Effects of Renal Sympathetic Denervation on Blood Pressure, Sleep Apnea Course, and Glycemic Control in Patients With Resistant Hypertension and Sleep Apnea
Adam Witkowski,Aleksander Prejbisz,Elżbieta Florczak,Jacek Kądziela,Paweł Śliwiński,Przemyslaw Bielen,Ilona Michałowska,Marek Kabat,E. Warchol,Magdalena Januszewicz,Krzysztof Narkiewicz,Virend K. Somers,Paul A. Sobotka,Andrzej Januszewicz +13 more
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TLDR
Catheter-based renal sympathetic denervation lowered BP in patients with refractory hypertension and obstructiveSleep apnea, which was accompanied by improvement of sleep apnea severity, and Interestingly, there are also accompanying improvements in glucose tolerance.Abstract:
Percutaneous renal sympathetic denervation by radiofrequency energy has been reported to reduce blood pressure (BP) by the reduction of renal sympathetic efferent and afferent signaling. We evaluated the effects of this procedure on BP and sleep apnea severity in patients with resistant hypertension and sleep apnea. We studied 10 patients with refractory hypertension and sleep apnea (7 men and 3 women; median age: 49.5 years) who underwent renal denervation and completed 3-month and 6-month follow-up evaluations, including polysomnography and selected blood chemistries, and BP measurements. Antihypertensive regimens were not changed during the 6 months of follow-up. Three and 6 months after the denervation, decreases in office systolic and diastolic BPs were observed (median: -34/-13 mm Hg for systolic and diastolic BPs at 6 months; both P<0.01). Significant decreases were also observed in plasma glucose concentration 2 hours after glucose administration (median: 7.0 versus 6.4 mmol/L; P=0.05) and in hemoglobin A1C level (median: 6.1% versus 5.6%; P<0.05) at 6 months, as well as a decrease in apnea-hypopnea index at 6 months after renal denervation (median: 16.3 versus 4.5 events per hour; P=0.059). In conclusion, catheter-based renal sympathetic denervation lowered BP in patients with refractory hypertension and obstructive sleep apnea, which was accompanied by improvement of sleep apnea severity. Interestingly, there are also accompanying improvements in glucose tolerance. Renal sympathetic denervation may conceivably be a potentially useful option for patients with comorbid refractory hypertension, glucose intolerance, and obstructive sleep apnea, although further studies are needed to confirm these proof-of-concept data.read more
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Importance of thorough investigation of resistant hypertension before renal denervation: should compliance to treatment be evaluated systematically?
Ján Rosa,Ján Rosa,Tomáš Zelinka,Ondřej Petrák,Branislav Štrauch,Z. Somloova,T. Indra,Robert Holaj,K Ccaron,urila,Petr Tousek,Michal Senitko,Petr Widimský,Jiří Widimský +13 more
TL;DR: A thorough examination of severe hypertension including 24 h ABPM, secondary hypertension exclusion and drug compliance testing before considering RD reveals that majority of these patients are not suitable for RD.
Journal ArticleDOI
The sympathetic nervous system and new nonpharmacologic approaches to treating hypertension: a focus on renal denervation
TL;DR: This paper examines the rationale and the technical details, as well as the results achieved so far, with the use of a new technique that allows the elimination of afferent and efferent innervation of the kidney in resistant hypertension, ie, the ablation of renal nerves.
Patent
Device for mapping and ablating renal nerves distributed on the renal artery
TL;DR: In this article, a device for mapping and ablating the renal nerves distributed on the renal artery is provided, comprising a guide catheter, a mapping-ablation catheter (12), a handle (13), and a connector.
Journal ArticleDOI
Renal denervation: current implications and future perspectives
Jianzhong Xu,Dagmara Hering,Dagmara Hering,Yusuke Sata,Antony Walton,Henry Krum,Henry Krum,Murray D. Esler,Murray D. Esler,Markus P. Schlaich,Markus P. Schlaich,Markus P. Schlaich +11 more
TL;DR: The physiology of the renal nerves and their role in hypertension and other relevant disease states is reviewed, the data currently available from clinical studies pertaining to the safety and efficacy of renal denervation in resistant hypertension is summarized, and potential future implications and the available data supporting such a role are discussed.
Journal ArticleDOI
Renal artery anatomy affects the blood pressure response to renal denervation in patients with resistant hypertension.
Dagmara Hering,Dagmara Hering,Petra Marusic,Petra Marusic,Antony Walton,Jacqueline Duval,Rebecca Lee,Yusuke Sata,Henry Krum,Henry Krum,Elisabeth Lambert,Karlheinz Peter,Karlheinz Peter,Geoff Head,Gavin W. Lambert,Murray D. Esler,Murray D. Esler,Markus P. Schlaich +17 more
TL;DR: The presence of single renal arteries with or without structural abnormalities is associated with a more pronounced BP and MSNA lowering effect than the presence of dual renal arteries in patients with RH, however, when patients withDual renal arteries received renal nerve ablation in all arteries there was trend towards a greater BP reduction.
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A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects.
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