Document Detail


Catheter-based renal nerve ablation and centrally generated sympathetic activity in difficult-to-control hypertensive patients: prospective case series.
MedLine Citation:
PMID:  23045466     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Endovascular renal nerve ablation has been developed to treat resistant hypertension. In addition to lowering efferent renal sympathetic activation, the intervention may attenuate central sympathetic outflow through decreased renal afferent nerve traffic, as evidenced by a recent case report. We tested the hypothesis in 12 nonpreselected patients with difficult-to-control hypertension (aged 45-74 years) admitted for renal nerve ablation. All patients received ≥ 3 antihypertensive medications at full doses, including a diuretic. Electrocardiogram, respiration, brachial and finger arterial blood pressure, and muscle sympathetic nerve activity were recorded before and 3 to 6 months after renal nerve ablation. Heart rate and blood pressure variability were analyzed in the time and frequency domain. Pharmacological baroreflex slopes were determined using the modified Oxford bolus technique. Resting heart rate was 61 ± 3 bpm before and 58 ± 2 bpm after ablation (P = 0.4). Supine blood pressure was 157 ± 7/85 ± 4 mm Hg before and 157 ± 6/85 ± 4 mm Hg after ablation (P = 1.0). Renal nerve ablation did not change resting muscle sympathetic nerve activity (before, 34 ± 2 bursts per minute; after, 32 ± 3 bursts per minute P = 0.6), heart rate variability, or blood pressure variability. Pharmacological baroreflex control of heart rate and muscle sympathetic nerve activity did not change. We conclude that reduced central sympathetic inhibition may be the exception rather than the rule after renal nerve ablation in unselected patients with difficult-to-control arterial hypertension.
Authors:
Julia Brinkmann; Karsten Heusser; Bernhard M Schmidt; Jan Menne; Gunnar Klein; Johann Bauersachs; Hermann Haller; Fred C Sweep; Andre Diedrich; Jens Jordan; Jens Tank
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-10-08
Journal Detail:
Title:  Hypertension     Volume:  60     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-15     Completed Date:  2013-02-07     Revised Date:  2013-07-23    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1485-90     Citation Subset:  IM    
Affiliation:
Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT01355055
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MeSH Terms
Descriptor/Qualifier:
Aged
Antihypertensive Agents / pharmacology,  therapeutic use
Blood Pressure / drug effects,  physiology*
Catheter Ablation*
Female
Heart Rate / drug effects,  physiology
Humans
Hypertension / drug therapy,  physiopathology,  surgery*
Kidney / innervation*,  physiopathology
Male
Middle Aged
Prospective Studies
Sympathectomy*
Sympathetic Nervous System / physiopathology,  surgery*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antihypertensive Agents
Comments/Corrections
Comment In:
Hypertension. 2013 Feb;61(2):e13   [PMID:  23248152 ]
Hypertension. 2013 Feb;61(2):e8   [PMID:  23213193 ]
Hypertension. 2013 Feb;61(2):e9-10   [PMID:  23444459 ]
Hypertension. 2013 Feb;61(2):e17   [PMID:  23248153 ]
Hypertension. 2013 Feb;61(2):e18   [PMID:  23444462 ]
Hypertension. 2013 Feb;61(2):e14   [PMID:  23444460 ]
Hypertens Res. 2013 Jun;36(6):492-3   [PMID:  23595049 ]
Hypertension. 2012 Dec;60(6):1385-6   [PMID:  23045467 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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