Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by <scp>SCAI</scp> and <scp>NKF</scp>

Kandzari, David E.; Townsend, Raymond R.; Bakris, George L.; Basile, Jan; Bloch, Michael J.; Cohen, Debbie L.; East, Cara; Ferdinand, Keith C.; Fisher, Naomi D.L.; Kirtane, Ajay J.; Lee, David P.; Puckrein, Gary; Rader, Florian; Vassalotti, Joseph A.; Weber, Michael A.; Willis, Kerry; Secemsky, Eric A.

doi:10.1002/ccd.29884

Cited by 31 publications

(54 citation statements)

References 73 publications

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“…Although the precise mechanisms of RDN are not fully understood, it is believed that RDN may exert hypotension, anti-arrhythmia, and attenuating heart failure effects by inhibiting sympathetic overactivation ( 31 ), and thereby reducing plasma concentrations of norepinephrine ( 32 ), renin, and angiotensin ( 33 ). Basal HR may reflect systemic sympathetic activity to some extent.…”

Section: Discussionmentioning

confidence: 99%

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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%

“…Increased baseline BP and HR are associated with the increased sympathetic activity ( 33 ), and can predict BP reduction after RDN ( 31 ). Böhm et al ( 10 ) suggested that there was a significant difference of BP change between RDN and sham group at HRs ≥ 73.5 bpm, but not for patients with HRs < 73.5 bpm.…”

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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“…Interventional therapies, such as catheter-based RDN, have demonstrated consistent and clinically meaningful reductions in BP. [3][4][5][6][7]9,38,39 Accordingly, a DCE assessment of patient preference for alternatives to traditional pharmaceutical and lifestyle interventions is essential to align treatments with patient values in the shared decision-making process. As the first DCE inclusive of both pharmaceutical and interventional therapies for HTN, the findings of this study are: (1) respondents prioritized BP reduction over all other attributes and prefer receiving treatment over no treatment; (2) procedural safety and drug-related side effects did not substantially influence preference for effective treatment; (3) an estimated 2.3-mm Hg reduction in SBP was required to shift patient preference in favor of interventional therapy; and (4) patients' tolerance for risk was higher and expectation for benefit was lower than what has been observed in recent randomized sham-controlled trials of RDN.…”

Section: Discussionmentioning

confidence: 99%

Patient Preferences for Pharmaceutical and Device-Based Treatments for Uncontrolled Hypertension: Discrete Choice Experiment

Kandzari

Weber

Poulos

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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BACKGROUND: Discrete choice experiment is a survey method used to understand how individuals make decisions and to quantify the relative importance of features. Using discrete choice experiment methods, we quantified patient benefit–risk preferences for hypertension treatments, including pharmaceutical and interventional treatments, like renal denervation. METHODS: Respondents from the United States with physician-confirmed uncontrolled hypertension selected between treatments involving a procedure or pills, using a structured survey. Treatment features included interventional, noninterventional, or no hypertension treatment; number of daily blood pressure (BP) pills; expected reduction in office systolic BP; duration of effect; and risks of drug side effects, access site pain, or vascular injury. The results of a random–parameters logit model were used to estimate the importance of each treatment attribute. RESULTS: Among 400 patients completing the survey between 2020 and 2021, demographics included: 52% women, mean age 59.2±13.0 years, systolic BP 155.1±12.3 mm Hg, and 1.8±0.9 prescribed antihypertensive medications. Reduction in office systolic BP was the most important treatment attribute. The remaining attributes, in decreasing order, were duration of effect, whether treatment was interventional, number of daily pills, risk of vascular injury, and risk of drug side effects. Risk of access site pain did not influence choice. In general, respondents preferred noninterventional over interventional treatments, yet only a 2.3 mm Hg reduction in office systolic BP was required to offset this preference. Small reductions in office systolic BP would offset risks of vascular injury or drug side effects. At least a 20% risk of vascular injury or drug side effects would be tolerated in exchange for improved BP. CONCLUSIONS: Reduction in systolic BP was identified as the most important driver of patient treatment preference, while treatment-related risks had less influence. The results indicate that respondents would accept interventional treatments in exchange for modest reductions in systolic BP compared with those observed in renal denervation trials.

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“…However, Asia RDN consensus recommended that RDN should not be considered a therapy of last resort but as an initial therapy option that may be applied alone or as a complementary therapy to antihypertensive medication [40]. Should RDN gain approval in the USA, but the challenge will be to identify appropriate patients and to build interdisciplinary networks for referrals [41]. Therefore, patients selection and accurate evaluation of BP reduction with RDN therapy will affect the routine clinical use of RDN.…”

Section: Discussionmentioning

confidence: 99%

Intravascular Renal Denervation Reduces Ambulatory and Office Blood Pressure in Patients with Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Trials

Yang

Liu

Chen

et al. 2022

Kidney Blood Press Res

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Background: This meta-analysis was designed to evaluate the antihypertensive efficacy of intravascular renal denervation (RDN) in patients with essential hypertension, especially to determine the magnitude of blood pressure (BP) reduction with RDN therapy using second-generation catheters. Methods: PubMed was searched to identify randomized sham-controlled trials from inception through August 2021. The endpoints were changes in 24-hours (24-h) ambulatory BP or office BP (OBP). This meta-analysis was performed by calculating the weighted mean difference (WMD) with 95% confidence interval (CI) using the random-effects model when the I2 index was < 50%. Fixed-effects model was used when the I2 index was ≥ 50%. Results: A total of 1297 patients were included in 8 randomized, sham-controlled trials in this meta-analysis. Intravascular RDN reduced 24-h ambulatory systolic BP (SBP) −3.02 (WMD, 95% CI, −4.95, −1.10, p <0.01,) and diastolic BP (DBP) −1.66 (WMD, 95% CI, −2.44, −0.88, p<0.001) mm Hg, respectively. In the studies using first-generation catheters, the WMD of 24-h ambulatory SBP and DBP changes between intravascular RDN and sham-control were −2.67 (95% CI, −5.08, -0.27; P<0.05) and −0.82 (95% CI, −2.19, 0.56; P>0.05) mm Hg. In the studies using second-generation catheters, the WMD of 24-h ambulatory SBP and DBP changes between intravascular RDN and sham-control were −3.14 (95% CI, −5.94, −0.33, p<0.05) and –2.06 (95% CI, −3.02, −1.11, p<0.001) mm Hg. Intravascular RDN using second-generation catheters reduced office SBP −6.30 (WMD, 95% CI, −7.67, −4.93, p<0.001) and DBP −3.88 (WMD, 95% CI, −4.44, −3.33, p<0.001) mm Hg, respectively. Conclusions: Intravascular RDN using second-generation catheters reduces ambulatory and office BP in patients with essential hypertension. The selection of appropriate hypertensive patients may be the major challenge for the performance of intravascular RDN in routine clinical practice.

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Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF

Cited by 31 publications

References 73 publications

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

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

Patient Preferences for Pharmaceutical and Device-Based Treatments for Uncontrolled Hypertension: Discrete Choice Experiment

Intravascular Renal Denervation Reduces Ambulatory and Office Blood Pressure in Patients with Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Trials

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