Renal Denervation for Treating Hypertension

Weber, Michael A.; Mahfoud, Felix; Schmieder, Roland E.; Kandzari, David E.; Tsioufis, Κonstantinos; Townsend, Raymond R.; Kario, Kazuomi; Böhm, Michael; Sharp, Andrew; Davies, Justin E.; Osborn, John W.; Fink, Greg D.; Euler, David E.; Cohen, Debbie L.; Schlaich, Markus P.; Esler, Murray

doi:10.1016/j.jcin.2019.02.050

Cited by 76 publications

(27 citation statements)

References 58 publications

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“…SNS hyperactivity occurs also in patients with CKD, probably with significant consequence on the prognosis (20)(21)(22)(23). Renal denervation (RDN) that causes the ablation of renal afferent and efferent nerve fibers, was originally developed for the treatment of resistant hypertension and, despite many controversies, such hypertension remains the main indication for RDN (24). However, recent studies suggest that RDN might also be a promising tool for the treatment of CHF (25)(26)(27).…”

Section: Introductionmentioning

confidence: 99%

Effects of renal sympathetic denervation on the course of congestive heart failure combined with chronic kidney disease: Insight from studies with fawn-hooded hypertensive rats with volume overload induced using aorto-caval fistula

Honetschlägerová

Škaroupková

Kikerlová

et al. 2021

Clinical and Experimental Hypertension

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Section: Introductionmentioning

confidence: 99%

Effects of renal sympathetic denervation on the course of congestive heart failure combined with chronic kidney disease: Insight from studies with fawn-hooded hypertensive rats with volume overload induced using aorto-caval fistula

Honetschlägerová

Škaroupková

Kikerlová

et al. 2021

Clinical and Experimental Hypertension

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“…We found that RF MRA and branches consistently provided the largest reduction in 24-h ambulatory, daytime and nighttime SBP and DBP. The Symplicity Spyral was specifically designed to also treat RA branches with a diameter of 3 to 8 mm [4]. Having a higher number of ablated sites may improve the chance of hitting pressor nerves around the arteries [3].…”

Section: What Our Study Adds To the Literaturementioning

confidence: 99%

“…Reasons for negative findings include patients' failure to adhere to antihypertensive medication as well as the inexperience of those performing the renal ablation. More recent RCTs improved the Symplicity HTN-3 trial's shortcomings; the DENERHTN trial, the SPYRAL HTN-OFF trial, the SPYRAL HTN-ON trial, and the RADIANCE-HTN SOLO trial showed clinically significant decreases in ambulatory BP [3,4].…”

Section: Introductionmentioning

confidence: 99%

Renal Denervation for Uncontrolled and Resistant Hypertension: Systematic Review and Network Meta-Analysis of Randomized Trials

Silverwatch

Marti

Phan

et al. 2021

JCM

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Comparative efficacy and safety of renal denervation (RDN) interventions for uncontrolled (UH) and resistant hypertension (RH) is unknown. We assessed the comparative efficacy and safety of existing RDN interventions for UH and RH. Six search engines were searched up to 1 May 2020. Primary outcomes were mean 24-h ambulatory and office systolic blood pressure (SBP). Secondary outcomes were mean 24-h ambulatory and office diastolic blood pressure (DBP), clinical outcomes, and serious adverse events. Frequentist random-effects network meta-analyses were used to evaluate effects of RDN interventions. Twenty randomized controlled trials (RCTs) (n = 2152) were included, 15 in RH (n = 1544) and five in UH (n = 608). Intervention arms included radiofrequency (RF) in main renal artery (MRA) (n = 10), RF in MRA and branches (n = 4), RF in MRA+ antihypertensive therapy (AHT) (n = 5), ultrasound (US) in MRA (n = 3), sham (n = 8), and AHT (n = 9). RF in MRA and branches ranked as the best treatment to reduce 24-h ambulatory, daytime, and nighttime SBP and DBP versus other interventions (p-scores: 0.83 to 0.97); significant blood pressure effects were found versus sham or AHT. RF in MRA+AHT was the best treatment to reduce office SBP and DBP (p-scores: 0.84 and 0.90, respectively). RF in MRA and branches was the most efficacious versus other interventions to reduce 24-h ambulatory SBP and DBP in UH or RH.

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“…The type of sympatholytic therapy most frequently mentioned in the literature recently is renal denervation (RDN). It is a minimally invasive therapeutic method based on catheter radiofrequency (although ultrasound or alcohol injection may be used) ablation of afferent and efferent renal sympathetic fibers, which is usually reserved for severe AH that is resistant to pharmacological treatment and AH with concomitant chronic renal failure, although it has recently been suggested to expand the indications to uncomplicated AH [17][18][19]. In March this year, the first study was published that proves the reduced efferent renal sympathetic innervation after chemical RDN in humans, as well as the positive effects of this procedure on AH [20].…”

Section: Pharmacological Aspectsmentioning

confidence: 99%

Stress and arterial hypertension - from pathophysiology to pharmacology

et al. 2021

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Arterial hypertension is the most massive chronic non-infectious disease of mankind nowadays. It may remain undiagnosed for years, provoking later complications, such as acute heart failure, cerebrovascular stroke, myocardial infarction, renal failure, hypertensive retinopathy, or sudden death. Primary arterial hypertension is more common, while secondary occurs in about 5-20% of cases. The recent studies have shown that stress may be a core factor in development of essential hypertension in some patients. For the patients suffering from post-traumatic stress disorder, stress is the dominant etiological factor that leads to the disease. It has been proven that chronic stress can affect blood pressure regulation and endocrine-metabolic functions through the limbic-hypothalamic centers, therefore it can affect the arterial hypertension development. The strong association between stress and arterial hypertension have been also confirmed in preclinical and animal studies. For the pharmacotherapy approach, the most important are beta-adrenergic blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors) and AT1-receptor blockers (sartans). As a second line treatment, calcium channel blockers, diuretics, alpha-adrenergic blockers, and central antihypertensive agents may be required. The anxiolytics, such as benzodiazepines, should be considered if chronic anxiety and psychosomatic disorders are present.

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Renal Denervation for Treating Hypertension

Cited by 76 publications

References 58 publications

Effects of renal sympathetic denervation on the course of congestive heart failure combined with chronic kidney disease: Insight from studies with fawn-hooded hypertensive rats with volume overload induced using aorto-caval fistula

Effects of renal sympathetic denervation on the course of congestive heart failure combined with chronic kidney disease: Insight from studies with fawn-hooded hypertensive rats with volume overload induced using aorto-caval fistula

Renal Denervation for Uncontrolled and Resistant Hypertension: Systematic Review and Network Meta-Analysis of Randomized Trials

Stress and arterial hypertension - from pathophysiology to pharmacology

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