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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Diagnosis and Treatment of Resistant Hypertension: The Critical Role of Ambulatory Blood Pressure Monitoring
J. Rick Turner,Eoin O'Brien +1 more
TL;DR: While some trials that employ CBPM may be very well conducted and may indeed show an effect on BP at the snapshot in time at which a measurement is taken, they cannot provide information on the duration of anEffect on BP throughout a 24-hour period or its effect during the nocturnal period.
Journal ArticleDOI
Catheter-based Radiofrequency Renal Sympathetic Denervation for Resistant Hypertension
B. Damascelli,Gianluigi Patelli,Vladimira Tichà,Federica Della Rocca,Salvatore Lattuada,Chiara Sala,Alberto Albertoni,Andrea D’Alessio,Alfonso Funaro,Lorenza Scotti +9 more
TL;DR: Catheter-based RDN was carried out safely, even in patients with comorbidities, abnormal renal arteries, or anatomic variants, and Renal function remained unchanged in all patients, including those with renal failure.
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Device-based approaches for renal nerve ablation for hypertension and beyond
TL;DR: The pathological rationale for targeting sympathetic renal nerves for blood pressure control is explored and preliminary evidence in support of renal denervation as a possible therapeutic option in disease states characterized by central sympathetic overactivity is presented.
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Sleep apnea is not associated with worse outcomes in kidney transplant recipients
Katalin Fornadi,Katalin Zsuzsanna Ronai,Csilla Zita Turányi,Tushar S Malavade,Colin M. Shapiro,Marta Novak,Istvan Mucsi,Miklos Z. Molnar +7 more
TL;DR: No association was found between the presence of OSA and the rate of progression of CKD or all-cause mortality in prevalent kidney transplant recipients.
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Is Aberrant Reno-Renal Reflex Control of Blood Pressure a Contributor to Chronic Intermittent Hypoxia-Induced Hypertension?
TL;DR: Focus is drawn to the potential contribution of aberrant renal afferent signaling in the development, maintenance and progression of high blood pressure, which may have relevance to CIH-induced hypertension.
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