Treatment resistant hypertension. Value of a new treatment concept

被引:0
作者
Siekierka-Harreis, M. [1 ]
Rump, L. C. [1 ]
Vonend, O. [1 ]
机构
[1] Univ Dusseldorf, Univ Klinikum Dusseldorf, Fak Med, Klin Nephrol, D-40225 Dusseldorf, Germany
来源
INTERNIST | 2012年 / 53卷 / 12期
关键词
Arterial hypertension; Refractory hypertension; Renal denervation; Baroreflex activation; Sympathetic nervous system; RENAL SYMPATHETIC DENERVATION; BAROREFLEX ACTIVATION THERAPY; OBSTRUCTIVE SLEEP-APNEA; POSITIVE AIRWAY PRESSURE; LOWERS BLOOD-PRESSURE; SPIRONOLACTONE; PREVALENCE; STATEMENT; DIAGNOSIS;
D O I
10.1007/s00108-012-3134-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Sympathetic overexpression can be found in a majority of hypertensive patients. Resistant arterial hypertension requires a targeted diagnostic procedure in order to exclude secondary causes of hypertension which can be treated specifically with established therapies. If secondary reasons are not identified, the antihypertensive medication is already optimal and lifestyle changes have been realized, but still the goal of antihypertensive therapy cannot be achieved, alternative invasive therapy strategies such as renal sympathetic denervation and baroreflex activation have been developed to achieve blood pressure control. These therapies are restricted to specialized centers which treat well-defined patients with therapy-resistant hypertension. Little long-term data concerning safety and efficacy are available for the two strategies. However, they should preferably be used as an ultima-ratio and add-on pathway to conservative procedures when established medication fails to achieve blood pressure control. To date, the effectiveness of the interventional antihypertensive therapies has only been shown on patients with systolic blood pressure over 160 mmHg and a mean oral medication of five drugs.
引用
收藏
页码:1411 / +
页数:7
相关论文
共 41 条
[11]   Case detection, diagnosis, and treatment of patients with primary aldosteronism: An endocrine society clinical practice guideline [J].
Funder, John W. ;
Carey, Robert M. ;
Fardella, Carlos ;
Gomez-Sanchez, Celso E. ;
Mantero, Franco ;
Stowasser, Michael ;
Young, William F., Jr. ;
Montori, Victor M. .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2008, 93 (09) :3266-3281
[12]   Renal Denervation in Moderate to Severe CKD [J].
Hering, Dagmara ;
Mahfoud, Felix ;
Walton, Antony S. ;
Krum, Henry ;
Lambert, Gavin W. ;
Lambert, Elisabeth A. ;
Sobotka, Paul A. ;
Boehm, Michael ;
Cremers, Bodo ;
Esler, Murray D. ;
Schlaich, Markus P. .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2012, 23 (07) :1250-1257
[13]   Carotid Baroreceptor Stimulation, Sympathetic Activity, Baroreflex Function, and Blood Pressure in Hypertensive Patients [J].
Heusser, Karsten ;
Tank, Jens ;
Engeli, Stefan ;
Diedrich, Andre ;
Menne, Jan ;
Eckert, Siegfried ;
Peters, Tim ;
Sweep, Fred C. G. J. ;
Haller, Hermann ;
Pichlmaier, Andreas M. ;
Luft, Friedrich C. ;
Jordan, Jens .
HYPERTENSION, 2010, 55 (03) :619-626
[14]   Minimally invasive system for baroreflex activation therapy chronically lowers blood pressure with pacemaker-like safety profile: results from the Barostim neo trial [J].
Hoppe, Uta C. ;
Brandt, Mathias-Christoph ;
Wachter, Rolf ;
Beige, Joachim ;
Rump, Lars Christian ;
Kroon, Abraham A. ;
Cates, Adam W. ;
Lovett, Eric G. ;
Haller, Hermann .
JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION, 2012, 6 (04) :270-276
[15]  
Kaltenbach B, 2012, CATHETER CA IN PRESS
[16]   Catheter-Based Renal Denervation for Resistant Hypertension: Rationale and Design of the SYMPLICITY HTN-3 Trial [J].
Kandzari, David E. ;
Bhatt, Deepak L. ;
Sobotka, Paul A. ;
O'Neill, William W. ;
Esler, Murray ;
Flack, John M. ;
Katzen, Barry T. ;
Leon, Martin B. ;
Massaro, Joseph M. ;
Negoita, Manuela ;
Oparil, Suzanne ;
Rocha-Singh, Krishna ;
Straley, Craig ;
Townsend, Raymond R. ;
Bakris, George .
CLINICAL CARDIOLOGY, 2012, 35 (09) :528-535
[17]   Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study [J].
Krum, Henry ;
Schlaich, Markus ;
Whitbourn, Rob ;
Sobotka, Paul A. ;
Sadowski, Jerzy ;
Bartus, Krzysztof ;
Kapelak, Boguslaw ;
Walton, Anthony ;
Sievert, Horst ;
Thambar, Suku ;
Abraham, William T. ;
Esler, Murray .
LANCET, 2009, 373 (9671) :1275-1281
[18]  
Kuhlmann U, 2000, CLIN NEPHROL, V53, P460
[19]   Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies [J].
Law, M. R. ;
Morris, J. K. ;
Wald, N. J. .
BMJ-BRITISH MEDICAL JOURNAL, 2009, 338 :1245
[20]  
Lazich I, 2011, CONTRIB NEPHROL, V172, P223, DOI 10.1159/000328988