Skip to main content
SpringerLink
Log in

Neue Methode

Interventionelle renale sympathische Denervation bei therapierefraktärer arterieller Hypertonie

Novel technique

Interventional renal sympathetic denervation for resistant hypertension

  • Interventionelle Kardiologie
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Die Ursachen einer therapierefraktären Hypertonie sind multifaktoriell bedingt, wobei eine entscheidende pathophysiologische Rolle der Aktivierung des sympathischen Nervensystems zukommt. Erste Daten zeigen, dass mit der Durchführung einer interventionellen renalen sympathischen Denervation bei Patienten mit therapierefraktärer arterieller Hypertonie eine signifikante Reduktion der Sympathikusaktivität sowie eine deutliche und nachhaltige Blutdrucksenkung erzielt werden kann. In die aktuell laufende Symplicity-HTN-2-Studie werden Patienten eingeschlossen, bei denen trotz einer 3-fach antihypertensiven Therapie keine adäquate Blutdrucksenkung (Gelegenheitsblutdruck >160 mmHg systolisch, bei Patienten mit Diabetes mellitus Typ 2 >150 mmHg) zu erzielen ist. Das plausible pathophysiologische Konzept und die sichere, einfache und effiziente Anwendung eröffnen weitere Einsatzgebiete, beispielsweise bei Patienten mit Diabetes mellitus, chronischer Herzinsuffizienz und terminaler Niereninsuffizienz.

Abstract

Hyperactivity of the sympathetic nervous system has been shown as one of the factors contributing to the complex pathophysiology of resistant hypertension. Preliminary data demonstrate that in these patients catheter-based renal sympathetic denervation can significantly attenuate sympathetic activity and result in marked and sustained blood pressure reduction. The ongoing randomized Symplicity-HTN-2 trial enrolls patients with office systolic blood pressure of 160 mmHg or more (150 mmHg for patients with type 2 diabetes), despite at least a triple antihypertensive drug regimen. Based on a plausible pathophysiological concept, interventional sympathetic renal denervation is safe, effective and easy to perform and might offer benefits in other areas as well, e.g., in patients with diabetes, chronic heart failure or end-stage renal disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Bell-Reuss E, Trevino Dl, Gottschalk CW (1976) Effect of renal sympathetic nerve stimulation on proximal water and sodium reabsorption. J Clin Invest 57:1104–1107

    Article  CAS  PubMed  Google Scholar 

  2. Calhoun DA, Jones D, Textor S et al (2008) Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 117:e510–e526

    Article  PubMed  Google Scholar 

  3. Chobanian AV, Bakris GL, Black HR et al (2003) Seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure. Hypertension 42:1206–1252

    Article  CAS  PubMed  Google Scholar 

  4. Dahlof B, Devereux RB, Kjeldsen SE et al (2002) Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 359:995–1003

    Article  CAS  PubMed  Google Scholar 

  5. Doumas M, Douma S (2009) Interventional management of resistant hypertension. Lancet 373:1228–1230

    Article  PubMed  Google Scholar 

  6. Esler M, Jennings G, Lambert G (1989) Noradrenaline release and the pathophysiology of primary human hypertension. Am J Hypertens 2:140S–146S

    CAS  PubMed  Google Scholar 

  7. Hausberg M, Kosch M, Harmelink P et al (2002) Sympathetic nerve activity in end-stage renal disease. Circulation 106:1974–1979

    Article  PubMed  Google Scholar 

  8. Isaksson H, Ostergren J (1994) Prognosis in therapy-resistant hypertension. J Intern Med 236:643–649

    Article  CAS  PubMed  Google Scholar 

  9. Kon V (1989) Neural control of renal circulation. Miner Electrolyte Metab 15:33–43

    CAS  PubMed  Google Scholar 

  10. Krum H, Schlaich M, Whitbourn R et al (2009) Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 373:1275–1281

    Article  PubMed  Google Scholar 

  11. Lewington S, Clarke R, Qizilbash N et al (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360:1903–1913

    Article  PubMed  Google Scholar 

  12. Peet MM (1947) Results of subdiaphragmatic splanchicectomy for arterial hypertension. N Eng J Med 236:270–276

    Article  CAS  Google Scholar 

  13. Pepine CJ, Handberg EM, Cooper-Dehoff RM et al (2003) A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA 290:2805–2816

    Article  CAS  PubMed  Google Scholar 

  14. Schlaich MP, Lambert E, Kaye DM et al (2004) Sympathetic augmentation in hypertension: role of nerve firing, norepinephrine reuptake and Angiotensin neuromodulation. Hypertension 43:169–175

    Article  CAS  PubMed  Google Scholar 

  15. Schlaich MP, Socratous F, Hennebry S et al (2009) Sympathetic activation in chronic renal failure. J Am Soc Nephrol 20:933–939

    Article  PubMed  Google Scholar 

  16. Wolf-Maier K, Cooper RS, Banegas JR et al (2003) Hypertension prevalence and blood pressure levels in 6 European countries, Canada and the United States. JAMA 289:2363–2369

    Article  PubMed  Google Scholar 

  17. Zanchetti AS (1977) Neural regulation of renin release: experimental evidence and clinical implications in arterial hypertension. Circulation 56:691–698

    CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, 66421, Homburg/Saar, Deutschland

    F. Mahfoud, B. Cremers &  M. Böhm

  2. Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australien

    M. Schlaich

Authors
  1. F. Mahfoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Schlaich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Cremers
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Böhm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to F. Mahfoud or M. Böhm.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mahfoud, F., Schlaich, M., Cremers, B. et al. Neue Methode. Kardiologe 3, 474–479 (2009). https://doi.org/10.1007/s12181-009-0231-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12181-009-0231-0

Schlüsselwörter

Keywords

Search

Navigation