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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe sympathetic nervous system (SNS) has recently been hypothesized to play a key role in resistant hypertension. As a result, recent studies have explored renal artery denervation therapy as a potential treatment option for patients with resistant hypertension. This article discusses the current and future landscape of renal denervation therapy, as well as potential mechanisms by which increased sympathetic activity may result in effect blood pressure.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Radiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertension \u0026amp; Kidney Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Radiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertension \u0026amp; Kidney Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe sympathetic nervous system (SNS) has recently been hypothesized to play a key role in resistant hypertension. As a result, recent studies have explored renal artery denervation therapy as a potential treatment option for patients with resistant hypertension. Mohammad I. Kurdi, MBBS, Al Takhassoussi Hospital, Riyadh, Saudi Arabia, presented the current and future landscape of renal denervation therapy.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESystemic hypertension is associated with major adverse cardiac and cerebral events and pharmacologic control of hypertension has been shown to reduce cardiovascular and cerebrovascular events. However, some patients continue to have poorly controlled hypertension despite multidrug therapy or have adverse drug events or contraindications to pharmacotherapy that prevent adequate control of hypertension. Interestingly, increased sympathetic tone, in part mediated by the kidneys, has been hypothesized as a potential mechanism in the pathophysiology of hypertension. Therefore, several recent studies sought to evaluate the benefit of therapies that inhibit the effects of the kidneys on the sympathetic nervous system in patients with resistant hypertension.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAlthough the results of an ongoing, large randomized, controlled trial are needed to confirm the efficacy and safety of renal denervation therapy, Prof. Kurdi stated that several smaller studies have demonstrated that surgical renal sympathectomy can result in improved blood pressure control. The potential benefits of renal denervation therapy may include decreased cardiac size, improved renal function, decrease incidence of headache, decreased precordial pain, and fewer cerebrovascular events.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn the Catheter-Based Renal Sympathetic Denervation for Resistant Hypertension proof-of-principle trial [Symplicity HTN-1 Investigators; Krum H. \u003Cem\u003EHypertension\u003C\/em\u003E 2011], bilateral radiofrequency application to the renal arteries was evaluated in 45 patients with drug-resistant hypertension. Following renal artery angiography, patients received anticoagulation therapy and opioid analgesics for diffuse abdominal pain. An 8-French guide catheter was used via an 8-French femoral artery access and positioned in the renal arteries, with subsequent radiofrequency application. Patients experienced a significant decrease in systolic blood pressure of 14 mm Hg at 1 month and 27 mm Hg at 12 months. Diastolic blood pressure decreased by 10 mm Hg at 1 month and 17 mm Hg at 12 months. In addition, the antihypertensive medications were adjusted in 13 patients; 9 patients had a decrease in the number of antihypertensive medications while 4 patients had an increase. Importantly, even after adjusting for the 4 patients whose treatment was intensified, the blood pressure was significantly reduced. No response to renal denervation therapy occurred in 13% of patients.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EIn the Renal Sympathetic Denervation in Patients With Treatment-Resistant Hypertension trial [Symplicity HTN-2 Investigators; Esler MD et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2012], 106 patients with resistant hypertension were randomized to receive catheter-based renal sympathectomy plus pharmacologic treatment or pharmacologic treatment only. Patients that received catheter-based therapy experienced a significantly greater blood pressure reduction from baseline compared with pharmacologic therapy only, with a mean blood pressure decrease of 33\/11 mm Hg at 6 months\u0027 follow-up (p\u0026lt;0.0001; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). In addition, 84% of patients treated with renal sympathectomy experienced a blood pressure decline of at least 10 mm Hg compared with 35% of patients that received pharmacologic therapy only (p\u0026lt;0.001).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EProf. Kurdi explained the structure of several renal denervation systems. The Symplicity systems include the first-generation denervation system, a single-point ablation catheter that is manually rotated with 4 points of ablation, and the second generation denervation catheter with a spiral, helical-shaped wire with 4 simultaneous points of ablation. The EnligHTN System consists of a catheter with 4 electrodes placed in staggered positions in a basket configuration, each having a temperature and impedance sensor.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/7\/22\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Mean Change in Blood Pressure Following Renal Denervation in the Symplicity HTN-2 Trial\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-324717763\u0022 data-figure-caption=\u0022Mean Change in Blood Pressure Following Renal Denervation in the Symplicity HTN-2 Trial\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/7\/22\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/7\/22\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/7\/22\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13469\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EMean Change in Blood Pressure Following Renal Denervation in the Symplicity HTN-2 Trial\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced from Esler MD et al. Renal Sympathetic Denervation for Treatment of Drug-Resistant Hypertension: One-Year Results From the Symplicity HTN-2 Randomized, Controlled Trial. \u003Cem\u003ECirculation\u003C\/em\u003E 2012;126(25):2976\u20132982. With permission from Lipincott, Williams and Wilkins.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EEmerging renal sympathectomy systems are balloon-based and include the Covidien system, which has 8 ablation sites with water irrigation and a timing of 2 minutes; the Boston Scientific Balloon with 8 ablation points and a timing of 30 seconds; and the Cordis system. Prof. Kurdi suggested that renal sympathectomy should be evaluated in the treatment of other cardiovascular diseases including, heart failure and severe hypertension with end organ damage (eg, left ventricular hypertrophy, proteinuria, or retinopathy), since reduction in blood pressure in patients with these conditions may also improve cardiovascular outcomes.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EMahmoud Hassanein, MD, Alexandria University, Alexandria, Egypt, presented potential mechanisms by which increased sympathetic activity may result in effect blood pressure. As mentioned above, recent research has implicated the SNS in the development of hypertension, as sympathetic nervous activity can initiate and sustain blood pressure elevation. Although sympathetic denervation in the thoracic, abdominal, and pelvic regions has been demonstrated to decrease blood pressure in patients with malignant hypertension, they are associated with high morbidity, such as bowel, bladder, and erectile dysfunction; severe postural hypotension, and death.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003ERenal denervation has emerged as a treatment of resistant hypertension due to the observation that efferent sympathetic activity to the kidneys is higher in patients with hypertension [Esler M et al. \u003Cem\u003EAm J Hypertens\u003C\/em\u003E 1989]. In addition, patients with hypertension demonstrate renal norepinephrine spillover, in which norepinephrine escapes neuronal uptake and local deactivation, allowing it to \u201cspillover\u201d into systemic circulation. Importantly, the efferent and afferent sympathetic nerves, which are located adjacent to the renal artery, are essential for systemic hypertension [DiBona GF. \u003Cem\u003ECurr Opin Nephrol Hypertens\u003C\/em\u003E 2002]. An increase in renal sympathetic activity results in decreased sodium excretion, increased water retention, stimulation of the juxtaglomerular apparatus resulting in greater release of the enzyme renin, and changes to the renal blood flow. All of these characteristics contribute to both acute and long-term increases in blood pressure.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EDr. Hassanein highlighted a multicenter, proof-of-principle study, in which 45 patients with resistant hypertension with a mean of 4.7 antihypertensive medications were treated with percutaneous radiofrequency catheter-based therapy and followed for 1 year [Krum H et al. \u003Cem\u003ELancet\u003C\/em\u003E 2009]. The mean change in office blood pressure from baseline after the procedure is shown in \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/7\/22\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Effect of Renal Denervation on Office Blood Pressure\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-324717763\u0022 data-figure-caption=\u0022Effect of Renal Denervation on Office Blood Pressure\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/7\/22\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/7\/22\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/7\/22\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13470\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003EEffect of Renal Denervation on Office Blood Pressure\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Krum H et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. \u003Cem\u003ELancet\u003C\/em\u003E 2009;373(9671):1275\u20131281. With permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-14\u0022\u003EDr. Hassanein concluded that selective renal sympathetic denervation is a promising approach for the treatment of resistant hypertension, since it interrupts renal sympathetic activity without affecting nerves in the abdominal, pelvic, or lower extremity regions of the body. Ongoing clinical outcomes trials of renal denervation will determine whether it will become a standard treatment option for patients with resistant hypertension.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/7\/22.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzntk2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzntk2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}