNx would mitigate renal inflammation. After 21 days of DOCA-salt treatment, male Sprague-Dawley rats underwent TRDNx ( n = 16), ARDNx ( n = 16), or Sham ( n = 14) treatment and were monitored for 14 days. Compared with baseline, TRDNx and ARDNx decreased MAP similarly (TRDNx -14 ± 4 and ARDNx -15 ± 6 mmHg). After analysis of diurnal rhythm, rhythm-adjusted mean and amplitude of night/day cycle were also reduced in TRDNx and ARDNx groups compared with Sham. Notably, no change in renal inflammation, injury, or function was detected with either treatment. We conclude from these findings that: 1) RDNx mitigates established DOCA-salt hypertension; 2) the MAP responses to RDNx are primarily mediated by ablation of afferent renal nerves; and 3) renal nerves do not contribute to the maintenance of renal inflammation in DOCA-salt hypertension.
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Affiliation(s)
- Christopher T Banek
- Department of Integrative Biology and Physiology, University of Minnesota , Minneapolis, Minnesota
| | - Madeline M Gauthier
- Department of Integrative Biology and Physiology, University of Minnesota , Minneapolis, Minnesota
| | - Daniel C Baumann
- Department of Integrative Biology and Physiology, University of Minnesota , Minneapolis, Minnesota
| | - Dusty Van Helden
- Department of Integrative Biology and Physiology, University of Minnesota , Minneapolis, Minnesota
| | | | | | - Gregory D Fink
- Department of Pharmacology and Toxicology, Michigan State University , East Lansing, Michigan
| | - John W Osborn
- Department of Integrative Biology and Physiology, University of Minnesota , Minneapolis, Minnesota
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Weir MA, Herzog CA. Beta blockers in patients with end-stage renal disease-Evidence-based recommendations. Semin Dial 2018; 31:219-225. [PMID: 29482260 DOI: 10.1111/sdi.12691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For patients who require hemodialysis, beta blockers offer a simultaneous opportunity and challenge in the treatment of cardiovascular disease. Beta blockers are well supported by data from nondialysis populations and directly mitigate the sympathetic overactivity that links chronic kidney disease with cardiovascular sequelae. However, the evidence supporting their use in patients receiving hemodialysis is sparse and the heterogeneity of the beta blocker class makes it difficult to prescribe these medications with confidence. Despite these limitations, both trial and observational data exist that can help guide the use of these medications. In this review, we outline the reasons to consider beta blockers for patients receiving hemodialysis, discuss the barriers to their use, and provide specific evidence-based recommendations for beta blocker use in patients with heart failure, hypertension, ischemic heart disease and arrhythmia.
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Affiliation(s)
- Matthew A Weir
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA.,Division of Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
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Barber-Chamoux N, Esler MD. Predictive factors for successful renal denervation: should we use them in clinical trials? Eur J Clin Invest 2017; 47:860-867. [PMID: 28771706 DOI: 10.1111/eci.12792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/29/2017] [Indexed: 01/01/2023]
Abstract
Renal denervation (RDN) is facing various challenges to its initial claimed value in hypertension treatment. Major concerns are the choice of the patients and the technical efficacy of the RDN. Different factors have been described as predicting the capacity of RDN to decrease blood pressure. These factors are related to the patients, the procedure and the tools to confirm successful neural ablation. Their use in future trials should help to improve RDN trials understanding and outcomes. This review summarizes the different predictive factors available and their potential benefits in patient selection and in procedure guidance.
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Affiliation(s)
- Nicolas Barber-Chamoux
- Cardiology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.,Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia
| | - Murray D Esler
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia.,Heart Centre, Alfred Hospital, Melbourne, Vic., Australia
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Tsioufis C, Dimitriadis K, Papademetriou V, Tousoulis D. SPYRAL HTN-OFF MED study: Renal denervation in the spiral orbits of current results and future studies. Hellenic J Cardiol 2017; 58:320-321. [PMID: 29056558 DOI: 10.1016/j.hjc.2017.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/26/2017] [Indexed: 01/24/2023] Open
Affiliation(s)
- Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
| | - Kyriakos Dimitriadis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | | | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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Liu Z, Shen L, Huang W, Zhao X, Fang W, Wang C, Yin Z, Wang J, Fu G, Liu X, Jiang J, Zhang Z, Li J, Lu Y, Ge J. Efficacy and safety of renal denervation for Chinese patients with resistant hypertension using a microirrigated catheter: study design and protocol for a prospective multicentre randomised controlled trial. BMJ Open 2017; 7:e015672. [PMID: 28864691 PMCID: PMC5588951 DOI: 10.1136/bmjopen-2016-015672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Available data show that approximately 8%-18% of patients with primary hypertension will develop resistant hypertension. In recent years, catheter-based renal denervation (RDN) has emerged as a potential treatment option for resistant hypertension. A number of observational studies and randomised controlled trials among non-Chinese patients have demonstrated its potential safety and efficacy. METHODS AND ANALYSIS This is a multicentre, randomised, open-label, parallel-group, active controlled trial that will investigate the efficacy and safety of a 5F saline-irrigated radiofrequency ablation (RFA) used for RDN in the treatment of Chinese patients with resistant hypertension. A total of 254 patients who have failed pharmacological therapy will be enrolled. Eligible subjects will be randomised in a 1:1 ratio to undergo RDN using the RFA plus antihypertensive medication or to receive treatment with antihypertensive medication alone. The primary outcome measure is the change in 24 hours average ambulatory systolic blood pressure from baseline to 3 months, comparing the RDN-plus-medication group with the medication-alone group. Important secondary endpoints include the change in office blood pressure from baseline to 6 months after randomisation. Safety endpoints such as changes in renal function will also be evaluated. The full analysis set, according to the intent-to-treat principle, will be established as the primary analysis population. ETHICS AND DISSEMINATION All participants will provide informed consent; the study protocol has been approved by the Independent Ethics Committee for each site. This study is designed to investigate the efficacy and safety of RDN using a 5F saline microirrigated RFA. Findings will be shared with participating hospitals, policymakers and the academic community to promote the clinical management of resistant hypertension in China. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02900729; pre-results.
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Affiliation(s)
- Zongjun Liu
- Department of Cardiology, Putuo Hospital affiliated to Shanghai Traditional Chinese Medicine University, Shanghai, China
| | - Li Shen
- Department of Cardiology, Zhongshan Hospital affiliated to Fu Dan University, Shanghai, China
| | - Weijian Huang
- Department of Cardiology, The First Hospital affiliated to Wenzhou Medical College, Wenzhou, China
| | - Xianxian Zhao
- Department of Cardiology, Changhai Hospital affiliated to Second Military Medical University, Shanghai, China
| | - Weiyi Fang
- Department of Cardiology, Shanghai Chest Hospital affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Changqian Wang
- Department of Cardiology, Shanghai Ninth People’s Hospital affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Zhaofang Yin
- Department of Cardiology, Shanghai Ninth People’s Hospital affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Jianan Wang
- Department of Cardiology, The Second Hospital affiliated to Zhejiang University, Hangzhou, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital affiliated to Zhejiang University, Hangzhou, China
| | - Xuebo Liu
- Department of Cardiology, Tongji Hospital affiliated to Tongji University, Shanghai, China
| | - Jianjun Jiang
- Department of Cardiology, Taizhou Hospital, Taizhou, China
| | - Zhihui Zhang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, China
| | - Jingbo Li
- Department of Cardiology, Shanghai Sixth People’s Hospital affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Yingmin Lu
- Department of Cardiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine Chongming Branch, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital affiliated to Fu Dan University, Shanghai, China
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