Renal Hemodynamics and Renal Function After Catheter-Based Renal Sympathetic Denervation in Patients With Resistant Hypertension

Mahfoud, Felix; Cremers, Bodo; Janker, Julia; Link, Britta; Vonend, Oliver; Ukena, Christian; Linz, Dominik; Schmieder, Roland E.; Rump, Lars Christian; Kindermann, Ingrid; Sobotka, Paul; Krum, Henry; Scheller, Bruno; Schlaich, Markus P.; Laufs, Ulrich; Böhm, Michael

doi:10.1161/hypertensionaha.112.193870

Cited by 285 publications

(175 citation statements)

References 34 publications

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“…In our study cohort, calculated RVR (using renal perfusion assessed by MRI-ASL and brachial mean arterial pressure) was significantly reduced 3 months after RDN, indicating reduced resistance in renal vascular bed. These data are in accordance with another report relying on duplex ultrasonography that found a decreased renal resistive index after 6 months of RDN, indicating reduced intraparenchymal resistance (30). Thus, in this study we observed that renal perfusion did not change acutely or after 3 months of RDN ( Figure 1).…”

Section: Discussionsupporting

confidence: 93%

Vascular and Renal Hemodynamic Changes after Renal Denervation

Ott¹,

Janka

Schmid

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Renal denervation (RDN) has been shown to be effective in reducing BP in treatmentresistant hypertension. Measurement of the renal and sympathetic activity revealed a decrease in sympathetic drive to the kidney and small resistance vessels after RDN. However, the consequences on renal perfusion and renal vascular resistance (RVR), as well as central hemodynamics, are unknown.Design, setting, participants, & measurements Nineteen patients with treatment-resistant hypertension (office BP$140/90 mmHg, despite at least three antihypertensive drugs [including a diuretic], and diagnosis confirmed by 24-hour ambulatory BP monitoring) underwent RDN between January and October 2011. Renal perfusion and RVR were noninvasively assessed by magnetic resonance imaging with arterial spin labeling, and renal function was assessed by estimating GFR before (day 21), after (day +1), and again after 3 months of RDN. Central hemodynamics was assessed using pulse wave analysis at day 21 and after 6 months of RDN.

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Section: Discussionsupporting

confidence: 93%

Vascular and Renal Hemodynamic Changes after Renal Denervation

Ott¹,

Janka

Schmid

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…However, it has been shown that systolic BP at baseline is correlated to BP lowering after the procedure. 2 This is supported by the finding that patient no. 3 with a baseline BP of 222/101 mm Hg, apparently suitable according to present recommendations, 3,4 experienced a pronounced reduction by 66/29 mm Hg.…”

mentioning

confidence: 73%

Catheter-Based Renal Nerve Ablation and Centrally Generated Sympathetic Activity in Difficult-to-Control Hypertensive Patients: Prospective Case Series

et al. 2013

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The recently published article by Brinkmann et al 1 attempted to investigate the effect of catheter-based renal denervation (RDN) on blood pressure (BP) and muscle sympathetic nerve activity. The article is of interest; however, some aspects require clarification.In disagreement with several other studies, the authors report no significant overall blood BP lowering effect after RDN in a small group of 12 patients, and not surprisingly did not observe any changes in muscle sympathetic nerve activity. As shown in larger series, procedural success is clearly observed in patients with high BP as a surrogate of increased sympathetic activity. In contrast to the Symplicity trials, the baseline BP herein was 157/85 mm Hg and thereby ≈20/10 mm Hg lower. To avoid invasive treatment by RDN in patients with low probability of BP lowering afterward, identification of predictors of response are essential. However, it has been shown that systolic BP at baseline is correlated to BP lowering after the procedure.2 This is supported by the finding that patient no. 3 with a baseline BP of 222/101 mm Hg, apparently suitable according to present recommendations, 3,4 experienced a pronounced reduction by 66/29 mm Hg.As the authors are aware and claim in their Perspectives, RDN should be restricted to patients with true resistant hypertension and high cardiovascular risk. The authors also express their concerns on the widespread adoption of RDN (especially in Germany), leading to softer criteria for patient eligibility. This has been addressed by different, recently published position papers from national 3 and international societies, 4 aimed to provide practical recommendations on the application of RDN. Based on the current available evidence there is a broad consensus that only patients with severe resistant hypertension, defined as office systolic BP≥160 mm Hg (≥150 mm Hg in type 2 diabetes mellitus), should be considered for RDN. The question that inevitably arises while reading the article by Brinkmann et al 1 is why subjects with nontreatment-resistant hypertension (42% of the patients had systolic BP≤140 mm Hg, patient no. 11 was even normotensive: 121/65 mm Hg) were selected for RDN, when current recommendations consider this as an exclusion criterion. Inclusion of these patients represents a serious limitation of the study, also raising an ethical issue. The authors could not expect a significant BP drop in normotensive or nonresistant patients. Interestingly, heart rate was significantly reduced in the majority of patients (7/12), which might indicate a more sensitive surrogate for significant effects in patients with normal BP and is in line with recent data by Ukena et al. 5 We are confident that proper scientific investigation of the new approaches (including RDN and baroreflex stimulation) for patients who failed to respond to drug treatment and lifestyle modification will, if performed on a scientifically sound basis, help to definitely determine the role of these devicebased therapies.

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“…Амбу-латорное и домашнее АД снижается не очень сильно; описано уменьшение потребности в антигипертен-зивных препаратах [627]. Получены также некото-рые данные о дополнительной пользе метода в виде, например, уменьшения артериальной жесткости, обратного развития ГЛЖ и диастолической дис-функции, ренопротекции и улучшения толерантно-сти к глюкозе [628][629][630]. За исключением редко воз-никающих проблем с катетеризацией (местная гема-тома, травма сосуда и т.…”

Section: денервация почекunclassified

2013 Esh/Esc Guidelines for the Management of Arterial Hypertension

Mancia

Fagard²,

Redón³

et al. 2014

Russ J Cardiol

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Авторы/члены рабочей группы: Giuseppe Mancia (сопредседатель; италия)*, Robert Fagard (сопредседатель; бельгия)*, Krzysztof Narkiewicz (координатор секции, Польша), Josep Redón (координатор секции; испания), Alberto Zanchetti (координатор секции, италия), Michael Böhm

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Renal Hemodynamics and Renal Function After Catheter-Based Renal Sympathetic Denervation in Patients With Resistant Hypertension

Cited by 285 publications

References 34 publications

Vascular and Renal Hemodynamic Changes after Renal Denervation

Vascular and Renal Hemodynamic Changes after Renal Denervation

Catheter-Based Renal Nerve Ablation and Centrally Generated Sympathetic Activity in Difficult-to-Control Hypertensive Patients: Prospective Case Series

2013 Esh/Esc Guidelines for the Management of Arterial Hypertension

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