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Renale Denervation als Therapieoption

Therapieresistente arterielle Hypertonie

  • Original- und Übersichtsarbeiten
  • CME-Schwerpunkt: Hypertonie
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CardioVasc Aims and scope

Abstract

Die therapierefraktäre arterielle Hypertonie ist eine chronische Erkrankung mit weitreichenden Folgen für das kardiovaskuläre System. Trotz vielfacher medikamentöser Optionen leiden auch heute noch ca. 5–15% aller Hypertoniker an einer therapierefraktären Form des Bluthochdrucks. Deren Behandlung stellt sowohl den Arzt als auch den Patienten vor große Schwierigkeiten. Mit der renalen Denervation steht uns heute ein minimal-invasives interventionelles Verfahren zur Verfügung, durch das vielen therapierefraktären Hypertonikern geholfen werden kann. In diesem Artikel werden pathophysiologische Hintergründe, die prozedurale Durchführung und insbesondere die Indikationsstellung der renalen Denervation dargestellt. Hierfür werden Daten aus Studien, Konsensusartikeln und eigene Erfahrungen unseres Zentrums zusammengefasst.

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Literatur

  1. Smithwick RH. Hypertensive vascular disease; results of and indications for splanchnicectomy. Journal of chronic diseases. 1955;1(5):477–496.

    Article  PubMed  CAS  Google Scholar 

  2. Effects of treatment on morbidity in hypertension: Results in patients with diastolic blood pressures averaging 115 through 129 mm hg. JAMA. 1967;202(11):1028-1034.

    Google Scholar 

  3. Whitelaw GP, Kinsey D, Smithwick RH. Factors Influencing the Choice of Treatment in Essential Hypertension. Surgical, Medical or a Combination of Both. American journal of surgery. 1964;107:220–231.

    Article  PubMed  CAS  Google Scholar 

  4. Allen EV. Sympathectomy for essential hypertension. Circulation. 1952;6(1):131–140.

    Article  PubMed  CAS  Google Scholar 

  5. Isberg EM, Peet MM. The influence of supradiaphragmatic splanchnicectomy on the heart in hypertension. American heart journal. 1948;35(4):567–583.

    Article  PubMed  CAS  Google Scholar 

  6. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 17 1997;349(9063):1436–1442.

    Article  PubMed  CAS  Google Scholar 

  7. Todesursachenstatistik 2010. Statistisches Bundesamt. 2012.

  8. Prugger C, Heuschmann PU, Keil U. [Epidemiology of hypertension in Germany and worldwide]. Herz. 2006;31(4):287–293.

    Article  PubMed  Google Scholar 

  9. Manson JE, Tosteson H, Ridker PM, et al. The primary prevention of myocardial infarction. N Engl J Med. 1992;326(21):1406–1416.

    Article  PubMed  CAS  Google Scholar 

  10. Straus SE, Majumdar SR, McAlister FA. New evidence for stroke prevention: scientific review. JAMA 2002;288(11):1388–1395.

    Article  PubMed  Google Scholar 

  11. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 2003;290(2):199–206.

    Article  PubMed  Google Scholar 

  12. Lloyd-Jones DM, Evans JC, Larson MG, et al. Differential control of systolic and diastolic blood pressure: factors associated with lack of blood pressure control in the community. Hypertension. 2000;36(4):594–599.

    Article  PubMed  CAS  Google Scholar 

  13. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288(23):2981–2997.

  14. Cushman WC, Ford CE, Cutler JA, et al. Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). J Clin Hypertens (Greenwich). 2002;4(6):393–404.

    Article  Google Scholar 

  15. Leitlinie zur Behandlung der arteriellen Hypertonie. Deutsche Hochdruckliga. 2011.

  16. Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. Journal of hypertension. 2009;27(11):2121–2158.

    Article  PubMed  CAS  Google Scholar 

  17. Lowel H, Meisinger C, Heier M, et al. [Epidemiology of hypertension in Germany. Selected results of population-representative cross-sectional studies]. Dtsch Med Wochenschr. 2006;131(46):2586–2591.

    Article  PubMed  CAS  Google Scholar 

  18. Wolf-Maier K, Cooper RS, Kramer H, et al. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension. 2004;43(1):10–17.

    Article  PubMed  CAS  Google Scholar 

  19. Calhoun DA, Jones D, Textor S, et al. 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. 2008;117(25):e510–526.

    Article  PubMed  Google Scholar 

  20. Douma S, Petidis K, Doumas M, et al. Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study. Lancet. 2008;371(9628):1921–1926.

    Article  PubMed  CAS  Google Scholar 

  21. Buckalew VM, Jr., Berg RL, Wang SR, et al. Prevalence of hypertension in 1,795 subjects with chronic renal disease: the modification of diet in renal disease study baseline cohort. Modification of Diet in Renal Disease Study Group. American journal of kidney diseases: the official journal of the National Kidney Foundation. 1996;28(6):811–821.

    Article  Google Scholar 

  22. Dusing R. Optimizing blood pressure control through the use of fixed combinations. Vascular health and risk management. 2010;6:321–325.

    Article  PubMed  Google Scholar 

  23. Epstein BJ. Improving blood pressure control rates by optimizing combination antihypertensive therapy. Expert opinion on pharmacotherapy. 2010;11(12):2011–2026.

    Article  PubMed  CAS  Google Scholar 

  24. Thoenes M, Tebbe U, Rosin L, et al. Blood pressure management in a cohort of hypertensive patients in Germany treated by cardiologists. Clin res cardiol 2011;100(6):483–491.

    Article  PubMed  Google Scholar 

  25. Epstein M, Calhoun DA. Aldosterone blockers (mineralocorticoid receptor antagonism) and potassium-sparing diuretics. J Clin Hypertens (Greenwich). 2011;13(9):644–648.

    Article  CAS  Google Scholar 

  26. Roush GC, Holford TR, Guddati AK. Chlorthalidone compared with hydrochlorothiazide in reducing cardiovascular events: systematic review and network meta-analyses. Hypertension. 2012;59(6):1110–1117.

    Article  PubMed  CAS  Google Scholar 

  27. Hausberg M, Kosch M, Harmelink P, et al. Sympathetic nerve activity in end-stage renal disease. Circulation. 8 2002;106(15):1974–1979.

    Article  PubMed  Google Scholar 

  28. Joyner MJ, Charkoudian N, Wallin BG. Sympathetic nervous system and blood pressure in humans: individualized patterns of regulation and their implications. Hypertension. 2010;56(1):10–16.

    Article  PubMed  CAS  Google Scholar 

  29. Kalaitzidis RG, Karasavvidou D, Siamopoulos KC. Renal Sympathetic Denervation and Renal Physiology. Current clinical pharmacology. 2012.

  30. Krum H, Schlaich M, Sobotka P, et al. Novel procedure- and device-based strategies in the management of systemic hypertension. European heart journal. 2011.

  31. Schlaich MP, Socratous F, Hennebry S, et al. Sympathetic activation in chronic renal failure. JASN. 2009;20(5):933–939.

    Article  PubMed  Google Scholar 

  32. Barajas L, Powers K, Wang P. Innervation of the renal cortical tubules: a quantitative study. The American journal of physiology. 1984;247(1 Pt 2):F50–60.

    PubMed  CAS  Google Scholar 

  33. Esler M, Rumantir M, Kaye D, et al. Sympathetic nerve biology in essential hypertension. Clinical and experimental pharmacology & physiology. 2001;28(12):986–989.

    Article  CAS  Google Scholar 

  34. Doumas M, Faselis C, Papademetriou V. Renal sympathetic denervation and systemic hypertension. The American journal of cardiology. 2010;105(4):570–576.

    Article  PubMed  Google Scholar 

  35. DiBona GF, Kopp UC. Neural control of renal function. Physiological reviews. 1997;77(1):75–197.

    PubMed  CAS  Google Scholar 

  36. Bello-Reuss E, Colindres RE, Pastoriza-Munoz E, et al. Effects of acute unilateral renal denervation in the rat. The Journal of clinical investigation. 1975;56(1):208–217.

    Article  PubMed  CAS  Google Scholar 

  37. Bonjour JP, Churchill PC, Malvin RL. Change of tubular reabsorption of sodium and water after renal denervation in the dog. The Journal of physiology. 1969;204(3):571–582.

    PubMed  CAS  Google Scholar 

  38. Wu XC, Johns EJ. Nitric oxide modulation of neurally induced proximal tubular fluid reabsorption in the rat. Hypertension. 2002;39(3):790–793.

    Article  PubMed  CAS  Google Scholar 

  39. Coote JH. A role for the paraventricular nucleus of the hypothalamus in the autonomic control of heart and kidney. Experimental physiology. 2005;90(2):169–173.

    CAS  Google Scholar 

  40. Mahfoud F, Vonend O, Bruck H, et al. Interventionelle renale Sympathikusdenervation zur Behandlung der therapieresistenten Hypertonie. Dtsch Med Wochenschr. 2011;136:2418–2418.

    Article  PubMed  CAS  Google Scholar 

  41. Pathak A, Girerd X, Azizi M, et al. Expert consensus: renal denervation for the treatment of arterial hypertension. Archives of cardiovascular diseases. 2012;105(6–7):386–393.

    PubMed  Google Scholar 

  42. Krum H, Schlaich M, Whitbourn R, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet. 2009;373(9671):1275–1281.

    Article  PubMed  Google Scholar 

  43. Flack J. A promising therapy for a vexing problem. Cadiol News. 2012;10(2):2.

    Google Scholar 

  44. Ukena C, Mahfoud F, Kindermann I, et al. Cardiorespiratory response to exercise after renal sympathetic denervation in patients with resistant hypertension. Journal of the American College of Cardiology. 2011;58(11):1176–1182.

    Article  PubMed  Google Scholar 

  45. Mahfoud F, Cremers B, Janker J, et al. Renal Hemodynamics and Renal Function After Catheter-Based Renal Sympathetic Denervation in Patients With Resistant Hypertension. Hypertension. 2012 2012;60(2):419–424.

    Article  PubMed  CAS  Google Scholar 

  46. Lambert GW, Hering D, Esler MD, et al. Health-Related Quality of Life After Renal Denervation in Patients With Treatment-Resistant Hypertension. Hypertension. 2012;60(6):1479–1484.

    Article  PubMed  CAS  Google Scholar 

  47. Mahfoud F, Schlaich M, Kindermann I, et al. Effect of Renal Sympathetic Denervation on Glucose Metabolism in Patients With Resistant Hypertension: A Pilot Study. Circulation. 2011;123(18):1940–1946.

    Article  PubMed  CAS  Google Scholar 

  48. Brandt MC, Mahfoud F, Reda S, et al. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. Journal of the American College of Cardiology. 2012;59(10):901–909.

    Article  PubMed  Google Scholar 

  49. Pokushalov E, Romanov A, Corbucci G, et al. Does atrial fibrillation burden measured by continuous monitoring during the blanking period predict the response to ablation at 12-month follow-up? Heart rhythm 2012;9(9):1375–1379.

    Google Scholar 

  50. Geisler BP, Egan BM, Cohen JT, et al. Cost-Effectiveness and Clinical Effectiveness of Catheter-Based Renal Denervation for Resistant Hypertension. Journal of the American College of Cardiology. 2012.

  51. Mahfoud F, Vonend O, Bruck H, et al. [Expert consensus statement on interventional renal sympathetic denervation for hypertension treatment]. Dtsch Med Wochenschr. 2011;136(47):2418.

    Article  PubMed  CAS  Google Scholar 

  52. Esler MD, Krum H, Sobotka PA, et al. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet. 2010;376(9756):1903–1909.

    Article  PubMed  Google Scholar 

  53. Collins AJ, Li S, Ma JZ, Herzog C. Cardiovascular disease in end-stage renal disease patients. American journal of kidney diseases: the official journal of the National Kidney Foundation. 2001;38(4 Suppl 1):S26–29.

    Article  CAS  Google Scholar 

  54. Anavekar NS, McMurray JJ, Velazquez EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl j med. 2004;351(13):1285–1295.

    Article  PubMed  CAS  Google Scholar 

  55. Grassi G, Quarti-Trevano F, Seravalle G, et al. Early sympathetic activation in the initial clinical stages of chronic renal failure. Hypertension. 2011;57(4):846–851.

    Article  PubMed  CAS  Google Scholar 

  56. Briguori C, Airoldi F, D’Andrea D, et al. Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): a randomized comparison of 3 preventive strategies. Circulation. 2007;115(10):1211–1217.

    PubMed  CAS  Google Scholar 

  57. Scolari F, Ravani P. Atheroembolic renal disease. Lancet. 2010;375(9726):1650–1660.

    Article  PubMed  Google Scholar 

  58. Lewalter T, Brodherr T. Three-dimensional guided renal denervation to treat drug-resistant arterial hypertension in a patient with renal insufficiency. Hypertension. 2012;60(4):e33.

    Article  PubMed  CAS  Google Scholar 

  59. Hering D, Mahfoud F, Walton AS, et al. Renal denervation in moderate to severe CKD. JASN. 2012;23(7):1250–1257.

    Article  PubMed  CAS  Google Scholar 

  60. Sudano I, Flammer AJ, Roas S, et al. Nonsteroidal antiinflammatory drugs, acetaminophen, and hypertension. Current hypertension reports. 2012;14(4):304–309.

    Article  Google Scholar 

  61. Grossman E, Messerli FH. Drug-induced hypertension: an unappreciated cause of secondary hypertension. The American journal of medicine. 2012;125(1):14–22.

    Article  PubMed  CAS  Google Scholar 

  62. Grossman E, Messerli FH. High blood pressure. A side effect of drugs, poisons, and food. Archives of internal medicine. 1995;155(5):450–460.

    Article  PubMed  CAS  Google Scholar 

  63. Chasan-Taber L, Willett WC, Manson JE, et al. Prospective study of oral contraceptives and hypertension among women in the United States. Circulation. 1996;94(3):483–489.

    Article  PubMed  CAS  Google Scholar 

  64. Izzo AA, Di Carlo G, Borrelli F, Ernst E. Cardiovascular pharmacotherapy and herbal medicines: the risk of drug interaction. International journal of cardiology. 2005;98(1):1–14.

    Article  PubMed  Google Scholar 

  65. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl j med. 2000;343(25):1833–1838.

    Article  PubMed  CAS  Google Scholar 

  66. Ponticelli C. Cyclosporine in idiopathic nephrotic syndrome. Immunopharmacology and immunotoxicology. 1993;15(4):479–489.

    Article  PubMed  CAS  Google Scholar 

  67. Snanoudj R, Kriaa F, Arzouk N, et al. Single-center experience with cyclosporine therapy for kidney transplantation: analysis of a twenty-year period in 1200 patients. Transplantation proceedings. 2004;36(2 Suppl):83S–88S.

    Google Scholar 

  68. Glass TR, Ungsedhapand C, Wolbers M, et al. Prevalence of risk factors for cardiovascular disease in HIV-infected patients over time: the Swiss HIV Cohort Study. HIV medicine. 2006;7(6):404–410.

    Article  PubMed  CAS  Google Scholar 

  69. Savoca MR, MacKey ML Evans CD, et al. Association of ambulatory blood pressure and dietary caffeine in adolescents. American journal of hypertension. 2005;18(1):116–120.

    Article  PubMed  CAS  Google Scholar 

  70. MacMahon SW, Blacket RB, Macdonald GJ, Hall W. Obesity, alcohol consumption and blood pressure in Australian men and women. The National Heart Foundation of Australia Risk Factor Prevalence Study. Journal of hypertension. 1984;2(1):85–91.

    Article  PubMed  CAS  Google Scholar 

  71. Johnson BA, Wells LT, Roache JD, et al. Isradipine decreases the hemodynamic response of cocaine and methamphetamine results from two human laboratory studies: results from two human laboratory studies. American journal of hypertension. 2005;18(6):813–822.

    Article  PubMed  CAS  Google Scholar 

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  1. Charitél - Campus Benjamin Franklin, Med. Klinik mit SP Nephrologie, Hindenburgdamm 30, 12203, Berlin, Deutschland

    Markus Tölle

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  1. Markus Tölle
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  2. Markus van der Giet
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Correspondence to Markus Tölle.

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Tölle, M., van der Giet, M. Renale Denervation als Therapieoption. CV 13, 38–44 (2013). https://doi.org/10.1007/s15027-013-0022-1

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