Hypertension

Device therapy for uncontrolled hypertension: new approaches to an old problem

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Uncontrolled hypertension is an important clinical problem and is associated with considerable morbidity and mortality. A new report from the SPYRAL HTN-OFF MED researchers, which describes the use of renal denervation in patients with uncontrolled hypertension, might reignite enthusiasm for this technique, while a first-in-human description of endovascular baroreflex amplification from the CALM-FIM_EUR investigators highlights the potential of this new approach to inhibit sympathetic activity.

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References

  1. 1

    GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioral, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease study 2016. Lancet 390, 1345–1422 (2017).

  2. 2

    de Jager, R. L. et al. Impact of medication adherence on the effect of renal denervation: the SYMPATHY trial. Hypertension 69, 678–684 (2017).

  3. 3

    Gupta, P. et al. Risk factors for nonadherence to antihypertensive treatment. Hypertension 69, 1113–1120 (2017).

  4. 4

    Townsend, R. R. et al. 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 http://dx.doi.org/10.1016/S0140-6736(17)32281-X (2017).

  5. 5

    Spiering, W. et al. Endovascular baroreflex amplification for resistant hypertension: a safety and proof-of-principle clinical study. Lancet http://dx.doi.org/10.1016/S0140-6736(17)32337-1 (2017).

  6. 6

    Vink, E. E. et al. Limited destruction of renal nerves after catheter-based renal denervation: results of a human case study. Nephrol. Dial Transplant. 29, 1608–1610 (2014).

  7. 7

    de Jager, R. L. et al. Renal denervation in hypertensive patients not on blood pressure lowering drugs. Clin. Res. Cardiol. 105, 755–762 (2016).

  8. 8

    Chow, C. K. et al. Quarter-dose quadruple combination therapy for initial treatment of hypertension: placebo-controlled, crossover, randomised trial and systematic review. Lancet 389, 1035–1042 (2017).

  9. 9

    de Beus, E. et al. Sympathetic activation secondary to chronic kidney disease: therapeutic target for renal denervation? J. Hypertens. 32, 1751–1761 (2014).

  10. 10

    de Jager, R. L. et al. Catheter based renal denervation as therapy for chronic severe kidney related pain. Nephrol. Dial Transplant. http://dx.doi.org/10.1093/ndt/gfx086 (2017).

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Correspondence to Peter J. Blankestijn.

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Competing interests

P.J.B. has received research grants from Medtronic, ZonMw and Nierstichting Nederland. The grants were paid to the institution. M.L.B. declares no competing interests.

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