The Prevalence of Japanese Outpatients with Hypertension Who Meet the Definition of Treatment Resistant Hypertension and Are Eligible for Enrolment in Clinical Trials of Endovascular Ultrasound Renal Denervation

Abstract

Objective A clinical trial (REQUIRE) was started to investigate the use of an ultrasound renal denervation system in the treatment of resistant hypertension (RHT). We analyzed the prevalence of patients who were eligible for inclusion in this cross-sectional study at the time of screening. Methods Nine-hundred ninety-nine consecutive hypertension (HT) patients who were treated in our hospital as outpatients were classified into the following categories: patients treated with at least 3 types of antihypertensive drugs including diuretic agents who were eligible for enrolment in SYMPLICITY HTN-Japan (SH-J) with an office systolic blood pressure (SBP) of ≥160 mmHg, who were ≤80 years of age, and an estimated glomerular filtration rate (eGFR) of ≥45 mL/min/1.73 m2 (RHT-S); and patients who were treated similar medications and who were eligible for enrolment in REQUIRE, with an SBP of ≥150 mmHg, ≤75 years of age, and an eGFR of ≥40 mL/min/1.73 m2 (RHT-R). We investigated the proportion of patients in each category. We also investigated HT patients (1,423 cases) who were enrolled in the Chikushi Anti-Hypertension Trial (CHAT), a research network that includes general practitioners. Results Eleven patients (1.1%) with RHT-S and 18 patients (1.8%) with RHT-R were identified. After the exclusion of patients with secondary HT and a diastolic blood pressure (DBP) of <90 mmHg (applied in REQUIRE), 5 patients (0.5%) with RHT-S and 4 patients (0.4%) with RHT-R remained. In the analysis of the CHAT study, only 2 (0.1%) patients with RHT-R remained. Conclusion The number of eligible patients in the REQUIRE trial was decreased, largely due to the strict age restriction and the new DBP limitation. The prevalence of eligible patients in REQUIRE was estimated to be approximately 0.5 to 0.8 times that in SH-J. Since patient enrollment will be difficult, drastic measures may be required to recruit eligible patients.

Exosomes Derived From Mesenchymal Stromal Cells Pretreated With Advanced Glycation End Product-Bovine Serum Albumin Inhibit Calcification of Vascular Smooth Muscle Cells

“…Despite the effect of AGEs on inducing VSMC osteogenesis transformation, it played an opposite role in bone-related cells. Previous studies have revealed that AGEs are a an important promotive factor in osteoporosis ( 8 ). Thus, it is meaningful to illuminate the mechanisms underlying those contradictory phenomena.…”

Reduction of Blood Pressure Following After Renal Artery Adventitia Stripping During Total Nephroureterectomy: Potential Effect of Renal Sympathetic Denervation

“…However, the number of eligible patients enrolled in the REQUIRE trial so far is quite small and patient recruitment is challenging [ 21 ]. Based on the results of SH-3 [ 6 ], renal denervation is generally seen as being of doubtful value for hypertension and patient enrollment also appears slow in the other studies.…”

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“…Hence, beta-blockers have been used extensively for prophylaxis of AF after cardiac surgery, and the efficacy of them as first-line agents for the prevention of POAF has been confirmed in several clinical trials and meta-analysis 9,10 . However, several studies have elucidated that differences in response to β 1 -adrenergic receptor (β 1 AR) antagonists could have been influenced by considerable interindividual and interethnic variations 11,12 . These findings suggest that the genetic variation of the β 1 AR gene may be the basis of interindividual differences in response to betablocking medications as prophylaxis for POAF in patients after cardiac surgery.…”