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15July, 2016

Interventional Management Of Resistant Hypertension

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  1. Stents no Benefit in Renal Artery Stenosis (Coral Trial 2013) – “Effective Medical Therapy should be the first line of treatment in patients with presumed Renovascular Hypertension”.  For patients who fail medical therapy or are unable to tolerate medical therapy, stenting remains a reasonable option.
  1. Approaches that target the Sympathetic Nervous System in Resistant Hypertension

 

Renal denervation (RD) is a minimally invasive percutaneous approach that involves placement of an electrode in the renal arteries followed by ablation of sympathetic nerves.  Sympathetic innervations stimulates renin release from the juxtoglomerular apparatus and afferent vasoconstriction of renal vessels, both of which lead to increased tubular reabsorption of sodium and elevated blood pressure.  Renal denervation is therefore based on the principle that deactivation of renal sympathetic nerves will curb hypertension.
1-Recently available data indicated that this procedure provides moderate blood pressure reduction in patients with resistant hypertension.  This was demonstrated in several unblended studies, including SYMPLICITY – HTN2.  That trial, conducted in centres across Australia, New Zealand and Europe, demonstrated a mean pressure reduction of 32/11 mm Hg at six months post-RD, and was not associated with any major complications.
2-However, a blinded randomized controlled trial released in April 2014, SYMPLICITY-HTN-3, failed to demonstrate any blood pressure benefit for RD versus a sham control procedure in 535 patients with resistant hypertension
3-Other emerging intervention is carotid sinus stimulation.  This is founded on the theory that continuous electrical stimulation of carotid baroreceptors, via an implantable device, should inhibit sympathetic output.  Carotid baroreflex activation is a new procedure with limited experience.  Although several feasibility studies have demonstrated appreciable pressure reduction the safety of this technique is not yet certain.

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Dr Vinod Sharma
National Heart Institute
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East Of Kailash,New Delhi - 110065
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Email : drvs1994@gmail.com
Website : www.drvinodsharma.in

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