Renal denervation for resistant hypertension

Pisano, Anna; Iannone, Luigi Francesco; Leo, Antonio; Russo, Emilio; Coppolino, Giuseppe; Bolignano, Davide

doi:10.1002/14651858.cd011499.pub3

Cited by 18 publications

(15 citation statements)

References 149 publications

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“…In the present study, although most of the included participants were treated with beta-blocker ( Table 2 ), RDN significantly reduced HR compared with the baseline, further confirming the HR lowering effect of RDN. In addition, although recently a meta-analysis with limited studies demonstrated that RDN may induce bradycardia [relative risk ( RR ) = 6.63, 95% CI : 1.19–36.84, p = 0.03] ( 36 ). In the present meta-analysis, only one study reported the adverse effect with 5 (5/30) patients who suffered from bradycardia after RDN ( 23 ), it may be related to the significant and fast decreased sympathetic activity, and whether bradycardia was a side effect of RDN should be demonstrated by large-scale RCTs.…”

Section: Discussionmentioning

confidence: 99%

Effect of Renal Denervation for the Management of Heart Rate in Patients With Hypertension: A Systematic Review and Meta-Analysis

Xiong

et al. 2022

Front. Cardiovasc. Med.

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Objective:The effect of renal denervation (RDN) on heart rate (HR) in patients with hypertension had been investigated in many studies, but the results were inconsistent. This meta-analysis was performed to evaluate the efficacy of RDN on HR control.Methods:Databases, such as PubMed, EMBASE, Cochrane, and ClinicalTrials.gov, were searched until September 2021. Randomized controlled trials (RCTs) or non-RCTs of RDN in hypertensive patients with outcome indicators, such as HR, were selected. Weighted mean difference (WMD) was calculated for evaluating the changes in HR from baseline using fixed-effects or random-effects models. The Spearman's correlation coefficients were used to identify the relationship between the changes of HR and systolic blood pressure (SBP).Results:In the current meta-analysis, 681 subjects from 16 individual studies were included. This study showed that RDN could reduce office HR in patients with hypertension [WMD = −1.93 (95% CI: −3.00 to −0.85, p < 0.001)]. In addition, 24-h HR and daytime HR were decreased after RDN [WMD = −1.73 (95% CI: −3.51 to −0.31, p = 0.017) and −2.67 (95% CI: −5.02 to −0.32, p = 0.026) respectively], but nighttime HR was not significantly influenced by RDN (WMD = −2.08, 95% CI: −4.57 to 0.42, p = 0.103). We found that the reduction of HR was highly related to the decrease of SBP (r = 0.658, p < 0.05).Conclusion:Renal denervation could reduce office, 24-h, and daytime HR, but does not affect nighttime HR. And the effect is highly associated with blood pressure (BP) control.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021283065.

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Section: Discussionmentioning

confidence: 99%

Effect of Renal Denervation for the Management of Heart Rate in Patients With Hypertension: A Systematic Review and Meta-Analysis

Xiong

et al. 2022

Front. Cardiovasc. Med.

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“…Renal sympathetic denervation involves ablation of renal afferent and efferent nerves through a minimally invasive, catheter-based percutaneous intervention. Alternative methods such as neurotoxic agents, cryotherapy, and brachytherapy are being explored [3 ▪▪ ]…”

Section: Introductionmentioning

confidence: 99%

Renal denervation for the treatment of hypertension and kidney disease

Camafort,

Ihm,

Ruilope

2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review Hypertension is a condition characterized by increased sympathetic activity and the autonomic nervous system. Resistant hypertension, a condition with a prevalence of 10% to 20% in the general hypertensive population, is more likely to experience poor outcomes and adverse cardiovascular events. Renal sympathetic denervation (RDN), a minimally invasive, catheter-based percutaneous intervention, has been considered for treating this condition. Clinical trials have used various catheters, such as the Symplicity Spyral catheter, Vessix Renal Denervation system, and Paradise endovascular ultrasound renal denervation system. Recent findings After the first randomized clinical trials examining the effectiveness and safety of RDN for lowering blood pressure in hypertensive patients, new clinical trials have used various catheters based on radiofrequency, such as the Spyral catheter, Vessix Renal Denervation system, or based on radiofrequency as the Paradise endovascular ultrasound renal denervation system. Positive results on this trials have shown that endovascular RDN (radiofrequency energy or high focused ultrasound energy) could be considered as a treatment option for uncontrolled resistant hypertension. Summary Therefore, endovascular RDN (radiofrequency energy or high focused ultrasound energy) could be considered as a treatment option for uncontrolled resistant hypertension, which can be considered as an alternative to increasing medication. Nevertheless more data are needed, mainly in cardiovascular outcomes. RDN should be performed in experienced and specialized centers with a multidisciplinary team, and the benefits and risks of RDN should be addressed in a shared-decision-making process.

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“… [208] Invasive nonpharmacologic treatments for resistant hypertension may include renal denervation therapy. [ 221 , 222 ] Initiation of antihypertensive drug therapy with 2 first-line agents of different classes, either as separate agents or in a fixed-dose combination, is recommended for adults with an average BP more than 20/10 mm Hg above their BP target. [208] Specifically, single pill combination antihypertensive therapy is often recommended for initial therapy (i.e., angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker in combination with a calcium channel blocker or thiazide diuretic in the same pill.)…”

Section: Introductionmentioning

confidence: 99%

“… [208] Invasive nonpharmacologic treatments for resistant hypertension may include renal denervation therapy. [ 221 , 222 ]…”

Section: Introductionmentioning

confidence: 99%