Despite the development of numerous antihypertensive medications and the use of multidrug therapy, about 5% to 20% of all hypertensive patients are resistant to medical therapy. Sympathetic overdrive is responsible for the development and maintenance of resistant hypertension (RH). In the kidney, efferent sympathetic activity promotes Na+ re-absorption and renin release, while afferent nerves stimulate central sympathetic outflow and produce vasoconstriction. The physiological basis of renal sympathetic denervation (RDN) is the suppression of the hyperadrenergic state by the interruption of the renal sympathetic nerve fibers. Two trials Symplicity HTN-1 and Symplicity HTN-2—have demonstrated the efficacy and the safety of RDN in patients with RH. In these trials, patients with renal artery stenosis or stent were excluded; therefore, there are few data about RDN in these patients. Moreover, a meta-analysis did not find an improvement in blood pressure (BP) in patients with renal artery stenosis treated with renal artery stenting.[4] Therefore, a double mechanism maintains hypertension: renovascular and sympathetic tone. In the following, we report the case of a patient with RH treated by RDN after renal artery stenting.
Renal Sympathetic Denervation in a Previously Stented Renal Artery.
VEGLIO, Franco
2014-01-01
Abstract
Despite the development of numerous antihypertensive medications and the use of multidrug therapy, about 5% to 20% of all hypertensive patients are resistant to medical therapy. Sympathetic overdrive is responsible for the development and maintenance of resistant hypertension (RH). In the kidney, efferent sympathetic activity promotes Na+ re-absorption and renin release, while afferent nerves stimulate central sympathetic outflow and produce vasoconstriction. The physiological basis of renal sympathetic denervation (RDN) is the suppression of the hyperadrenergic state by the interruption of the renal sympathetic nerve fibers. Two trials Symplicity HTN-1 and Symplicity HTN-2—have demonstrated the efficacy and the safety of RDN in patients with RH. In these trials, patients with renal artery stenosis or stent were excluded; therefore, there are few data about RDN in these patients. Moreover, a meta-analysis did not find an improvement in blood pressure (BP) in patients with renal artery stenosis treated with renal artery stenting.[4] Therefore, a double mechanism maintains hypertension: renovascular and sympathetic tone. In the following, we report the case of a patient with RH treated by RDN after renal artery stenting.
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