Treatment of resistant hypertension with renal denervation – yes or no?
Abstract
The true resistant hypertension is rare. The reasons are not entirely clear, but undoubtedly vegetative nervous system (renal afferent and efferent nerves) plays an important role. Surgical sympathectomy is effective but because of serious side effects is inappropriate. In recent years, a special catheter for endovascular renal radiofrequent denervation has been developed. With this method we have treated in accordance with the Slovenian and European recommendations, five patients with resistant hypertension. The radiofrequent ablation of renal arteries was not effective in our patients which is not what we expected because of the results of the first two non-randomized uncontrolled studies - Simplicity HTN 1 and 2. The third in a series of international multicentre studies - a randomized, controlled, single-blind study Simplicity HTN 3 showed, however, that renal denervation is not effective method for the treatment of resistant hypertension. A detailed overview of enrolled patients suggests that certain patients may be eligible for intervention, but have not yet been identified.
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References
Accetto R, Salobir B. Epidemiološka raziskava hipertenzije v Sloveniji – delno poročilo. XVIII. Strokovni sestanek Sekcije za hipertenzijo . Zbornik. 2009;9-17
Accetto R, Salobir B. Epidemiologija arterijske hipertenzije – regionalne razlike. XIX. Strokovni sestanek sekcije za hipertenzijo. Zbornik. 2010;7-16
Hoobler SW, Manning JT, Paine WG in sod. The effects of splanchnicectomy on the blood pressure in hypertension; a controlled study. Circulation 1951; 4: 173–83
Smithwick RH, Thompson JE. Splanchnicectomy for essential hypertension; results in 1,266 cases. J Am Med Assoc 1953;152: 1501–04
Esler M, Jennings G, Korner P, in sod. Assessment of human sympathetic nervous system activity from measurements of norepinephrine turnover. Hypertension 1988; 11: 3–20
DiBona GF, Kopp UC. Neural control of renal function. Physiol Rev 1997;77:75-97
Kopp UC, Cicha MZ, Smith LA in sod. Renal sympathetic nerve activity modulates afferent renal nerve activity by PGE2-dependent activation of alpha1- and alpha2-adrenoceptors on renal sensory nerve fibers. Am J Physiol Regul Integr Comp Physiol 2007; 293: R1561–72
Hausberg M, Kosch M, Harmelink P, in sod. Sympathetic nerve activity in end-stage renal disease. Circulation 2002; 106: 1974–79
Stella A, Zanchetti A. Functional role of renal afferents. Physiol Rev 1991; 71: 659–82
Krum H, Schlaich M, Whitbourn R, in sod. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 2009; 373: 1275–81
Schmieder RE, Redon J, Grassi G, Kjeldsen SE, Mancia G, Narkiewicz K, in sod. ESH Position Paper: Renal denervation – an interventional therapy of resistant hypertension. J Hypertens 2012; 30: 837-41.
Salobir B, Accetto R, Kuhelj D. Evropska in slovenska priporočila za zdravljenje hipertenzije z renalno denervacijo. Zbornik / XXI. strokovni sestanek Sekcije za hipertenzijo, Ljubljana, 22.-23. november 2012 ; [urednik zbornika Primož Dolenc]. - Ljubljana : Slovensko zdravniško društvo, Sekcija za hipertenzijo, 2012, 19-24
Accetto R, Salobir B, Kuhelj D. Succesfull denervation – haemodynamic changes during ablation: a case report. 23rd European Meeting on Hypertension &Cardiovascular Protection. Abstract book. Milan, June 14 – 17, 2013)
Symplicity HTN-1 Investigators. Symplicity HTN-1. Catheter-Based Renal Sympathetic Denervation for Resistant Hypertension: Durability of Blood Pressure Reduction Out to 24 Months. Hypertension. 2011;57:911-917
Symplicity HTN-2 Investigators. Symplicity HTN-2. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet 2010; 376: 1903–09
Franke RH, Kaul JD. The Hawthorne experiment: First statistical interpretation. American Socilogical Review. 1978;43:623-643)
Fadl Elmula FE, Hoffmann P, Fossum E, in sod. Renal Sympathetic Denervation in Patients With Treatment-Resistant Hypertension After Witnessed Intake of Medication Before Qualifying Ambulatory Blood Pressure. Hypertension. 2013;62:526-532
Fadl Elmula FE, Hoffmann P, Larstorp AC, in sod. Adjusted Drug Treatment Is Superior to Renal Sympathetic Denervation in Patients With True Treatment-Resistant Hypertension. Hypertension. 2014;63:991-999
Persu A, Jin Yu, Baelen M, in sod. Eligibility for Renal Denervation Experience at 11 European Expert Centers. Hypertension. 2014;63:1319-1325
Bhatt DL, Kandzari DE, O’Neill WW, in sod. A Controlled Trial of Renal Denervation for Resistant Hypertension. N Engl J Med 2014;370:1393-401
Aguila FJ, Mediavilla JD, Navarro EM in sod. Bilateral renal artery stenosis after renal denervation. Hypertension 2014;63:e126-e127
ESH Statement on Simplicity HTN-3 results. Hypertension specialist news. http://www.eshonline.org)
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