Renal Sympathetic Denervation for Treating Resistant Hypertension

Polimeni, Alberto; Curcio, Antonio; Indolfi, Ciro

doi:10.1253/circj.cj-13-0297

Cited by 22 publications

(16 citation statements)

References 45 publications

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“…26,28,29 The impact of the renal sympathetic nervous system has received more attention in recent years, and catheter-based renal artery sympathetic denervation has been systematically studied based on the observation that renal sympathetic innervation overactivity contributes to resistance to pharmacologic antihypertensive treatments. 28,30 While there was initial excitement over the use of renal artery denervation for the treatment of resistant hypertension, the efficacy of such an approach is unresolved due to recent negative trials. [31][32][33] Limitations There are several limitations of this retrospective cohort study.…”

Section: Change In Blood Pressure Duringmentioning

confidence: 99%

Improvement in All‐Cause Mortality With Blood Pressure Control in a Group of US Veterans With Drug‐Resistant Hypertension

Fatemi

Goa

Faselis

et al. 2015

J of Clinical Hypertension

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The current definition of drug-resistant hypertension includes patients with uncontrolled (URH) (taking ≥3 antihypertensive medications) and controlled hypertension (CRH; blood pressure [BP] ≤140/90 mm Hg) (taking ≥4 medications). The authors hypothesized that all-cause mortality is reduced when URH is controlled. Qualified patients followed at the Washington DC VA Medical Center were included. BPs were averaged for each year of follow-up. In 2006, among 2906 patients who met the criteria for drug-resistant hypertension, 628 had URH. During follow-up, 234 patients were controlled (group 1) and 394 patients remained uncontrolled (group 2).The mortality rate among patients with URH was 28% (110 of 394) and among patients with CRH was 13% (30 of 234), a 54% reduction (P<.01). Multivariate analysis identified independent predictors of mortality as uncontrolled HTN (hazard ratio, 2.5; 95% confidence interval, 1.67-3.75; P<.01), age (hazard ratio, 1.03; 95% confidence interval, 1.01-1.04; P<.01), and diabetes (hazard ratio, 1.46; 95% confidence interval, 1.04-2.05; P<.027). The authors conclude that controlling drug-resistant hypertension markedly reduces all-cause mortality. J Clin Hypertens (Greenwich).

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Section: Change In Blood Pressure Duringmentioning

confidence: 99%

Improvement in All‐Cause Mortality With Blood Pressure Control in a Group of US Veterans With Drug‐Resistant Hypertension

Fatemi

Goa

Faselis

et al. 2015

J of Clinical Hypertension

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“…The altered expression and function of AT2R in the IML may contribute to the sympatho-excitation in the above mentioned diseases. For instance, renal nerve ablation (renal sympathetic denervation) is a novel strategy to treat resistant hypertension [55]. Our findings suggested that the AT2R in the IML has a postsynaptic effect which can inhibit the sympathetic outflow.…”

Section: Perspectivesmentioning

confidence: 78%

Angiotensin type 2 receptors in the intermediolateral cell column of the spinal cord: Negative regulation of sympathetic nerve activity and blood pressure

Chao

Gao

Parbhu

et al. 2013

International Journal of Cardiology

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BACKGROUND Our previous study demonstrated that AT2R in brainstem nuclei participated in the regulation of sympathetic outflow and cardiovascular function. However, the functional significance of AT2R in the intermediolateral cell column (IML) of the thoracic spinal cord in normal rats remains elusive. We hypothesized that AT2R activation in the IML exert a sympatho-inhibitory effect. METHODS and RESULTS Using Western-blot analysis, immunohistochemical staining and quantitative Real-Time PCR, both AT1R and AT2R expression were detected in the spinal cord. The highest AT2R protein expression was found in the IML, while AT1R expression didn’t display regional differences within the gray matter. Microinjection of AngII into the IML dose-dependently elevated mean blood pressure (MAP, employing a transducer-tipped catheter) and renal sympathetic nerve activity (RSNA, using a pair of platinum-iridium recording electrodes), which was completely abolished by Losartan, and attenuated by TEMPOL and apocynin. Activation of AT2R in the IML with CGP42112 evoked hypotension (ΔMAP: −21 ± 4 mmHg) and sympatho-inhibition (RSNA: 73 ± 3% of baseline), which were completely abolished by PD123319 and L-NAME. Blockade of AT2R in the IML with PD123319 significantly increased MAP (11 ± 1 mmHg) and sympathetic nerve activity (RSNA: 133 ± 13 % of baseline). Moreover, PD123319 significantly enhanced the AngII induced pressor response. Furthermore, in isolated IML neurons, CGP42112 treatment augmented potassium current and decreased resting membrane potential by employing whole-cell patch clamp. Conclusion In the normal condition, AT2R in the IML tonically inhibit sympathetic activity through an NO/NOS dependent pathway and subsequent potassium channel activation.

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“…По данным СМАД, сред-несуточное АД к этому сроку наблюдения уменьши-лось на 18,58/14,62 мм рт.ст., среднее дневное АД -на 17,1/14,9 мм рт.ст., а в ночное время -на 21,1/14,47 мм рт.ст. Полученные цифры снижения АД к 12 мес наблюдения согласуются с данными литературы и еще раз дают основание считать, что денервация почечной артерии у больных с резистент-ной АГ может быть методом снижения АД [11][12][13]. Примечание: * -p<0,01; † р<0,02 -значимые различия по отношению к периоду до выполнения почечной денервации.…”

Section: результаты и обсуждениеunclassified

Effects of Renal Artery Denervation on Left Ventricular Deformation and Blood Flow Velocity in the Distal Segment of Anterior Descending Coronary Artery Among Patients With Resistant Arterial Hypertension

Павлюкова¹,

Мордовии²,

Pekarskiĭ³

et al. 2014

Russ J Cardiol

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Renal Sympathetic Denervation for Treating Resistant Hypertension

Cited by 22 publications

References 45 publications

Improvement in All‐Cause Mortality With Blood Pressure Control in a Group of US Veterans With Drug‐Resistant Hypertension

Improvement in All‐Cause Mortality With Blood Pressure Control in a Group of US Veterans With Drug‐Resistant Hypertension

Angiotensin type 2 receptors in the intermediolateral cell column of the spinal cord: Negative regulation of sympathetic nerve activity and blood pressure

Effects of Renal Artery Denervation on Left Ventricular Deformation and Blood Flow Velocity in the Distal Segment of Anterior Descending Coronary Artery Among Patients With Resistant Arterial Hypertension

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