Clinical benefits and safety of renal denervation in severe arterial hypertension: A long‐term follow‐up study

Naduvathumuriyil, Tino; Held, Ulrike; Steigmiller, Klaus; Denegri, Andrea; Cantatore, Silviya; Obeid, Slayman; Flammer, Andreas J.; Ruschitzka, Frank; Lüscher, Thomas F.; Sudano, Isabella

doi:10.1111/jch.14005

Cited by 8 publications

(6 citation statements)

References 43 publications

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“…However, when assessed immediately after intervention (1 min), RDN was showed to be effective in reducing HRV [58]. There are also studies that did not show any significant effect of RDN on HR [59]. However, most of these studies suffer from some limitations, such as low patient numbers, lack of control group, lack of sham procedure, great number patients included under treatment of beta blockers, to name just few.…”

Section: Heart Ratementioning

confidence: 99%

Renal denervation in the antihypertensive arsenal – knowns and known unknowns

Messerli

Bavishi

Brguljan

et al. 2022

Journal of Hypertension

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

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Section: Heart Ratementioning

confidence: 99%

Renal denervation in the antihypertensive arsenal – knowns and known unknowns

Messerli

Bavishi

Brguljan

et al. 2022

Journal of Hypertension

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“…Data showed that DBP and SBP levels were significantly lower at 24 months after RDN, and neither the recovery of nerve fibers nor the effective counter-regulatory mechanism that elevates BP was found [39]. Even 36 months after RDN, BP was significantly lower than before RDN [40].…”

Section: Discussionmentioning

confidence: 90%

Efficacy and safety of renal denervation for hypertension in patients with chronic kidney disease: a meta-analysis

Xia

Liu

Chen

et al. 2021

International Journal of Hyperthermia

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Background: Renal denervation (RDN) is a new treatment for hypertension in patients with chronic kidney disease (CKD), but its efficacy is still debated. This meta-analysis aimed to evaluate the efficacy and safety of RDN for hypertension in patients with CKD. Methods: PubMed, Web of Science, EMBASE, and Ovid databases were searched for relevant studies published. We performed both fixed-and random-effects meta-analyses of the changes in blood pressure, estimated glomerular filtration rate (eGFR), and urinary albumin-to-creatinine ratio (UACR) after RDN. Results: The meta-analysis included 238 patients from 11 single-center, non-randomized, uncontrolled studies. Office blood pressure and 24-hour ambulatory blood pressure (24 h-ABP) showed a significant reduction 1 month after RDN (p < 0.05). This decrease of 24 h-ABP persisted for 24 months after RDN showed difference systolic blood pressure (p < 0.001) and diastolic blood pressure (p ¼ 0.001). The 24 h-ABP exhibited a similar trend in the subgroup analysis. eGFR measurements obtained at each time point of analysis after RDN were not significantly different from those obtained before (p > 0.05). UACR levels were significantly reduced at 3 months and 6 months after RDN (p < 0.001). After RDN, the heart rate showed no significant changes (p > 0.05), and few major complications were encountered. Conclusions: The meta-analysis showed that RDN may be effective and safe for treating CKD patients with hypertension. Well-designed randomized controlled trials of RDN are urgently needed to confirm the safety and reproducibility of RDN and to assess its impact on clinical outcomes.

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“…It might lower blood pressure by reversing these mechanisms. Clinical trials [14][15][16][17][18] showed that RDN can effectively reduce intractable blood pressure in hypertensive patients. This study is a prospective, randomized controlled study, and the results also show that RDN can significantly reduce patient blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Main Renal Artery Plus Branch Ablation in the Treatment of Resistant Hypertension with Renal Denervation

Liu

2021

CVIA

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Objective: To study the safety and efficacy of denervation of renal artery branches in the treatment of resistant hypertension.Methods: Sixty patients with resistant hypertension were enrolled. The patients were randomly assigned to the mainrenal artery plus branch ablation group or the main renal artery ablation group. The clinical data and operation-relatedparameters, including number of ablation points, temperature, and average energy, were recorded. Ambulatory bloodpressure were taken for all patients at the baseline and at 6 months after treatment. Office blood pressure was recordedbefore treatment and after treatment every 3 months for 2 years.Results: Sixty patients with resistant hypertension were enrolled in this study. There were 30 patients in each group.Angiography was performed after ablation. No renal artery complications, such as stenosis and dissection, occurredin the two groups. There was no significant difference in age, sex, BMI, comorbid disease, and medication betweenthe two groups (P > 0.05). The number of ablation points for the main renal artery plus branch ablation group wasgreater than that for the main renal artery ablation group. The office blood pressure and 24-hour blood pressure weresignificantly lower 6 months after treatment than before treatment in both groups (P < 0.05). Office blood pressure inthe main renal artery plus branch ablation group was lower than that in the main renal artery ablation group during the3–12-month follow-up period, with a statistical difference. However, as the follow-up time increased, the differencedisappeared.Conclusion: The results of this study show that main renal artery plus branch ablation is a safe interventional method,but there was no obvious advantage on long-term follow-up compared with only main renal artery ablation.

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Clinical benefits and safety of renal denervation in severe arterial hypertension: A long‐term follow‐up study

Cited by 8 publications

References 43 publications

Renal denervation in the antihypertensive arsenal – knowns and known unknowns

Renal denervation in the antihypertensive arsenal – knowns and known unknowns

Efficacy and safety of renal denervation for hypertension in patients with chronic kidney disease: a meta-analysis

Main Renal Artery Plus Branch Ablation in the Treatment of Resistant Hypertension with Renal Denervation

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