Drug Resistant Hypertension - No SIMPLE Way Out

Skrzypecki, Janusz; Ufnal, Marcin

doi:10.1159/000368483

Cited by 6 publications

(2 citation statements)

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“…SYMPLICITY I, II and III renal denervation trials were aimed at patients with treatment resistant hypertension defined as an ABP over 140/90 mmHg despite treatment with at least 3 antihypertensive drugs, including a diuretic [33][34][35]. Although these studies did not show any advantage of renal denervation over pharmacotherapy, they did prove patient safety for the procedure [33][34][35]. SPYRAL HTN-OFF, which followed, showed that renal denervation might offer a viable antihypertensive management for patients who are not using ABP lowering medication [36].…”

Section: Renal Denervation Clinical Trialsmentioning

confidence: 99%

“…SPYRAL HTN-OFF, which followed, showed that renal denervation might offer a viable antihypertensive management for patients who are not using ABP lowering medication [36]. The effectiveness of renal denervation is mechanistically tied to sympathetic nervous system inhibition [33]. Considering that non-selective beta-blockers are utilized to lower IOP, it could be hypothesized that renal denervation could simultaneously decrease ABP and IOP [37], thus offering a viable alternative to pharmacotherapy in patients with both glaucoma Janusz Skrzypecki et al, Blood pressure and glaucoma and hypertension.…”

Section: Renal Denervation Clinical Trialsmentioning

confidence: 99%

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Blood pressure and glaucoma: At the crossroads between cardiology and ophthalmology

et al. 2019

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Glaucoma is an optic nerve neuropathy of undetermined cause. Although many mechanisms are thought to be involved in the development and progression of the disease, only an increased intraocular pressure has been established as a clinically significant modifiable risk factor. Nevertheless, up to 40% of patients develop glaucoma without evidence of increased intraocular pressure. Ample evidence suggests that alterations in the control of arterial blood might negatively affect optic nerve function. However, evidence-based guidelines on the management of arterial blood pressure in glaucoma patients are lacking. Regrettably, intraocular pressure is generally not included as a secondary end-point in clinical trials on arterial hypertension. Considering the relative simplicity of intraocular pressure measurements and large number of patients included in hypertension studies, the benefits of including intraocular pressure as a secondary end-point could be of a great value for improving care for glaucoma patients. Therefore, closer collaboration between cardiologists and ophthalmologists is needed.

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Section: Renal Denervation Clinical Trialsmentioning

confidence: 99%

Section: Renal Denervation Clinical Trialsmentioning

confidence: 99%

Blood pressure and glaucoma: At the crossroads between cardiology and ophthalmology

et al. 2019

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Modulation of Sympathetic Overactivity to Treat Resistant Hypertension

Voora

Hinderliter

2018

Curr Hypertens Rep

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Based on the two best current techniques available for assessing sympathetic nerve activity, resistant hypertension is characterized by increased sympathetic nerve activity. Several device therapies, including renal denervation baroreflex activation therapy and carotid body ablation, have been developed as non-pharmacologic means of reducing blood pressure in resistant hypertension. With respect to renal denervation, the technologies for renal denervation have evolved since the unfavorable results from the HTN-3 study, and the revised technologies are being actively studied. Data from the first phase of the SPYRAL HTN Clinical Trial Program have been published. Results from the SPYRAL HTN-OFF MED trial suggest that ablating renal nerves can reduce blood pressure in patients with untreated mild-to-moderate hypertension. The SPYRAL HTN-ON MED trial demonstrated the safety and efficacy of catheter-based renal denervation in patients with uncontrolled hypertension on antihypertensive treatment. Interestingly, there was a high rate of medication non-adherence among patients with hypertension in this study. One attractive alternative to radiofrequency ablation is the use of ultrasound for renal denervation. Proof of concept data for the Paradise endovascular ultrasound renal denervation system was recently published in the RADIANCE-HTN SOLO trial. The results of this trial indicate that, among patients with mild to moderate hypertension on no medications, renal denervation with the Paradise system results in a greater reduction in both SBP and DBP at 2months compared with a sham procedure. Overall reductions were similar in magnitude to those noted in the SPYRAL HTN-OFF MED study. With respect to carotid body ablation, there is an ongoing proof of concept study that is investigating the safety and feasibility of ultrasound-based endovascular carotid body ablation in 30 subjects with treatment-resistant hypertension outside of the USA. The sympathetic nervous system is an important contributor to resistant hypertension. Modulation of sympathetic overactivity should be an important goal of treatment. Innovative therapies using non-pharmacologic means to suppress the sympathetic nervous system are actively being studied to treat resistant hypertension.

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