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Old 04-07-2009, 08:56 PM   #1
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A new treatment of resistant hypertension

The results of a study in which a percutaneous catheter ablation of renal artery sympathetic nerves was performed on 45 people with resistant hypertension were published on March 30 in Lancet magazine. The study participants all had resistant hypertension, with baseline mean blood pressure of 177/101mmHg. They were on an average of 4.7 blood pressure medications with an estimated GFR of 81ml/min/1.73m2.

The primary endpoints of this study were office blood pressure reduction and safety data at 1, 3, 6, 9 and 12 months post-procedure. The tests used were renal angiography before, right after, and 14-30 days after the procedure, and magnetic resonance angiogram at 6 months after the ablation.
The average blood pressure reductions were 14/10, 21/10, 22/11, 24/11 and, finally, 27/17mmHg at 1,3,6,9 and 12 months after the procedure. Five people showed no reduction in blood pressure.

It has been concluded that in people with resistant hypertension, percutaneous radiofrequency catheter based treatment (renal denervation)results in a substantial and sustained reduction in blood pressure without serious side effects. Randomized clinical trials are needed to study and evaluate the effectiveness of this procedure in treating resistant hypertension.

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Old 04-08-2009, 06:43 AM   #2
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Re: A new treatment of resistant hypertension

I know this is a stupid question but is that BP with or without medication?

 
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Old 04-08-2009, 09:39 AM   #3
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Re: A new treatment of resistant hypertension

It is not a stupid question at all! I was wondering about the same thing while reading the study. Limited information about the study has been made available as far as I can tell. For an access to a detailed study, a subscription is needed. I do have a subscription to a clinical website but it is not updated on a weekly basis, so not much info there yet. I have managed to find a fairly descriptive write-up of the study. There was no mention of the study participants remaining on antihypertensive medication. I think that even with the resulting very impressive reductions in blood pressure, the blood pressure levels in some people would still have been inadequate, because the baseline blood pressure readings were so high. As they say, more clinical trials are needed to study the long-term effects of this procedure on blood pressure. It would appear that the reductions in blood pressure increased through time, which I think is the most interesting part. A coincidence?

If this information has been released, I'll find it and post it here.

flowergirl

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Old 04-10-2009, 08:30 PM   #4
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Re: A new treatment of resistant hypertension

I've read the whole study (at least I think so ), so here is some additional information.

This minimally invasive procedure, which would likely be performed by interventional radiologists and/or interventional cardiologists, consists of several (4-6) 2 minute applications of RF energy to the renal artery nerves. It is simple, safe and the kidney function is not affected.

Blood pressure reductions were achieved as early as 1 month after the ablation. Not all people in the study responded. 83% had sustained reductions in blood pressure of >10mmHg, while 17% did not. The reason for the non-responsiveness could have been an inadequately performed ablation, or non-involvement of the renal sympathetic activation in these individuals' hypertension.

Now comes the part we were wondering about. Medications were stable over the course of the trial (what do they mean, stable???) with three people requiring a reduction in blood pressure medication when they developed symptomatic hypotension, as their blood pressure normalized, and nine requiring increased medication. The trial had 50 participants in all, 5 of which were not treated. The blood pressure of people not receiving the ablation treatment continued to rise and they are included in these stats.

Interestingly, ambulatory blood pressure monitoring showed that people who were non-dippers before the procedure became dippers after the RF ablation. The others quickly returned to their normal nightime blood pressure variations (decreases).

There are plans to investigate this procedure in the setting of chronic kidney disease and systolic heart failure. This procedure could eventually have applications in people with less severe forms of hypertension. A randomized trial is next.

FG

Last edited by flowergirl2day; 04-10-2009 at 08:55 PM.

 
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