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A clinician's perspective of the role of renal sympathetic nerves in hypertension.

Briasoulis A, Bakris GL - Front Physiol (2015)

Bottom Line: The renal sympathetic nerves have significant contribution to the control of different aspects of kidney function.Recently, data from prospective cohorts and randomized studies showed that renal denervation therapy (RDN) is a safe procedure but is associated with only modest reduction of ambulatory blood pressure (BP) in patients on intensive medical therapy.The main goal of this article is to review the results of preclinical and clinical studies on the contribution of the renal sympathetic nervous system to hypertension and the therapeutic applications of catheter-based renal denervation.

View Article: PubMed Central - PubMed

Affiliation: American Society of Hypertension Comprehensive Hypertension Center, Department of Medicine, The University of Chicago Medicine Chicago, IL, USA.

ABSTRACT
The renal sympathetic nerves have significant contribution to the control of different aspects of kidney function. Early animal studies of renal denervation in a large number of different models of hypertension showed that that RDN improved BP control. Recently, data from prospective cohorts and randomized studies showed that renal denervation therapy (RDN) is a safe procedure but is associated with only modest reduction of ambulatory blood pressure (BP) in patients on intensive medical therapy. The main goal of this article is to review the results of preclinical and clinical studies on the contribution of the renal sympathetic nervous system to hypertension and the therapeutic applications of catheter-based renal denervation.

No MeSH data available.


Related in: MedlinePlus

Systolic blood pressure change at symplicity HTN-3 study at 6 months according to ablation pattern.
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Figure 1: Systolic blood pressure change at symplicity HTN-3 study at 6 months according to ablation pattern.

Mentions: Based on the findings of the first cohorts and randomized trials a number of concerns arise regarding the utility of RDN on patients with RH: (i) A limited number of patients with RH are candidates for the procedure due to presence of secondary form of HTN, CKD, normal home BP measurement or unsuitable anatomy. (ii) A significant portion of patients (15–30%) will have less than 10/5 mmHg BP reduction with RDT due to procedural-related limitations, operator experience and number of treatment delivered. In a subgroup analysis of Symplicity HTN-3 higher number of ablations (10–13) and also ablations in all for quadrants of the arterial wall cross sections (Figure 1) were associated with significant ambulatory BP reduction compared to the sham control group (Kandzari et al., 2015). (iii) Non-adherence to antihypertensive regimens affects more than 50% of patients with difficult to control hypertension (Jung et al., 2013). In Symplicity-HTN 3, appropriate combination and dosage of antihypertensive regimens, improved patient compliance and assessment with home and ambulatory BP led to substantial BP reduction in the control group which was greater compared to previous RDN trials. The importance of medication adherence and structured adjustment of antihypertensive medications was also shown in the recently published Oslo RDN trial (Fadl Elmula et al., 2014), which stopped early in view of the dramatic superiority of adjusted drug treatment and witnessed medication intake compared to RDN at 6 months of follow-up. (iv) Finally, RDN may not be suitable for all subgroups of patients regardless of the degree of sympathetic activity. In SYMPLICITY HTN-3 subgroup analysis revealed that African American control patients demonstrated an unusually greater decrease in systolic blood pressure compared with non-African American controls and a blunted response to RDN compared to non-African Americans. The marked reduction in blood pressure in the sham control group could be related to a change in medical adherence, type of therapy or degree of sympathetic activation (Kandzari et al., 2015).


A clinician's perspective of the role of renal sympathetic nerves in hypertension.

Briasoulis A, Bakris GL - Front Physiol (2015)

Systolic blood pressure change at symplicity HTN-3 study at 6 months according to ablation pattern.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4373248&req=5

Figure 1: Systolic blood pressure change at symplicity HTN-3 study at 6 months according to ablation pattern.
Mentions: Based on the findings of the first cohorts and randomized trials a number of concerns arise regarding the utility of RDN on patients with RH: (i) A limited number of patients with RH are candidates for the procedure due to presence of secondary form of HTN, CKD, normal home BP measurement or unsuitable anatomy. (ii) A significant portion of patients (15–30%) will have less than 10/5 mmHg BP reduction with RDT due to procedural-related limitations, operator experience and number of treatment delivered. In a subgroup analysis of Symplicity HTN-3 higher number of ablations (10–13) and also ablations in all for quadrants of the arterial wall cross sections (Figure 1) were associated with significant ambulatory BP reduction compared to the sham control group (Kandzari et al., 2015). (iii) Non-adherence to antihypertensive regimens affects more than 50% of patients with difficult to control hypertension (Jung et al., 2013). In Symplicity-HTN 3, appropriate combination and dosage of antihypertensive regimens, improved patient compliance and assessment with home and ambulatory BP led to substantial BP reduction in the control group which was greater compared to previous RDN trials. The importance of medication adherence and structured adjustment of antihypertensive medications was also shown in the recently published Oslo RDN trial (Fadl Elmula et al., 2014), which stopped early in view of the dramatic superiority of adjusted drug treatment and witnessed medication intake compared to RDN at 6 months of follow-up. (iv) Finally, RDN may not be suitable for all subgroups of patients regardless of the degree of sympathetic activity. In SYMPLICITY HTN-3 subgroup analysis revealed that African American control patients demonstrated an unusually greater decrease in systolic blood pressure compared with non-African American controls and a blunted response to RDN compared to non-African Americans. The marked reduction in blood pressure in the sham control group could be related to a change in medical adherence, type of therapy or degree of sympathetic activation (Kandzari et al., 2015).

Bottom Line: The renal sympathetic nerves have significant contribution to the control of different aspects of kidney function.Recently, data from prospective cohorts and randomized studies showed that renal denervation therapy (RDN) is a safe procedure but is associated with only modest reduction of ambulatory blood pressure (BP) in patients on intensive medical therapy.The main goal of this article is to review the results of preclinical and clinical studies on the contribution of the renal sympathetic nervous system to hypertension and the therapeutic applications of catheter-based renal denervation.

View Article: PubMed Central - PubMed

Affiliation: American Society of Hypertension Comprehensive Hypertension Center, Department of Medicine, The University of Chicago Medicine Chicago, IL, USA.

ABSTRACT
The renal sympathetic nerves have significant contribution to the control of different aspects of kidney function. Early animal studies of renal denervation in a large number of different models of hypertension showed that that RDN improved BP control. Recently, data from prospective cohorts and randomized studies showed that renal denervation therapy (RDN) is a safe procedure but is associated with only modest reduction of ambulatory blood pressure (BP) in patients on intensive medical therapy. The main goal of this article is to review the results of preclinical and clinical studies on the contribution of the renal sympathetic nervous system to hypertension and the therapeutic applications of catheter-based renal denervation.

No MeSH data available.


Related in: MedlinePlus