Advertisement

Renal Artery Denervation for Hypertension

  • Lauren S. RanardEmail author
  • Rajesh V. Swaminathan
Coronary Artery Disease (D Feldman and V Voudris, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Coronary Artery Disease

Abstract

Purpose of review

Hypertension (HTN) has a growing impact, already affecting over 1 billion people. An estimated 2–16% of those with HTN have resistant HTN. The sympathetic nervous system (SNS) is a recognized contributor to the pathophysiology of resistant HTN. Current hypertensive pharmacotherapy has not fully targeted the SNS; therefore, the SNS has become a prominent research therapeutic target. This review summarizes the evidence and rationale behind renal denervation (RDN) therapy and the technology available.

Recent findings

Prior to the SYMPLICITY HTN-3 clinical trial, trials found RDN to be an effective procedure to control resistant hypertension. The failure of SYMPLICITY HTN-3 to meet its primary efficacy endpoint sparked further studies to address potential shortcomings. The subsequent SPYRAL program trials demonstrated efficacy of RDN therapy in a controlled manner; however, they were not adequately powered. Ongoing research is examining new, innovative RDN technology as well as defining appropriate patients to target for treatment.

Summary

The data currently available for RDN in HTN and other states of SNS activation suffer from potential biases and limitations, highlighting the need for continued exploration. Contemporary studies are more promising and hypothesis-generating. Future trials and continued device innovation will be crucial for understanding the clinical applications of RDN therapy.

Keywords

Renal denervation Resistant hypertension Sympathetic nervous system 

Notes

Compliance with Ethical Standards

Conflict of Interest

Lauren S. Ranard and Rajesh V. Swaminathan declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134(6):441–50.  https://doi.org/10.1161/circulationaha.115.018912.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon-Moran D. Hypertension prevalence and control among adults: United States, 2015-2016. NCHS data brief. 2017(289):1–8.Google Scholar
  3. 3.
    Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217–23.  https://doi.org/10.1016/s0140-6736(05)17741-1.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67–e492.  https://doi.org/10.1161/cir.0000000000000558.CrossRefGoogle Scholar
  5. 5.
    Arima H, Barzi F, Chalmers J. Mortality patterns in hypertension. J Hypertens. 2011;29(Suppl 1):S3–7.  https://doi.org/10.1097/01.hjh.0000410246.59221.b1.CrossRefPubMedGoogle Scholar
  6. 6.
    Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension. 2017;71:e13–e115.  https://doi.org/10.1161/hyp.0000000000000065.CrossRefPubMedGoogle Scholar
  7. 7.
    Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT, et al. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation. 2018;137(2):109–18.  https://doi.org/10.1161/circulationaha.117.032582.CrossRefPubMedGoogle Scholar
  8. 8.
    Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment. Circulation. 2008;117(25):e510–e26.  https://doi.org/10.1161/circulationaha.108.189141.CrossRefGoogle Scholar
  9. 9.
    Daugherty SL, Powers JD, Magid DJ, Tavel HM, Masoudi FA, Margolis KL, et al. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation. 2012;125(13):1635–42.  https://doi.org/10.1161/circulationaha.111.068064.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Judd E, Calhoun DA. Apparent and true resistant hypertension: definition, prevalence and outcomes. J Hum Hypertens. 2014;28(8):463–8.  https://doi.org/10.1038/jhh.2013.140.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lloyd-Jones DM, Evans JC, Larson MG, O’Donnell CJ, Roccella EJ, Levy D. Differential control of systolic and diastolic blood pressure—factors associated with lack of blood pressure control in the community. Hypertension. 2000;36(4):594–9.  https://doi.org/10.1161/01.Hyp.36.4.594.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Zheng L, Li J, Sun Z, Yu J, Zhang X, Zhang X, et al. Differential control of systolic and diastolic blood pressure: factors associated with lack of blood pressure control in rural Community of Liaoning Province, China. J Health Sci. 2007;53(2):209–14.  https://doi.org/10.1248/jhs.53.209.CrossRefGoogle Scholar
  13. 13.
    Cushman WC, Ford CE, Cutler JA, Margolis KL, Davis BR, Grimm RH, et al. Success and predictors of blood pressure control in diverse north american settings: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens. 2002;4(6):393–404.  https://doi.org/10.1111/j.1524-6175.2002.02045.x.CrossRefGoogle Scholar
  14. 14.
    Smith PA, Graham LN, Mackintosh AF, Stoker JB, Mary DA. Relationship between central sympathetic activity and stages of human hypertension. Am J Hypertens. 2004;17(3):217–22.  https://doi.org/10.1016/j.amjhyper.2003.10.010.CrossRefPubMedGoogle Scholar
  15. 15.
    Simms AE, Paton JF, Pickering AE, Allen AM. Amplified respiratory-sympathetic coupling in the spontaneously hypertensive rat: does it contribute to hypertension? J Physiol. 2009;587(3):597–610.  https://doi.org/10.1113/jphysiol.2008.165902.CrossRefPubMedGoogle Scholar
  16. 16.
    Yim HE, Yoo KH. Renin-angiotensin system—considerations for hypertension and kidney. Electrolyte Blood Press. 2008;6(1):42–50.  https://doi.org/10.5049/EBP.2008.6.1.42.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Nishi EE, Bergamaschi CT, Campos RR. The crosstalk between the kidney and the central nervous system: the role of renal nerves in blood pressure regulation. Exp Physiol. 2015;100(5):479–84.  https://doi.org/10.1113/expphysiol.2014.079889.CrossRefPubMedGoogle Scholar
  18. 18.
    Sata Y, Head GA, Denton K, May CN, Schlaich MP. Role of the sympathetic nervous system and its modulation in renal hypertension. Frontiers in Medicine. 2018.Google Scholar
  19. 19.
    Fisher JP, Fadel PJ. Therapeutic strategies for targeting excessive central sympathetic activation in human hypertension. Exp Physiol. 2010;95(5):572–80.  https://doi.org/10.1113/expphysiol.2009.047332.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Morrissey DM, Brookes VS, Cooke WT. Sympathectomy in the treatment of hypertension; review of 122 cases. Lancet. 1953;1(6757):403–8.CrossRefGoogle Scholar
  21. 21.
    • Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet. 2009;373(9671):1275–81.  https://doi.org/10.1016/s0140-6736(09)60566-3This study was the first proof-of-concept trial to evaluate RDN. The trial demonstrated that catheter-based denervation led to a substantial BP reduction without serious adverse events.CrossRefGoogle Scholar
  22. 22.
    Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months. Hypertension. 2011;57(5):911–7.  https://doi.org/10.1161/hypertensionaha.110.163014 Symplicity HTN-1 Investigators.
  23. 23.
    Krum H, Schlaich MP, Sobotka PA, Böhm M, Mahfoud F, Rocha-Singh K, et al. Percutaneous renal denervation in patients with treatment-resistant hypertension: final 3-year report of the Symplicity HTN-1 study. Lancet. 2014;383(9917):622–9.  https://doi.org/10.1016/S0140-6736(13)62192-3.CrossRefGoogle Scholar
  24. 24.•
    Esler M, Krum H, Sobotka P, Schlaich M, Schmieder R, Bohm M. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet. 2010;376(9756):1903–9.  https://doi.org/10.1016/S0140-6736(10)62039-9A multicentre RCT examining RDN versus control in patients with resistant hypertension. Catheter based RDN was demonstrated to lead to a substantial reduction in BP.CrossRefGoogle Scholar
  25. 25.
    Staessen JA, Den Hond E, Celis H, Fagard R, Keary L, Vandenhoven G, et al. Antihypertensive treatment based on blood pressure measurement at home or in the physician's office: a randomized controlled trial. JAMA. 2004;291(8):955–64.  https://doi.org/10.1001/jama.291.8.955.CrossRefPubMedGoogle Scholar
  26. 26.•
    Bakris GL, Townsend RR, Liu M, Cohen SA, D'Agostino R, Flack JM, et al. Impact of renal denervation on 24-hour ambulatory blood pressure: results from SYMPLICITY HTN-3. J Am Coll Cardiol. 2014;64(11):1071–8.  https://doi.org/10.1016/j.jacc.2014.05.012SYMPLICITY HTN-3 was a pivotal, prospective, sham-controlled study that did not demonstrate any benefit in the use of RDN for reduction of ambulatory BP compared to sham.CrossRefPubMedGoogle Scholar
  27. 27.
    Bhatt DL, Kandzari DE, O'Neill WW, D'Agostino R, Flack JM, Katzen BT, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014;370(15):1393–401.  https://doi.org/10.1056/NEJMoa1402670.CrossRefPubMedGoogle Scholar
  28. 28.
    Bakris GL, Townsend RR, Flack JM, Brar S, Cohen SA, D'Agostino R, et al. 12-month blood pressure results of catheter-based renal artery denervation for resistant hypertension: the SYMPLICITY HTN-3 trial. JACC. 2015;65(13):1314–21.  https://doi.org/10.1016/j.jacc.2015.01.037.CrossRefPubMedGoogle Scholar
  29. 29.•
    Kandzari DE, Bhatt DL, Brar S, Devireddy CM, Esler M, Fahy M, et al. Predictors of blood pressure response in the SYMPLICITY HTN-3 trial. Eur Heart J. 2015;36(4):219–27.  https://doi.org/10.1093/eurheartj/ehu441This is a post hoc analyses of the SYMPLICITY HTN-3 investigating possible reasons for its’ disparate results. Possible confounding factors identified included: baseline office BP, aldosterone antagonist use, number of ablations performed and non-use of vasodilators.CrossRefPubMedGoogle Scholar
  30. 30.
    Kario K, Bhatt DL, Kandzari DE, Brar S, Flack JM, Gilbert C, et al. Impact of renal denervation on patients with obstructive sleep apnea and resistant hypertension—insights from the SYMPLICITY HTN-3 trial. Circ J. 2016;80(6):1404–12.  https://doi.org/10.1253/circj.CJ-16-0035.CrossRefPubMedGoogle Scholar
  31. 31.
    Azizi M, Sapoval M, Gosse P, Monge M, Bobrie G, Delsart P, et al. Optimum and stepped care standardised antihypertensive treatment with or without renal denervation for resistant hypertension (DENERHTN): a multicentre, open-label, randomised controlled trial. Lancet. 2015;385(9981):1957–65.  https://doi.org/10.1016/S0140-6736(14)61942-5.CrossRefPubMedGoogle Scholar
  32. 32.
    •• Azizi M, Pereira H, Hamdidouche I, Gosse P, Monge M, Bobrie G, et al. Adherence to Antihypertensive Treatment and the Blood Pressure Lowering Effects of Renal Denervation in the Renal Denervation for Hypertension (DENERHTN) Trial. Circulation. 2016;134:847–57.  https://doi.org/10.1161/circulationaha.116.022922A contemporary study examining RDN in addition to standardized stepped-care antihypertensive treatment. A greater decrease in BP was seen with RDN plus standardized stepped-care antihypertensive treatment compared to the medication treatment regimen alone.CrossRefPubMedGoogle Scholar
  33. 33.
    •• Townsend RR, Mahfoud F, Kandzari DE, Kario K, Pocock S, Weber MA. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet. et al., 2017;390(10108):2160–70.  https://doi.org/10.1016/s0140-6736(17)32281-xAn international, multicentre, sham-controlled, proof-of-concept trial examining RDN, using the Symplicity Spyral catheter, in the absence of antihypertensive medications. This study provided biological proof of principle for the BP lowering effect of RDN.
  34. 34.
    •• Kandzari DE, Bohm M, Mahfoud F, Townsend RR, Weber MA, Pocock S, et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet. 2018;391(10137):2346–55.  https://doi.org/10.1016/s0140-6736(18)30951-6 An international, multicentre, sham-controlled, proof-of-concept trial examining RDN, using the Symplicity Spyral catheter, in the presence of antihypertensive medications. This study demonstrated greater reduction in BP at 6 months in the RDN group compared to sham group.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    •• Azizi M, Schmieder RE, Mahfoud F, Weber MA, Daemen J, Davies J, et al. Lancet. 2018, 2335;391(10137):–45.  https://doi.org/10.1016/s0140-6736(18)31082-1This study examined RDN using an alternative technology, endovascular ultrasound, to radiofrequency-based denervation. In the absence of antihypertensive medications, endovascular ultrasound RDN reduced ambulatory BP at 2 months compared to sham.
  36. 36.
    Tellez A, Rousselle S, Palmieri T, Rate WR, Wicks J, Degrange A, et al. Renal artery nerve distribution and density in the porcine model: biologic implications for the development of radiofrequency ablation therapies. Transl Res. 2013;162(6):381–9.  https://doi.org/10.1016/j.trsl.2013.07.002.CrossRefPubMedGoogle Scholar
  37. 37.
    Sakakura K, Ladich E, Cheng Q, Otsuka F, Yahagi K, Fowler DR, et al. Anatomic assessment of sympathetic peri-arterial renal nerves in man. JACC. 2014;64(7):635–43.  https://doi.org/10.1016/j.jacc.2014.03.059.CrossRefPubMedGoogle Scholar
  38. 38.
    Mahfoud F, Tunev S, Ewen S, Cremers B, Ruwart J, Schulz-Jander D, et al. Impact of lesion placement on efficacy and safety of catheter-based radiofrequency renal denervation. JACC. 2015;66(16):1766–75.  https://doi.org/10.1016/j.jacc.2015.08.018.CrossRefPubMedGoogle Scholar
  39. 39.
    Ormiston JA, Watson T, van Pelt N, Stewart R, Stewart JT, White JM, et al. Renal denervation for resistant hypertension using an irrigated radiofrequency balloon: 12-month results from the Renal Hypertension Ablation System (RHAS) Trial. EuroIntervention. 2013;9(1):70–4.  https://doi.org/10.4244/eijv9i1a11.CrossRefPubMedGoogle Scholar
  40. 40.
    Verheye S, Ormiston J, Bergmann MW, Sievert H, Schwindt A, Werner N, et al. Twelve-month results of the rapid renal sympathetic denervation for resistant hypertension using the OneShotTM ablation system (RAPID) study. EuroIntervention. 2015;10(10):1221–9.  https://doi.org/10.4244/eijy14m12_02.CrossRefPubMedGoogle Scholar
  41. 41.
    Worthley SG, Tsioufis CP, Worthley MI, Sinhal A, Chew DP, Meredith IT, et al. Safety and efficacy of a multi-electrode renal sympathetic denervation system in resistant hypertension: the EnligHTN I trial. Eur Heart J. 2013;34(28):2132–40.  https://doi.org/10.1093/eurheartj/eht197.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Sievert H, Schofer J, Ormiston J, Hoppe UC, Meredith IT, Walters DL, et al. Bipolar radiofrequency renal denervation with the Vessix catheter in patients with resistant hypertension: 2-year results from the REDUCE-HTN Trial. J Hum Hypertens. 2017;31(5):366–8.  https://doi.org/10.1038/jhh.2016.82.CrossRefPubMedGoogle Scholar
  43. 43.
    Mauri L, Kario K, Basile J, Daemen J, Davies J, Kirtane AJ, et al. A multinational clinical approach to assessing the effectiveness of catheter-based ultrasound renal denervation: the RADIANCE-HTN and REQUIRE clinical study designs. Am Heart J. 2018;195:115–29.  https://doi.org/10.1016/j.ahj.2017.09.006.CrossRefPubMedGoogle Scholar
  44. 44.
    Neuzil P, Ormiston J, Brinton TJ, Starek Z, Esler M, Dawood O, et al. Externally delivered focused ultrasound for renal denervation. JACC Cardiovasc Interv. 2016;9(12):1292–9.  https://doi.org/10.1016/j.jcin.2016.04.013.CrossRefPubMedGoogle Scholar
  45. 45.
    Prochnau D, Figulla HR, Surber R. Cryoenergy is effective in the treatment of resistant hypertension in non-responders to radiofrequency renal denervation. Int J Cardiol. 2013;167(2):588–90.  https://doi.org/10.1016/j.ijcard.2012.09.224.CrossRefPubMedGoogle Scholar
  46. 46.
    Bhatt N, Long SA, Gardner EA, Tay J, Ladich E, Chamberlain D, et al. Radiosurgical ablation of the renal nerve in a porcine model: a minimally invasive therapeutic approach to treat refractory hypertension. Cureus. 2017;9(2):e1055.  https://doi.org/10.7759/cureus.1055.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Fischell TA, Ebner A, Gallo S, Ikeno F, Minarsch L, Vega F, et al. Transcatheter alcohol-mediated perivascular renal denervation with the Peregrine System: first-in-human experience. JACC Cardiovasc Interv. 2016;9(6):589–98.  https://doi.org/10.1016/j.jcin.2015.11.041.CrossRefPubMedGoogle Scholar
  48. 48.
    Stefanadis C, Toutouzas K, Synetos A, Tsioufis C, Karanasos A, Agrogiannis G, et al. Chemical denervation of the renal artery by vincristine in swine. A new catheter based technique. Int J Cardiol. 2013;167(2):421–5.  https://doi.org/10.1016/j.ijcard.2012.01.002.CrossRefPubMedGoogle Scholar
  49. 49.
    Kirtane AJ, Schmieder R, Mahfoud F, Weber M, Daemen J, Basile J, et al. TCT-29 procedural and anatomic predictors of response in RADIANCE-HTN SOLO: a multicenter, randomized, sham-controlled trial of endovascular ultrasound renal denervation. JACC. 2018;72(13 Supplement):B13.CrossRefGoogle Scholar
  50. 50.
    •• Fengler K, Rommel K-P, Blazek S, Besler C, Hartung P, von Roeder M, et al. A three-arm randomized trial of Different Renal Denervation Devices and Techniques in Patients with Resistant Hypertension (RADIOSOUND-HTN). Circulation. 2018;0(0).  https://doi.org/10.1161/CIRCULATIONAHA.118.037654First trial to compare the effectiveness of three different strategies for RDN: (1) RF ablation of main renal arteries, (2) RF ablation of main renal arteries, side branches and accessories, and (3) endovascular ultrasound-based RDN of main renal artery. The study demonstrated that denervation using the Paradise endovascular ultrasound system had a greater reduction in ambulatory SBP compared to RF ablation of main renal artery alone.
  51. 51.
    Patel HC, Hayward C, Vassiliou V, Patel K, Howard JP, Di Mario C. Renal denervation for the management of resistant hypertension. Integ Blood Press Control. 2015;8:57–69.  https://doi.org/10.2147/IBPC.S65632.CrossRefGoogle Scholar
  52. 52.
    Shafi T, Chacko M, Berger Z, Wilson LM, Gayleard J, Bass EB et al. AHRQ Technology Assessments. Renal Denervation in the Medicare Population. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016.Google Scholar
  53. 53.
    Flack JM, Bhatt DL, Kandzari DE, Brown D, Brar S, Choi JW, et al. An analysis of the blood pressure and safety outcomes to renal denervation in African Americans and non-African Americans in the SYMPLICITY HTN-3 trial. J Am Soc Hypertens. 2015;9(10):769–79.  https://doi.org/10.1016/j.jash.2015.08.001.CrossRefPubMedGoogle Scholar
  54. 54.
    Sanders MF, Reitsma JB, Morpey M, Gremmels H, Bots ML, Pisano A, et al. Renal safety of catheter-based renal denervation: systematic review and meta-analysis. Nephrology Dialysis Transplantation. 2017;32(9):1440–7.  https://doi.org/10.1093/ndt/gfx088.CrossRefGoogle Scholar
  55. 55.
    Coppolino G, Pisano A, Rivoli L, Bolignano D. Renal denervation for resistant hypertension. Cochrane Database Syst Rev. 2017;2.  https://doi.org/10.1002/14651858.CD011499.pub2.
  56. 56.
    Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA. 1967;202(11):1028–34.Google Scholar
  57. 57.
    Ho CLB, Breslin M, Doust J, Reid CM, Nelson MR. Effectiveness of blood pressure-lowering drug treatment by levels of absolute risk: post hoc analysis of the Australian National Blood Pressure Study. BMJ Open. 2018;8(3):e017723.CrossRefGoogle Scholar
  58. 58.
    Kasiakogias A, Tsioufis C, Dimitriadis K, Konstantinidis D, Koumelli A, Leontsinis I, et al. Cardiovascular morbidity of severe resistant hypertension among treated uncontrolled hypertensives: a 4-year follow-up study. J Hum Hypertens. 2018;32(7):487–93.  https://doi.org/10.1038/s41371-018-0065-y.CrossRefPubMedGoogle Scholar
  59. 59.
    Soliman EZ, Ambrosius WT, Cushman WC, Zhang ZM, Bates JT, Neyra JA, et al. Effect of intensive blood pressure lowering on left ventricular hypertrophy in patients with hypertension: SPRINT (Systolic Blood Pressure Intervention Trial). Circulation. 2017;136(5):440–50.  https://doi.org/10.1161/CIRCULATIONAHA.117.028441.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Almuntaser I, Mahmud A, Brown A, Murphy R, King G, Crean P, et al. Blood pressure control determines improvement in diastolic dysfunction in early hypertension. Am J Hypertens. 2009;22(11):1227–31.  https://doi.org/10.1038/ajh.2009.173.CrossRefPubMedGoogle Scholar
  61. 61.
    Khurshid K, Yabes J, Weiss PM, Dharia S, Brown L, Unruh M, et al. Effect of antihypertensive medications on the severity of obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2016;12(8):1143–51.  https://doi.org/10.5664/jcsm.6054.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Pohl MA, Blumenthal S, Cordonnier DJ, De Alvaro F, DeFerrari G, Eisner G, et al. Independent and additive impact of blood pressure control and angiotensin II receptor blockade on renal outcomes in the Irbesartan diabetic nephropathy trial: clinical implications and limitations. J Am Soc Nephrol. 2005;16(10):3027–37.  https://doi.org/10.1681/asn.2004110919.CrossRefPubMedGoogle Scholar
  63. 63.
    Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281–357.  https://doi.org/10.1097/01.hjh.0000431740.32696.cc.CrossRefGoogle Scholar
  64. 64.
    Fengler K, Rommel KP, Blazek S, von Roeder M, Besler C, Hartung P, et al. Predictors for profound blood pressure response in patients undergoing renal sympathetic denervation. J Hypertens. 2018;36(7):1578–84.  https://doi.org/10.1097/hjh.0000000000001739.CrossRefPubMedGoogle Scholar
  65. 65.
    Davies JE, Manisty CH, Petraco R, Barron AJ, Unsworth B, Mayet J, et al. First-in-man safety evaluation of renal denervation for chronic systolic heart failure: primary outcome from REACH-Pilot study. Int J Cardiol. 2013;162(3):189–92.  https://doi.org/10.1016/j.ijcard.2012.09.019.CrossRefPubMedGoogle Scholar
  66. 66.
    Gao JQ, Yang W, Liu ZJ. Percutaneous renal artery denervation in patients with chronic systolic heart failure: a randomized controlled trial. Cardiol J. 2018.  https://doi.org/10.5603/CJ.a2018.0028.
  67. 67.
    Chen W, Ling Z, Xu Y, Liu Z, Su L, Du H, et al. Preliminary effects of renal denervation with saline irrigated catheter on cardiac systolic function in patients with heart failure: a prospective, randomized, controlled. Pilot Study Catheter Cardiovasc Interv. 2017;89(4):E153–e61.  https://doi.org/10.1002/ccd.26475.CrossRefPubMedGoogle Scholar
  68. 68.
    Schirmer SH, Sayed MM, Reil JC, Ukena C, Linz D, Kindermann M, et al. Improvements in left ventricular hypertrophy and diastolic function following renal denervation: effects beyond blood pressure and heart rate reduction. J Am Coll Cardiol. 2014;63(18):1916–23.  https://doi.org/10.1016/j.jacc.2013.10.073.CrossRefPubMedGoogle Scholar
  69. 69.
    Pokushalov E, Romanov A, Corbucci G, Artyomenko S, Baranova V, Turov A, et al. A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension. J Am Coll Cardiol. 2012;60(13):1163–70.  https://doi.org/10.1016/j.jacc.2012.05.036.CrossRefPubMedGoogle Scholar
  70. 70.
    Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–84.  https://doi.org/10.1056/nejm200005113421901.CrossRefPubMedGoogle Scholar
  71. 71.
    Warchol-Celinska E, Prejbisz A, Kadziela J, Florczak E, Januszewicz M, Michalowska I, et al. Renal denervation in resistant hypertension and obstructive sleep apnea. Randomized Proof-of-Concept Phase II Trial. Hypertension. 2018;72:381–90.  https://doi.org/10.1161/hypertensionaha.118.11180.CrossRefPubMedGoogle Scholar
  72. 72.
    Mahfoud F, Schlaich M, Kindermann I, Ukena C, Cremers B, Brandt MC, et al. Effect of renal sympathetic denervation on glucose metabolism in patients with resistant hypertension: a pilot study. Circulation. 2011;123(18):1940–6.  https://doi.org/10.1161/circulationaha.110.991869.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Duke University Medical CenterDurhamUSA
  2. 2.Duke Clinical Research InstituteDurhamUSA

Personalised recommendations