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World Journal of Clinical Cases 2021年第32期9卷 9970-9976页

作者： Ge Luo Jian-Jun Zhu Ming Yao Ke-Yue Xie Department of Anesthesiology and Pain The Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina

BACKGROUND resistant hypertension(RH)has always been a difficult problem in clinical diagnosis and *** present,there is no recognized safe and effective minimally invasive *** SUMMARY An 80-year-old woman was admitted to hospital due to trigeminal neuralgia(TN).The patient had a history of RH for more than 10 years and her blood pressure(BP)was not *** the treatment for TN,we decided to perform chemical renal sympathetic denervation with ethanol in the Pain Department of our *** year after the operation,she stopped taking antihypertensive drugs,and her BP was satisfactorily controlled within 4 years after *** Computed tomography-guided chemical renal sympathetic modulation may be a feasible method for the treatment of RH.

关键词： resistant hypertension Renal sympathetic denervation Ethanol Case report

The add-on effect of a Chinese herbal formula for patients with resistant hypertension: study protocol for a pilot cohort study

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Journal of Integrative Medicine 2015年第2期13卷 122-128页

作者： Ya Yuwen Yu-qi Liu Yan-ping Wang Jin-gang Dai Da-sheng Liu Yue-xi Wang Xue-jie Han Institute of Basic Research in Clinical Medicine China Academy of Chinese Medical Sciences Experimental Research Center China Academy of Chinese Medical Sciences

BACKGROUND： Despite a recent American Heart Association （AHA） consensus statement emphasizing the importance of resistant hypertension （RH）, its control is still a challenge for conventional medicine. The Chinese herbal formula, Qutan Huayu Fang, has been used effectively to assist antihypertensive agents in blood pressure control, but its effect for RH patients is still unclear. This pilot study aims to explore the effects of taking the formula in addition to antihypertensive medication in the management of RH. METHODS/DESIGN： A prospective cohort study will be conducted in two first-class hospitals of traditional Chinese medicine （TCM）. Eligible RH patients will be classified as the experimental group （n = 100） and the control group （n = 100） based on the interventions they receive. Participants taking antihypertensive agents and the Chinese herbal formula will be in the experimental group and those taking antihypertensive agents alone will be in the control group. The whole study will last 24 weeks, including an 8-week observation and follow-up at 24 weeks. The primary outcomes, assessed against patient baseline conditions, will be the reduction of systolic blood pressure and diastolic blood pressure as well as changes in TCM symptoms and signs. These outcomes will be assessed at weeks 2, 4, 6, and 8. The reductions of blood pressure will also be assessed at week 24. Cardiac events and mortality rate will be secondary outcomes and will be assessed at weeks 8 and 24. Any adverse reactions will be recorded during the study. The causal inference method will be used to assess the effectiveness of the inclusion of TCM herbal medicine in the management of patients with RH. DISCUSSION： This study will determine whether the Chinese herbal formula is helpful for RH patients treated with antihypertensive agents and the findings will provide a basis for further confirmatory studies TRIAL REGISTRATION NUMBER： ClinicalTria/*** Identifier NCT01904695

关键词： resistant hypertension cohort study medicine, Chinese traditional Complementary therapies study protocol

Main Renal Artery Plus Branch Ablation in the Treatment of resistant hypertension with Renal Denervation

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Cardiovascular Innovations and Applications 2021年第4期6卷 91-98页

作者： Tian-Jiao Lyu Ling-Yan Li Xu Wang Jian Ye Jun-Qing Gao Zong-Jun Liu Department of Cardiology Putuo Center Hospital Affi liated to Shanghai University of Traditional Chinese Medicine200062 ShanghaiPeople’s Republic of China

Objective:To study the safety and effi cacy of denervation of renal artery branches in the treatment of resistant ***:Sixty patients with resistant hypertension were *** patients were randomly assigned to the main renal artery plus branch ablation group or the main renal artery ablation *** clinical data and operation-related parameters,including number of ablation points,temperature,and average energy,were *** blood pressure was taken for all patients at the baseline and at 6 months after *** ce blood pressure was recorded before treatment and after treatment every 3 months for 2 ***:Sixty patients with resistant hypertension were enrolled in this *** were 30 patients in each *** was performed after *** renal artery complications,such as stenosis and dissection,occurred in the two *** was no signifi cant difference in age,sex,BMI,comorbid disease,and medication between the two groups(P>0.05).The number of ablation points for the main renal artery plus branch ablation group was greater than that for the main renal artery ablation *** offi ce blood pressure and 24-hour blood pressure were signifi cantly lower 6 months after treatment than before treatment in both groups(P<0.05).Offi ce blood pressure in the main renal artery plus branch ablation group was lower than that in the main renal artery ablation group during the 3-12-month follow-up period,with a statistical ***,as the follow-up time increased,the difference ***:The results of this study show that main renal artery plus branch ablation is a safe interventional method,but there was no obvious advantage on long-term follow-up compared with only main renal artery ablation.

关键词： Renal denervation resistant hypertension percutaneous renal artery sympathetic nerve ablation

Comparison of a 5 F Microtube-Irrigated Ablation Catheter and a General Ablation Catheter in the Treatment of resistant hypertension with Renal Denervation

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Cardiovascular Innovations and Applications 2021年第4期6卷 81-89页

作者： Jun-Qing Gao Hong Zhang Ling-Yan Li Xu Wang Jian Ye Zong-Jun Liu Department of Cardiology Putuo HospitalShanghai University of Traditional Chinese Medicine200069 ShanghaiPeople’s Republic of China

Objective:To assess the effectiveness of catheter-based renal denervation for reducing blood pressure in patients with resistant hypertension using a 5 F microtube-irrigated ablation ***:Sixty patients with resistant hypertension were divided into two groups:a microtube-irrigated ablation catheter group and a general ablation catheter *** conducted 12-month follow-up of all patients and recorded clinical blood pressure,ambulatory blood pressure,medication use,and biochemistry test results in both groups at the baseline and at the 12-month ***:All patients underwent renal *** the 6-month follow-up,ambulatory blood pressure in the mi-crotube-irrigated ablation catheter group was signifi cantly lower than in the general ablation catheter group(systolic blood pressure 142.0±14.4 mmHg vs.150.8±17.9 mmHg,P=0.04;diastolic blood pressure 81.2±7.0 mmHg vs.87.6±8.0 mmHg,P=0.002).At the 12-month follow-up,the between-group difference in ambulatory blood pressure was not statistically signifi *** the 12-month follow-up,the number of antihypertensive drugs and diuretics used in the microtube-irrigated ablation catheter group was less than in the general ablation catheter group(P=0.043).There was no statistical difference between the two groups in the results of biochemistry tests and ***:The microtube-irrigated ablation catheter is more effective in treating hypertension than the general ablation catheter at the 6-month follow up and thus fewer antihypertensive drugs were used in the microtube-irrigated ablation catheter group than in the general ablation catheter group.

关键词： Renal denervation sympathetic nervous system microtube-irrigated ablation catheter resistant hypertension

Renal denervation： a new therapeutic approach for resistant hypertension

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Chinese Medical Journal 2014年第18期127卷 3302-3308页

作者： Cao Longxing Fu Qiang Wang Binghui Li Zhiliang Cardiovascular Division Zhujiang Hospital Southern MedicalUniversity Guangzhou Guangdong 510280 China Centre of Cardiovascular Research and Education in Therapeutics Department of Epidemiology and Preventive Medicine School ofPublic Health and Preventive Medicine Faculty of Medicine Nursingand Health Sciences Monash University Melbourne Australia

Objective To review the advances in studies on renal denervation. Data sources References concerning renal denervation and resistant hypertension cited in this review were collected from PubMed published in English and those of renal denervation devices from official websites of device manufacturers up to January 2014. Study selection Articles with keywords ＂renal denervation＂ and ＂resistant hypertension＂ were selected. Results Renal and systemic sympathetic overactivity plays an important role in pathology of hypertension as well as other diseases characterized by sympathetic overactivity. Renal denervation is a new, catheter based procedure to reduce renal and systemic sympathetic overactivity by disruption of renal sympathetic efferent and afferent nerves through radiofrequency or ultrasound energy delivered to the endoluminal surface of both renal arteries. Although several studies have shown the efficacy and safety of renal denervation in the treatment of resistant hypertension and the potential benefit of the procedure in other diseases, Symplicity HTN 3 study, the most rigorous clinical trial of renal denervation to date, failed to meet its primary endpoint. The procedure also has other limitations such as the lack of long term, efficacy and safety data and the lack of the predictors for the blood pressure lowering response and nonresponse to the procedure. An overview of current renal denervation devices holding Conformite Europ6enne mark is also included in this review. Conclusions Renal denervation is a promising therapeutic approach in the management of resistant hypertension and other diseases characterized by sympathetic overactivity. In its early stage of clinical application, the efficacy of the procedure is still controversial. Large scale, blind, randomized, controlled clinical trials are still necessary to address the limitations of the procedure.

关键词： renal denervation resistant hypertension blood pressure sympathetic nervous system

Consensus of Chinese Specialists on Diagnosis and Treatment of resistant hypertension

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Chinese Medical Journal 2015年第15期128卷 2102-2108页

作者： Ning-Ling San Yong Huo Ji-Guang Wang Nan-Fang Li Jun Tao Yong Li Xiao-Wei Yan Xiong-Jing Jiang Xue-Wang Li Department of Cardiology Peking University People's Hospital Beijing 100044 China Department of Cardiology Peking University First Hospital Beijing 100034 China Shanghai Institute of hypertension Shanghai 200025 China Center for hypertension People's Hospital of Xinjiang Uygur Autonomous Region Hypertension Institute of Xinjiang Urumqi Xinjiang 830001 China Department of Cardiology The First Affiliated Hospital Sun Yat-sen University Guangzhou Guangdong 510080 China Department of Cardiology Shanghai Huashan Hospital Shanghai 200040 China Department of Cardiology Peking Union Medical College Hospital Beijing 100730 China hypertension Diagnosis and Treatment Center Fu Wai Hospital CAMS and PUMC Beijing 100370 China Department of Nephrology Peking Union Medical College Hospital Beijing 100730 China

INTRODUCTION resistant hypertension has become a challenge in the treatment of *** the population continues to age and obesity,sleep apnea hypopnea syndrome,and chronic kidney disease increase in incidence,resistant hypertension has become an increasingly common issue in clinical *** to control blood pressure can impair target organs such as the heart,brain,and kidney,facilitating the occurrence of clinical cardiovascular events.

关键词： Consensus of Chinese Specialists Diagnosis and Treatment resistant hypertension

Efficacy and safety of renal denervation for resistant hypertension:A systematic review and meta-analysis

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South China Journal of Cardiology 2020年第3期21卷 204-215页

作者： ZHAO Dan WANG Xiao-qing LIU Min HU Yun-ke WANG Pei-jian ZHOU Peng Chengdu Medical College Chengdu 610500China Department of Cardiology the First Affiliated Hospital of Chengdu Medical CollegeChengdu 610500China

Background Renal denervation has a tortuous *** reductions in blood pressure following denervation of the renal artery were observed in early trials,but subsequent denervation under sham surgery was found to be *** This study was performed according to search results by CNKI,WANFANG DATA,EMBASE database,Pubmed,Medline,the Cochrane Central Register of Controlled Trials,***,and World Health Organization International Clinical Trials Registry Platform from database inception to June 20,*** continuous outcomes,heterogeneity were assessed by Cochran’s Q test and random-effect models weighted for the inverse of the *** data were analyzed using relative risk(RR)with 95%*** was assessed by assessing the risk of major adverse events from stratified contingency *** 10 randomized controlled trials with a total of 1323 individuals were included in the quantitative *** analyses indicated that renal denervation was associated with a significantly greater reduction of office systolic blood pressure[mean difference(MD):-5.61 mm Hg,95%CI:-9.03 to-2.19,Z=3.21,P=0.0001]and 24-hour systolic blood pressure(MD:-4.40 mmHg,95%CI:-14.03 to-3.83,Z=5.09,Presistant hypertension patients maintained on antihypertensive drugs,renal denervation with the SYMPLICITY systems did significantly decrease blood *** denervation was not associated with an increased risk of major adverse events.

关键词： randomized clinical trial renal denervation resistant hypertension systematic review meta-analysis

A Very Severe Obstructive Sleep Apnea Syndrome: In a Cause of resistant hypertension with One Sample Case

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World Journal of Cardiovascular Diseases 2021年第3期11卷 223-229页

作者： Baldé Elhadj Yaya Bah Mamadou Bassirou Barry Ibrahima Sory Béavogui Mariama Sylla Ibrahima Sory Baldé Mamadou Aliou Koné Alpha Diallo Mamadou Camara Abdoulaye Baldé Siradiou Baldé Mamadou Dadhi Dièye Ousmane Condé Mamady Cardiology Department of the Ignace Deen Hospital Conakry Guinea Cardiology Department of Donka Hospital Conakry Guinea Sakina Clinic in Dakar Dakar Senegal

When blood pressure values remain above the target in a hypertensive patient treated concomitantly with three anti-hypertensive drugs including a diuretic, maximum well-tolerated doses, this is a resistant arterial hypertension. In this case, it is advisable to look for a secondary cause such as a drug intake that influencing the blood pressure or the presence of obstructive sleeping syndrome (OSAS). We report a clinical case of a patient with a high cardiovascular risk at the age of 50, hypertensive and diabetic, with dyslipidemia and obesity. He was on anti-hypertensive triple therapy at an optimal dose. Her diabetes was balanced with 6.4% glycated hemoglobin. Dyslipidemia has being treated. Despite healthy diet including a low sodium diet and weight loss, blood pres- sure target was not reached. With self-measurement, the mean arterial pressure was 180/110 mmHg and on ABPM it was 167/113 mmHg. The ventilatory polygraphy finds a severe OSA with an IAH = 56.6. Treatment with PCP (Con- tinuous positive pressure) allowed this patient to control blood pressure. The search for OSA should be systematic in face of resistant hypertension, in par- ticular in overweight or obese patients.

关键词： Obstructive Sleep Apnea Syndrome (OSAS) resistant hypertension Continuous Positive Airway Pressure (CPAP)

The Beneficial Effect of Renin-Angiotensin-Aldosterone System Blockade in Treatment of hypertension, resistant to Conventional Antihypertensives, in Patients on Maintenance Hemodialysis

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Open Journal of Nephrology 2023年第2期13卷 67-73页

作者： Kamel El-Reshaid Shaikha Al-Bader Department of Medicine Faculty of Medicine Kuwait University Kuwait City Kuwait Department of Nephrology Amiri Hospital Ministry of Health (Kuwait) Kuwait City Kuwait

Background: hypertension (HTN) is present in up to 90% of end stage kidney disease (ESRD) patients irrespective of the etiology of their kidney disease. Moreover, it is an important modifiable risk factor for progression to ESRD and its overall cardiovascular morbidity and mortality. Objective: to evaluate, prospectively, the role of Renin-Angiotensin-Aldosterone System blockade (RAAS) in HTN, resistant to 3 conventional antihypertensives, in patients on maintenance hemodialysis (MHD). Patients and methods: A total of 52 such patients were treated with Ramipril and 5 with Losartan after intolerable cough/shortness of breath following Ramipril-use. None of the patients had fluid depletion, renal artery stenosis and primary endocrinopathy. The study group was compared to a matched control group of MHD patients with normal blood pressure following 3 drugs-combination therapies. Results: All patients, with resistant HTN, had significant activation of RAAS system prior to treatment compared to inactive one in the control group. In those with resistant HTN, control of HTN, was established within 2 weeks of therapy and was associated with suppression of the RAAS. Such therapy was associated with minor side effects. Conclusion: Our study has shown that RAAS blockade is safe and effective in controlling such resistant HTN in MHD patients.

关键词： ACEI Aldosterone Angiotensin ARB Hemodialysis hypertension Renin resistant hypertension

Screening for significant atherosclerotic renal artery stenosis with a regression model in patients undergoing transradial coronary angiography/intervention

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2012年第8期13卷 631-637页

作者： Li-jin PU Ying SHEN Rui-yan ZHANG Qi ZHANG Lin LU Feng-hua DING Jian HU Zheng-kun YANG Wei-feng SHEN Department of Cardiology Ruijin Hospital Shanghai Jiao Tong Uniwzrsity School of MedicineShanghai 200025China Institute of Cardiovascular Diseases Shanghai Jiao Tong University School of MedicineShanghai 200025China

Objective:Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. Methods:Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1 813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. Results:Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as:P/(1 P)=exp( 2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. Conclusions:The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.

关键词： Renal artery stenosis Transradial coronary angiography resistant hypertension