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Current Problems in Cardiology Mar 2024We have attentively reviewed the article "Renal Denervation for Hypertension" and commend the author's dedication to addressing this intricate subject. However, we wish...
We have attentively reviewed the article "Renal Denervation for Hypertension" and commend the author's dedication to addressing this intricate subject. However, we wish to highlight a few points that, in our assessment, could enhance the overall quality of the article.
Topics: Humans; Sympathectomy; Hypertension; Kidney
PubMed: 38232919
DOI: 10.1016/j.cpcardiol.2024.102401 -
Hypertension Research : Official... Aug 2022
Topics: Antihypertensive Agents; Blood Pressure; Denervation; Humans; Hypertension; Kidney; Patient Preference; Sympathectomy; Treatment Outcome
PubMed: 35681043
DOI: 10.1038/s41440-022-00962-9 -
Cardiovascular Revascularization... Sep 2022Radio frequency (RF) based percutaneous catheter renal denervation systems offer an additional clinical tool, along with lifestyle modification and drug therapy, to... (Review)
Review
Radio frequency (RF) based percutaneous catheter renal denervation systems offer an additional clinical tool, along with lifestyle modification and drug therapy, to address the global epidemic of uncontrolled hypertension. The most widely applied RF system has been designed to optimize both procedural and safety and efficacy. Lesion size, shape, and depth result from a complex interaction of device design, anatomy, and tissue electrical conduction properties. Power control algorithms must be carefully designed, incorporating feedback to maximize nerve destruction while minimizing collateral damage. Physical and numerical modelling as well as analysis of sensor feedback provide insight into design performance that cannot be derived from clinical trials. This review is focused on key design and performance aspects of the most widely applied renal denervation system meant to optimize safety and efficacy of the procedure.
Topics: Blood Pressure; Catheter Ablation; Catheters; Denervation; Electric Impedance; Humans; Hypertension; Kidney; Renal Artery; Sympathectomy; Temperature; Treatment Outcome
PubMed: 35232663
DOI: 10.1016/j.carrev.2022.02.018 -
Life Sciences Jul 2023Renal denervation (RDNx) is emerging as a promising treatment for cardiovascular disease, yet the underlying mechanisms and contributions of afferent (sensory) and...
Renal denervation (RDNx) is emerging as a promising treatment for cardiovascular disease, yet the underlying mechanisms and contributions of afferent (sensory) and efferent (sympathetic) renal nerves in healthy conditions remains limited. We hypothesize that sympathetic renal nerves contribute to long-term MAP and renal function, whereas afferent renal nerves do not contribute to the maintenance of cardiovascular and renal function. To test this hypothesis, we performed two experiments. In experiment one, we performed total renal denervation (T-RDNx), ablating afferent and sympathetic renal nerves, in normotensive adult SD rats to determine effects on MAP and renal function. Experiment 2 employed a sequential surgical ablation using: (1) afferent targeted renal denervation (A-RDNx), then (2) sympathetic (T-RDNx) denervation to determine the individual contributions to cardiovascular and renal homeostasis. In experiment 1, MAP decreased following T-RDNx and GFR increased. In experiment 2, A-RDNx led to an increase in MAP but did not change renal function. In contrast, T-RDNx decreased MAP and improved renal filtration. Together, these data partially support our hypothesis that renal sympathetic nerves contribute to the chronic regulation of arterial pressure and renal function. Contrary to the hypothesis, A-RDNx produced an increase in MAP without a detected change in renal function. We concluded that renal sympathetic nerves influence MAP and renal function regulation through a well-defined tonic contribution to renal vascular resistance and sodium reabsorption, whereas afferent renal nerves likely contribute to the maintenance of MAP through a tonic sympatho-inhibitory, negative feedback regulation in the normotensive, healthy rat.
Topics: Male; Rats; Animals; Rats, Sprague-Dawley; Hypertension; Kidney; Sympathectomy; Sympathetic Nervous System; Blood Pressure; Denervation
PubMed: 37169146
DOI: 10.1016/j.lfs.2023.121768 -
Anesthesia and Analgesia Feb 2020Hip fracture is a challenging geriatric problem for the health care professionals, especially in patients with multiple comorbidities. In patients with inoperable hip...
BACKGROUND
Hip fracture is a challenging geriatric problem for the health care professionals, especially in patients with multiple comorbidities. In patients with inoperable hip fracture secondary to severe comorbid conditions, the pain can lead to significant challenges in nursing care. With the current understanding of the innervation of hip joint, we are now able to perform selective chemical denervation of the articular branches of femoral and obturator nerves to manage the pain associated with inoperable hip fracture.
METHODS
In this retrospective case series, we analyzed 20 consecutive patients with inoperable hip fracture who received chemical denervation and examined the effect of the denervation on pain and functional outcomes, including the maximally tolerable hip flexion and the ability to sit during their hospital stay. We also assessed the likelihood of being ambulatory as a long-term outcome.
RESULTS
The movement-related pain was significantly reduced at 10 minutes postprocedure, on postintervention days 1 and 5 (P values of <.001), and the degree of maximally tolerable hip flexion was doubled at the same time points (P values of <.001, .003, and .002, respectively). Fifty percent of the patients managed to sit within the first 5 days after procedure, and 3 of them managed to walk with aid 4 months after hip denervation. No procedural adverse event was noted.
CONCLUSIONS
We concluded that this chemical hip denervation could be a safe and effective measure to handle the pain-related and rehabilitation-related challenges as a result of inoperable hip fracture.
Topics: Aged; Aged, 80 and over; Denervation; Ethanol; Female; Femoral Nerve; Hip Fractures; Humans; Male; Middle Aged; Nerve Block; Pain Management; Retrospective Studies
PubMed: 30985383
DOI: 10.1213/ANE.0000000000004172 -
Future Cardiology Jul 2020
Topics: Antihypertensive Agents; Blood Pressure; Denervation; Humans; Hypertension; Kidney; Sympathectomy
PubMed: 32166965
DOI: 10.2217/fca-2019-0034 -
Journal of the American College of... Jun 2020
Topics: Denervation; Humans; Hypertension; Kidney; Registries
PubMed: 32527397
DOI: 10.1016/j.jacc.2020.04.058 -
Hypertension Research : Official... Dec 2023Inappropriate sympathetic nervous activation is the body's response to biological stress and is thought to be involved in the development of various lifestyle-related... (Review)
Review
Inappropriate sympathetic nervous activation is the body's response to biological stress and is thought to be involved in the development of various lifestyle-related diseases through an elevation in blood pressure. Experimental studies have shown that surgical renal denervation decreases blood pressure in hypertensive animals. Recently, minimally invasive catheter-based renal denervation has been clinically developed, which results in a reduction in blood pressure in patients with resistant hypertension. Accumulating evidence in basic studies has shown that renal denervation exerts beneficial effects on cardiovascular disease and chronic kidney disease. Interestingly, recent studies have also indicated that renal denervation improves glucose tolerance and inflammatory changes. In this review article, we summarize the evidence from animal studies to provide comprehensive insight into the organ-protective effects of renal denervation beyond changes in blood pressure.
Topics: Animals; Humans; Sympathectomy; Kidney; Hypertension; Sympathetic Nervous System; Blood Pressure; Denervation
PubMed: 37532952
DOI: 10.1038/s41440-023-01393-w -
Hypertension Research : Official... Jul 2023Cardiometabolic disorders are associated with a substantial loss in quality of life and pose a large burden on healthcare systems worldwide. Overactivation of the... (Review)
Review
Cardiometabolic disorders are associated with a substantial loss in quality of life and pose a large burden on healthcare systems worldwide. Overactivation of the sympathetic nervous system has been shown to be a key player in several aspects relating to cardiometabolic disturbances. While diet- and exercise-induced approaches to help reduce weight remains the main strategy to combat metabolic disorders, this is often difficult to achieve. Current pharmacological approaches result in variable responses in different patient cohorts and long-term efficacy may be limited by medication side effects and non-adherence in the long term. There is a clear clinical need for complementary therapies to curb the burden of cardiometabolic disease. One such approach may include interventional sympathetic neuromodulation of organs relevant to cardiometabolic control. Data from sham-controlled clinical trials demonstrate the feasibility, safety and efficacy of catheter-based renal denervation. In analogy, denervation of the common hepatic artery is now feasible in humans and may prove to be similarly useful in modulating sympathetic overdrive directed towards the liver, pancreas and duodenum. Such a targeted multi-organ neuromodulation strategy may beneficially influence multiple aspects of the cardiometabolic disease continuum including blood pressure, glucose and lipid control.
Topics: Humans; Hypertension; Sympathectomy; Quality of Life; Kidney; Sympathetic Nervous System; Blood Pressure; Denervation
PubMed: 37088807
DOI: 10.1038/s41440-023-01287-x -
JACC. Heart Failure Aug 2023
Topics: Humans; Hypertension, Pulmonary; Pulmonary Artery; Heart Failure; Denervation
PubMed: 37480880
DOI: 10.1016/j.jchf.2023.06.015