Effects of renal sympathetic denervation on blood pressure, sleep apnoea severity and metabolic indices: a prospective cohort study

Daniels, Florrie; Freitas, Simon De; Smyth, Andrew; Garvey, John; Judge, Conor; Gilmartin, J.J.; Sharif, Faisal

doi:10.1016/j.sleep.2016.09.014

Cited by 17 publications

(12 citation statements)

References 41 publications

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“…Their patients had less pronounced OSA (AHI was lower by >14 events per hour than in our study). 19 This may have influenced the results-in our study, the decrease in AHI correlated with baseline AHI and was more pronounced in patients with higher baseline AHI.…”

Section: 18mentioning

confidence: 64%

“…Among patients with selfreported OSA, reduction in office systolic BP tended to be more pronounced in patients without CPAP as compared with those with CPAP treatment. 13 Also, in a recent prospective cohort study of RDN, Daniels et al 19 showed significant reductions both in office and ambulatory BP at 6 months in 20 patients with CPAP-untreated OSA.…”

Section: 18mentioning

confidence: 97%

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Renal Denervation in Resistant Hypertension and Obstructive Sleep Apnea

Warchoł-Celińska

Prejbisz

Kądziela³

et al. 2018

Hypertension

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Abstract-It has been postulated that catheter-based renal denervation (RDN) may lower blood pressure (BP) and improve severity of obstructive sleep apnea (OSA) in resistant hypertensive patients. The aim of our study (NCT01366625) was to investigate in a prospective randomized trial the effect of RDN on BP and clinical course of OSA. Sixty patients with true resistant hypertension coexisting with moderate-to-severe OSA (apnea/hypopnea index, ≥15) were randomly allocated to RDN group (30 patients) and to control group (30 patients). The primary end point was reduction in office systolic BP at 3 months. Secondary end points included reduction in diastolic office and ambulatory BP, change in apnea/hypopnea index and biochemical measurements at 3 months, and change in echocardiographic measurements at 6 months. There were no differences in clinical characteristics between the groups. At 3 months in the RDN group, both office and ambulatory BP were significantly reduced, and a significant decrease in OSA severity (apnea/hypopnea index, 39.4 versus 31.2 events per hour; P=0.015) was observed. Between-group difference in apnea/hypopnea index change was significant at 0.05. At 6 months in the RDN group, reductions in office and ambulatory BP were sustained and were accompanied by significant improvement in echocardiographic measures of global longitudinal strain. There were no differences in metabolic variables in follow-up in both groups. In a randomized controlled trial, RDN lowered both office and ambulatory BP in patients with resistant hypertension and OSA. This was accompanied by improvement of the clinical severity of OSA. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01366625.

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Section: 18mentioning

confidence: 64%

Section: 18mentioning

confidence: 97%

Renal Denervation in Resistant Hypertension and Obstructive Sleep Apnea

Warchoł-Celińska

Prejbisz

Kądziela³

et al. 2018

Hypertension

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“…Witkowski et al [18] SYMPLICITY HTN-3 [5] GLOBAL SYMPLICITY REGISTRY [21] Daniels et al [22] Warchol-Celinska et al [19] Type of study to the control group (30 patients). The primary end point was reduction in office systolic BP at 3 months.…”

Section: Studymentioning

confidence: 99%

“…The obtained data were in concordance with the post hoc analyses from Symplicity-HTN-3 [20] and Global Symplicity Registry studies [21], suggesting that patients with OSA may be particularly responsive to RDN therapy. In another prospective study including twenty resistant hypertensive patients with OSA, moderate blood pressure reduction was achieved after renal denervation with no significant changes in sleep apnea severity [22]. A summary of these trials is presented in Table II.…”

Section: Studymentioning

confidence: 99%

Renal denervation – can we press the “ON” button again?

Kądziela

Warchoł-Celińska

Prejbisz

et al. 2018

pwki

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Nearly ten years ago percutaneous renal denervation (RDN) was introduced in clinical trials as a possible method of interventional treatment of resistant hypertension. The promising results of the first clinical trials initiated the intensive development of this method. However, the role of percutaneous renal denervation in the treatment of patients with resistant hypertension has been questioned since the results of the Symplicity HTN-3 trial have been published. It also resulted in downgrading the indications for RDN in the European Society of Cardiology/European Society of Hypertension Guidelines 2018. The authors discuss potential shortcomings of that trial, describe new generation devices and present the results of recently published trials: SPYRAL HTN-OFF MED, SPYRAL HTN-ON MED, RADIANCE-HTN SOLO and RADIOSOUND-HTN. The results of studies in patients with obstructive sleep apnea are also summarized and discussed. The upcoming large trials (SPYRAL PIVOTAL, RADIANCE II) are outlined-the results of those trials are expected to be published in the next 2-3 years. Until then, according to the European guidelines, the use of device-based therapies is not recommended for the treatment of hypertension, unless in the context of clinical studies and randomized controlled trials.

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“…However, half of the patients included in this study had mild OSAS (AHI <,15/hour) and two participants received concomitant CPAP therapy. Daniels et al (2017) conducted a renal denervation study on 20 patients with moderate-to-severe-OSAS, not receiving CPAP treatment. No significant improvement in AHI or oxygen saturation was observed 6 months following catheter-based denervation.…”

Section: Introductionmentioning

confidence: 99%

Is Aberrant Reno-Renal Reflex Control of Blood Pressure a Contributor to Chronic Intermittent Hypoxia-Induced Hypertension?

2019

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Renal sensory nerves are important in the regulation of body fluid and electrolyte homeostasis, and blood pressure. Activation of renal mechanoreceptor afferents triggers a negative feedback reno-renal reflex that leads to the inhibition of sympathetic nervous outflow. Conversely, activation of renal chemoreceptor afferents elicits reflex sympathoexcitation. Dysregulation of reno-renal reflexes by suppression of the inhibitory reflex and/or activation of the excitatory reflex impairs blood pressure control, predisposing to hypertension. Obstructive sleep apnoea syndrome (OSAS) is causally related to hypertension. Renal denervation in patients with OSAS or in experimental models of chronic intermittent hypoxia (CIH), a cardinal feature of OSAS due to recurrent apnoeas (pauses in breathing), results in a decrease in circulating norepinephrine levels and attenuation of hypertension. The mechanism of the beneficial effect of renal denervation on blood pressure control in models of CIH and OSAS is not fully understood, since renal denervation interrupts renal afferent signaling to the brain and sympathetic efferent signals to the kidneys. Herein, we consider the currently proposed mechanisms involved in the development of hypertension in CIH disease models with a focus on oxidative and inflammatory mediators in the kidneys and their potential influence on renal afferent control of blood pressure, with wider consideration of the evidence available from a variety of hypertension models. We draw focus to the potential contribution of aberrant renal afferent signaling in the development, maintenance and progression of high blood pressure, which may have relevance to CIH-induced hypertension.

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Effects of renal sympathetic denervation on blood pressure, sleep apnoea severity and metabolic indices: a prospective cohort study

Cited by 17 publications

References 41 publications

Renal Denervation in Resistant Hypertension and Obstructive Sleep Apnea

Renal Denervation in Resistant Hypertension and Obstructive Sleep Apnea

Renal denervation – can we press the “ON” button again?

Is Aberrant Reno-Renal Reflex Control of Blood Pressure a Contributor to Chronic Intermittent Hypoxia-Induced Hypertension?

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