Blood pressure changes after renal denervation at 10 European expert centers

Persu, Alexandre; Jin, Yu; Azizi, Michel; Baelen, Marie; Völz, Sebastian; Elvan, Arif; Severino, Francesca; Rosa, Ján; Adiyaman, Ahmet; Elmula, F.E. Fadl; Taylor, Alison; Péchère-Bertschi, Antoinette; Wuerzner, Grégoire; Jokhaji, Fadi; Kahan, Thomas; Renkin, Jean; Monge, Matthieu; Widimský, Petr; Jacobs, Lotte; Burnier, Michel; Mark, Patrick B.; Kjeldsen, Sverre E.; Andersson, Bert; Sapoval, Marc; Staessen, Jan A.

doi:10.1038/jhh.2013.88

Cited by 142 publications

(134 citation statements)

References 41 publications

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“…Data from a recent meta-analysis provide additional information on high variability in individual response to RSD. 34 This further confirms the need for expanded preinterventional screening. Thus, RSD should remain an interventional treatment option in wellselected patients with real resistant hypertension that is unresponsive to medical treatment.…”

Section: Discussionsupporting

confidence: 48%

Soluble fms-Like Tyrosine Kinase-1 and Endothelial Adhesion Molecules (Intercellular Cell Adhesion Molecule-1 and Vascular Cell Adhesion Molecule-1) as Predictive Markers for Blood Pressure Reduction After Renal Sympathetic Denervation

et al. 2014

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A rterial hypertension (HT) represents a major risk factor for cardiovascular morbidity and mortality.1 HT is associated with endothelial dysfunction that aggravates progressive vascular damage and atherosclerosis.2-4 Endothelial dysfunction can be indicated by elevated serum concentrations of endothelial adhesion molecules, including intercellular cell adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1). 5,6 These adhesion molecules play important roles in accelerating atherosclerosis by attaching inflammatory cells to the vascular endothelial wall and promoting their subsequent migration through the endothelium.The vascular endothelial growth factor and its soluble receptor fms-like tyrosine kinase-1 (sFLT-1) are also associated with endothelial dysfunction, vascular remodeling, and endothelial repair and regeneration mechanisms.7-11 Hypoxia and endothelial shear stress in HT are known to be major stimuli for sFLT-1 expression and release.12-16 Furthermore, sFLT-1 is stimulated by the vascular sympathetic nervous system and has been reported to be elevated in patients with HT. The persistence of hypertensive blood pressure (BP) in patients with resistant hypertension is partially regulated by the renal sympathetic nerve system. 17-21 Renal sympathetic denervation (RSD) is an interventional treatment option for patients who have resistant hypertension, despite optimal medical treatment. 22,23 However, RSD is not effective in ≈8% to 12% of treated patients. 22,23 Predictive parameters regarding the response or nonresponse to RSD have not yet been described.We postulated a relationship among successful RSD-related BP reduction, endothelial dysfunction, and activated endothelial cells as indicated by ICAM-1, VCAM-1, and sFLT-1, specific markers for endothelial cell activity and hypertension-related endothelial sheer stress. Therefore, the primary aim of the present study was to examine the predictive value of sFlt-1, ICAM-1, and See Editorial Commentary, pp 907-908Abstract-Renal sympathetic denervation (RSD) is a treatment option for patients with resistant arterial hypertension, but in some patients it is not successful. Predictive parameters on the success of RSD remain unknown. The angiogenic factors soluble fms-like tyrosine kinase-1 (sFLT-1), intercellular cell adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) are known to be associated with endothelial dysfunction, vascular remodeling, and hypertension. We evaluated whether sFLT-1, ICAM-1, and VCAM-1 are predictive markers for blood pressure reduction after RSD. Consecutive patients (n=55) undergoing renal denervation were included. Venous serum samples for measurement of sFlt-1, ICAM-1, and VCAM-1 were collected before and 6 months after RSD. A therapeutic response was defined as an office systolic blood pressure reduction of >10 mm Hg 6 months after RSD. A significant mean office systolic blood pressure reduction of 31.2 mm Hg was observed in 46 patients 6 months after RSD. Nine patients were classified as...

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Section: Discussionsupporting

confidence: 48%

Soluble fms-Like Tyrosine Kinase-1 and Endothelial Adhesion Molecules (Intercellular Cell Adhesion Molecule-1 and Vascular Cell Adhesion Molecule-1) as Predictive Markers for Blood Pressure Reduction After Renal Sympathetic Denervation

et al. 2014

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“…Discrepant results in RDN efficacy have been observed in previous studies. 2,4,6,11,12 Several differences in the methodology of these trials might have contributed to the disparity of results. Currently, the Symplicity HTN-3 study, which was recently published, is considered the most robust RDN study.…”

Section: Discussionmentioning

confidence: 99%

Randomized Comparison of Renal Denervation Versus Intensified Pharmacotherapy Including Spironolactone in True-Resistant Hypertension

et al. 2015

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T he prevalence of patients with resistant hypertension (RH) varies from 5% to 30%.1 Identification of true-RH, when secondary causes and medication noncompliance are excluded, is becoming more important with the implementation of novel, nondrug therapeutic approaches to RH, such as catheter-based renal-artery denervation (RDN) or baroreflex stimulation. Pilot studies using RDN described the method as feasible, effective, and safe for reducing blood pressure (BP) in the short term. 2-4The interpretation of the results from the majority of these studies was complicated by the lack of 24-hour ambulatory blood pressure monitoring (24-hour ABPM) data, lack of compliance confirmation, or small follow-up sample sizes.This study seeks to evaluate the efficacy of RDN in a prospective multicenter randomized trial with the acronym PRAGUE-15 in patients with true-RH, according to the recommendations for RDN.5 Twenty-four-hour ABPM, exclusion of secondary hypertension and evaluation of treatment compliance served as confirmation of true resistance. The efficacy of RDN was compared with intensified antihypertensive treatment including the use of spironolactone. To date, only 1 study has compared RDN with intensified pharmacological treatment.6 However, only 19Abstract-This prospective, randomized, open-label multicenter trial evaluated the efficacy of catheter-based renal denervation (Symplicity, Medtronic) versus intensified pharmacological treatment including spironolactone (if tolerated) in patients with true-resistant hypertension. This was confirmed by 24-hour ambulatory blood pressure monitoring after excluding secondary hypertension and confirmation of adherence to therapy by measurement of plasma antihypertensive drug levels before enrollment. One-hundred six patients were randomized to renal denervation (n=52), or intensified pharmacological treatment (n=54) with baseline systolic blood pressure of 159±17 and 155±17 mm Hg and average number of drugs 5.1 and 5.4, respectively. A significant reduction in 24-hour average systolic blood pressure after 6 months (−8. Betweengroup differences in change were not significant. The average number of antihypertensive drugs used after 6 months was significantly higher in the pharmacological group (+0.3 drugs; P<0.001). A significant increase in serum creatinine and a parallel decrease of creatinine clearance were observed in the pharmacological group; between-group difference were borderline significant. The 6-month results of this study confirmed the safety of renal denervation. In conclusion, renal denervation achieved reduction of blood pressure comparable with intensified pharmacotherapy.

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“…Det er publisert flere oversiktsartikler der det manes til forsiktighet, og det stilles en rekke kritiske spørsmål til dokumentasjon og ukritisk bruk av renal denervering (21,23,24). Fra et internasjonalt samarbeidsprosjekt, der studiene i Tromsø og Oslo inngår (17,18), er det nylig rapportert resultater fra 109 pasienter (25). Den blodtrykkssenkende effekten er langt mer beskjeden enn i Symplicity-1-og Symplicity-2-studiene (12,14).…”

Section: Figur 2 Ablasjonskateter I Nyrearterie Nervene Er Skjematisunclassified

Renal sympatisk denervering ved terapiresistent hypertensjon

Ht¹,

Elmula²,

Kjeldsen³

et al. 2014

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Blood pressure changes after renal denervation at 10 European expert centers

Cited by 142 publications

References 41 publications

Soluble fms-Like Tyrosine Kinase-1 and Endothelial Adhesion Molecules (Intercellular Cell Adhesion Molecule-1 and Vascular Cell Adhesion Molecule-1) as Predictive Markers for Blood Pressure Reduction After Renal Sympathetic Denervation

Soluble fms-Like Tyrosine Kinase-1 and Endothelial Adhesion Molecules (Intercellular Cell Adhesion Molecule-1 and Vascular Cell Adhesion Molecule-1) as Predictive Markers for Blood Pressure Reduction After Renal Sympathetic Denervation

Randomized Comparison of Renal Denervation Versus Intensified Pharmacotherapy Including Spironolactone in True-Resistant Hypertension

Renal sympatisk denervering ved terapiresistent hypertensjon

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