High Blood Pressure: Is Compliance to Medication Necessary?

Not too long ago a study came out that 1 in 4 people are not taking their blood pressure medications on time.  It is a known fact that patients with problematic or chronic diseases don't always take their medications on time and high blood pressure is definitely on that list.   Though at times being forgetful is okay, it is important that this doesn't turn into carelessness.  Not taking your medications on time increases stroke rate and mortality rate.  Small reductions in your blood pressure can be extremely beneficial. For example, a middle aged (between ages 40 and 69) person with a blood pressure reading of 175/105 mm Hg is 8X  (absolute risk increase of 800%) more likely to die of cardiovascular disease in the next 10 years in comparison to a patient of the same age/ethnicity/sex with a BP reading of 115/75 mmHg.

If blood pressure is persistently not controlled, it causes over-exertion of the heart. As the heart continues to pump blood at a normal heart rate of 72 beats per minute against high blood pressure, the heart wall muscles becomes thick and stiff over years, which is called left ventricular hypertrophy (LVH).  As the heart thickens, it cannot efficiently contract or relax normally. Diastolic dysfunction, inability of the heart to relax normally, leads to inefficient pumping of deoxygenated blood and subsequently may cause heart failure. With the progression of LVH, you may suffer from arrhythmia and stroke. Persistent hypertension can lead to hardening of the arteries and atherosclerosis (building of plaque in the arteries), which may cause heart attacks and angina.

Remember: Failure to control your blood pressure can lead to serious health problems.

By controlling your blood pressure, you delay the effects of high blood pressure on your organs to much later on in your life. For every increase in 20/10 mm Hg of blood pressure, there is 2-fold increase mortality and even a small reduction in blood pressure translates in to a benefit. Below are some suggestions to help you control your blood pressure.

v  Simple lifestyle and dietary changes can help reduce blood pressure (See Healthy Lifestyle)

v  Take your blood pressure medications on time and as prescribed (Click Here for More Information)

v  Properly treated high blood pressure should not interfere with daily living

Click Here for more information on high blood pressure and new therapies on the horizon

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Renal Denervation: “ The end of the beginning” Professor Murray Esler at ACC

Professor Murray Esler delivered 45th Annual Louis F. Bishop Lecture at ACC.
Prof. Esler, pioneer of the landmark research that lead to our current understanding of the role of beta-blocker in the treatment of CHF, opened his talk with the question: “Is it the end of the beginning or the end of the end of renal denervation(RDN)? He is as sure as he was before January 9th, 2014 and convinced that the sympathetic nervous system (SNS) has a very important role to play in the pathogenesis of hypertension/ resistant HTN and that RDN has a role in treating patients suffering from this condition. Prof. Esler has been studying the sympathetic nervous system(SNS) for over 20 years and has developed an isotope method to study the role of SNS in circulatory control, exercise physiology, mental stress, obesity, congestive heart failure (CHF) and hypertension (HTN).

He kicked-off his presentation with a data review of the role of SNS in the pathogenesis of CHF, orthostatic intolerance, ventricular and atrial arrhythmia, and HTN. His opening slides consisted of Thomas Willis’s first ever drawing of the sympathetic nervous system from 1664 and moving forward to the work of Claude Bernard (1913, Surgical sympathectomy), William Paton (developed centrally acting anti-adrenergic drugs) he elaborated on the 4 decades of work from multiple continents showing renal denervation (including surgical denervation) inhibits the preferential activation of renal sympathetic outflow in drug resistant HTN. (Perhaps the commonly used drugs are not targeting the primary pathophysiology?) He briefly mentioned the regional norepinephrine spillover and selective reduction of the beta 1 receptor in the heart failure and Carvedilol trials showing the benefit of sympathetic inhibition on the mortality of heart failure patients.

His take on the Symplicity HTN-3: 
The mean reduction of SBP by14 mmHg in the RDN group and by 11.7 mmHg in the sham group is very likely from the execution of the study.

In the US, 88 centers enrolled 360 patients in the RDN arm and were treated by 140 interventionalist out of which 120 interventionalist performed only one procedure each in the trial and that is the only renal RF ablation procedure they have done in their career. “Mea culpa”

There was no marker to confirm that the denervation was achieved. In Symplicity I, 45% reduction in the renal vein norepinephrine spillover was measured in the 10 patients. In 70 pigs 85% reduction of NE renal spillover in the renal vein were noted. The effective ablation was less in those 10 patients than in the animal study. The human use of the Ardian Symplicity catheter is not easy and is usually incomplete. Reduction in NE spillover ranged in wide verity and proved it was operator dependent. Success of denervation is operator dependent. He further mentioned that another possibility is the inefficient first generation device: energy form, intensity and heat penetration. “HTN-3 will be judged to have failed to achieve adequate renal denervation and to be on the wrong side of history”. There are two trials where better BP control was achieved by repeating the procedure – “Or have better device to do first job better”.

When asked about the question of what he tells to the patients about the SYMPLICITY HTN-3 data he said: I tell my patient “You remember that special treatment for your HTN which fixed you up, a large overseas clinical trial showed that it did not work”.

For him, “The real science of renal denervation now begins”. Moving forward some of the current RDN mysteries will need to be solved:

How much RDN is optimal?
How to standardize the denervation?
How to test if denervation is achieved?
Pre-selection of patient”
Will RDN show a “class effect”?

Dr. Murray Esler closed with “It is End of the beginning and not the end of end.”

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Global SYMPLICITY Registry 6-Month Data Reveals Strong Safety Profile And Blood Pressure Reduction

Medtronic, Inc. (NYSE: MDT), announced on March 30th that further analysis of six-month follow-up data from the first 1,000 patients enrolled in the Global SYMPLICITY Registry, which continue to demonstrate the safety of the Symplicity(TM) renal denervation system. Presented today during a late-breaking clinical trial session at the 63rd Scientific Sessions of the American College of Cardiology (ACC), the results of this observational, open-label study show that renal denervation with the Symplicity(TM) renal denervation system resulted in significant reductions in both office and 24-hour ambulatory blood pressure compared to baseline, with very low adverse event rates to six months. The Symplicity(TM) renal denervation system is available for investigational use only in the United States.

Of all patients available for six-month follow-up, overall office systolic blood pressure reduction was -11.9 mm Hg and mean 24-hour ABPM systolic blood pressure reduction was -7.9 mm Hg. For the subset of patients with baseline office SBP ≥ 160 mm Hg, and baseline 24 hour mean ABPM SBP ≥ 135 mm Hg that were treated with at least 3 medication classes, similar to those included in all other Symplicity trials, office systolic blood pressure reduction was -20.2 mm Hg.

“The Global SYMPLICITY Registry provides further evidence confirming the well-established safety profile of renal denervation with the Symplicity system,” said Michael Böhm, M.D., Ph.D., chairman, Department of Internal Medicine, University of Saarland, Homburg/Saar, Germany and Global SYMPLICITY Registry co-chair. “Presented on the heels of SYMPLICITY HTN-3, this real-world experience provides a significant contribution to the discussion about the efficacy of renal denervation and offers additional perspective when considering the option of renal denervation in clinical practice for high-risk patients suffering from uncontrolled hypertension who may have limited treatment options.”

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Does renal denervation have a future? TRENDS Conference gives a resounding Yes.

By Dr. Sameer Gafoor

The recent TRENDS conference in Frankfurt discussed at length the current status and future of renal denervation. Recent trial data has called this into question. This was discussed extensively.

Friday, February 7

This started with an overview of hypertension (Roland Schmieder) and an understanding of measurement modalities for blood pressure (Guido Grassi), an overlook of the the guidelines (Orfeas Liangos), and an overview of what you need to do to test for secondary hypertension (Stefan Bertog), optimize medical management (Orfeas Liangos) and select patients to implement a renal denervation practice (Oliver Vonend, Thomas Schmitz).

Then it was time to take a step back to discuss the anatomy and physiology by such renowned scholars as Dagmara Hering, Ariel Sverdlik, and Paul Sobotka. We took a look at renal denervation and pulse wave velocity (Kai Mortenson), and clinical endpoints (Robert Melder).

A special first-in-man experience of a new device with impressive results was presented by Dr. van der Heijden, proving how there was still much hope and promise for the future.

After lunch on Friday, it was time to take a deep dive into the different companies and their current updates – Simplicity (Marc Sapoval and Justin Davies), Vessix (Gerard Goh), Enlightn (Vasiolos Papademetriou), Covidien (Stefan Bertog), Paradise Recor Medical (Joost Daemen).

Dr. Darrel Francis came and stole the show with the simple explanations as to why Simplicity 3 turned out the way it did. He explained in depth why the press releases were ill-worded and badly interpreted. This was ‘irrational exuberance followed by unjustified despondency’ and now this was time for an exciting future based on science. This was due to ‘big day bias’, ‘check once more bias’, and ‘i’ll take them now bias’ that had harmed this trial, and there were solutions to all of these issues that future trials would have to pay attention to if they were to have any hope of success.

What are the other effects of renal denervation aside from hypertension? This includes effects on arrhythmias (Jennifer Franke), insulin resistance (Dagmara Hering), chronic kidney disease (Roland Schmieder), sleep apnea (Aleksander Prejbisz), exercise tolerance (Mathias-Christoph Brandt), renovascular hypertension (Yvonne Bausback), and psychometric aspects/quality of life (Dagmara Hering).

Once we learned all of the above, it was time for a step by step approach for the different devices. This started with a lecture on angiography (Mark Wholey), followed by instructions for Symplicity Flex and Covidien One Shot (Martin Bergmann), Vessix (Gerard Goh), EnligHTN (Vasiolos Papademetriou), Recor Medical (Joost Daemen). This was followed by a talk on invasive imaging results after the four different devices (Joost Daemen) and a talk on optimal followup (Peter de Leeuw).

Saturday, February 8

Saturday started with an exciting mix of talks and cases together.

The talks went beyond the earlier companies to discuss the new fields of baroreceptor stimulation, pulmonary artery denervation, new techniques for renal denervation, and more.

This started with an overview of the exciting new field of baroreceptor activation and other new systemic interventions. What is baroreceptor activation was covered by Joern Schmitt, followed by Barostim in renal denervation nonresponders (Hannes Reuter), chronic kidney disease patients (Michael Koziolek), and heart failure (Rolf Wachter).

The kidney nerves are not the only nerves that play a major role in hypertension. Paul Sobotka discussed carotid body ablation, followed by the promise and current status of pulmonary artery denervation for pulmonary hypertension (Alexander Rothman and Yao-Jun Zhang).

New Techniques for renal denervation was broken into two parts because of the wide plethora of devices available. This included overview talks on the advantages and disadvantages of radiofrequency (Justin Davies) and ultrasound (Martin Bergmann) and histopathology after ultrasound (Joost Daemen). Other techniques included Cardiosonic (Michael Jonas), in-stent renal denervation with TIVUS (Michael Jonas), Terumo Iberis renal denervation (Benjamin Honton), Cordis Thermocool (Martin Bergmann), Bullfrog catheter and radiation therapy (Jan Kulow), Medtronic Spyral (Erwin Blessing), and local anesthesia (Simon Lam).

The second part included externally focused ultrasound (Omar Dawood), Denervx Cooled Microwave Technology (Stefan Bertog), Perivascular Chemical Renal denervation (Tim Fischell), Northwind Medical (Mark Wholey), Chemical renal denervation by Vicristine (Christodoulous Stefanadis) and VERVE medical with an invasive non-vascular approach (Richard Heuser).

Other ‘systemic interventions’ included vagus nerve stimulation on arterial hypertension (Sekib Sokolovic), the ROX Medical AV Anastomosis therapy (Paul Sobotka) and future of neurohumoral modulation.

Cases, performed by Dr. Horst Sievert, Laura Vaskelyte, and Sameer Gafoor included live detailed step-by-step discussion of the Recor Medical Paradise, Medtronic Symplicity, Boston Vessix, St. Jude EnligHTN, and Terumo Iberis devices. Live invasive imaging was performed to help with decision management and discussion among the participants was extensive.

For more information about the conference please see the website. Selected lectures will be found online.

Dr. Sameer Gafoor

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High Blood Pressure Treatment to Avoid Serious Diseases

In 2000, 972 million (26%) adults had Hypertension (high blood pressure) worldwide. In 2025 about 1.5 billion people (29%) are projected to have hypertension. Even in established countries, such as the United States, many go untreated as only 65% of the patients are aware of their hypertension. In addition, among those that undergo treatment only 1 in 3 patient have their blood pressure controlled.

Blood Pressure is force of blood against your artery walls as it circulates through your body. BP normally rises and falls throughout the day. A normal blood pressure reading is 120/80 mm Hg with the systolic (top number) showing pressure when the heart beats and diastolic pressure (lower number) at rest between heartbeats, when the heart refills with blood. High Blood Pressure is a silent killer that often has no warning signs or symptoms, making it essential to have your Blood Pressure checked regularly. High Blood-Pressure may lead to some of these symptoms:

• Severe headache
• Difficulty breathing
• Fatigue or confusion
• Irregular heartbeat
• Vision problems
• Blood in the urine
• Chest pain
• Pounding in your chest, neck, or ears

Remember: Untreated hypertension can lead to serious diseases including Stroke, Heart Disease and Kidney Failure.

Uncontrolled Blood Pressure and a Stiff Heart

If blood pressure is persistently not controlled, it causes over-exertion of the heart. As the heart continuously pumps at 72 times/min against high blood pressure, the heart wall muscles becomes thick and stiff over the years, which is called left ventricular hypertrophy (LVH).

Kidneys also play a crucial role in regulating the blood pressure. Persistent High Blood Pressure leads to nephrosclerosis, a renal disease that starts with proteinuria progresses to kidney insufficiency and finally to end-stage kidney failure requiring dialysis.

How You Can Help Your Body

By controlling your blood pressure, you delay the effects of hypertension on your organs to much later in your life. For every increase in 20/10 mm Hg of blood pressure, there is 2-fold increase mortality and even a small reduction in blood pressure translates in to a benefit. Below are some suggestions to help you control your blood pressure.

• Simple lifestyle and dietary changes can help reduce blood pressure
• Take your blood pressure medications on time and as prescribed
• Properly treated high blood pressure should not interfere with daily living

Remember: Failure to control your blood pressure can lead to serious health problems and sometimes even death

High Blood Pressure Treatment:

 

The initial treatment for high blood pressure is a healthier lifestyle, inclusive of exercise, quitting smoking and good dietary habits. The second line of treatment is antihypertensive medications, which targets different organs or receptors to lower blood pressure—some remove extra fluid and salt from the body, some slow down the heart contraction and others relax and widen blood vessels. In many patients an effective therapy is a combination of these drugs.

About a 1/3 of the patients have "Resistant Hypertension". Their blood pressure remains high (>140/90 for all patients, >130/80 for diabetes and kidney insufficiency patients) despite the use of maximum tolerated doses of 3 antihypertensive drugs and compliance to the lifestyle measures.

One of the most important cause for high blood pressure overactive sympathetic nerves that connects Kidney with the Brain. These overactive nerves can be zapped and disabled by a minimally invasive endovascular procedure called Renal Denervation. Renal Denervation has shown significant blood pressure reductions in patient with severe high blood pressure.

To Learn more about Hypertenson, High Blood Pressure, Healthy Lifestyles and Renal Denervation go to www.renaldenervationworld.org

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Renaldenervationworld.org Launches Online, a core source for Renal Denervation News and Education

The launch of a comprehensive non-bias global interactive educational platform on Renal Denervation and more:

• Sympathetic Nerve Modulation
• Renal Denervation Technology
• Uncontrolled high blood pressure
• Hypertension
• Renal Denervation for conditions beyond hypertension 

Renal Denervation (RDN) is a new catheter-based minimally invasive procedure that has shown exceptional reductions in blood pressure for patients with uncontrolled hypertension in multiple clinical trials. The procedure targetsoveractive renal sympathetic nerves disabling the brain-kidney crosstalk and thereby reducing the sympathetic drive as well as the blood pressure.Within the past four years, the science of Renal Sympathetic Denervation has advanced at a very fast pace. Major industry players and innovative technologies have flooded the market place as the medical community is slowly starting to gain confidence in the therapy. With the treatment moving forward, there is a need for a comprehensive educational platform to increase awareness and knowledge about RDN. Renal Denervation is now being investigated in management of moderate Resistant Hypertension, congestive heart failure, diabetes, obstructive sleep apnea, arrhythmia and left ventricular hypertrophy.

Renaldenervationworld.org is a non-bias, dynamic digital platform envisioned to be the central location to educate and explore the evolution of RDN for both health care professionals and patients. Professional education spans across the “basics of the sympathetic nervous system” to the “applications of the RDN beyond the treatment of hypertension” bridging cardiologists, referring primary care physicians, interventionists, and nephrologists (hypertension specialist). Health care professionals can interact with the medical community by "submitting a case", reviewing the clinical trial archives, and querying the RDN experts. Patient education covers the basics of “hypertension/resistant hypertension” "what is renal denervation." and “what to expect on the day of procedure”. Patients can interact with other patients or read patients blogs. The education platform is edited with the guidance from international group of expert physicians including Nephrologist, Cardiologist, and Interventionalist. 

ABOUT COMPANY :

Established in 2013, RDNworld.org is an independent website, providing healthcare professionals and patients educational material on Sympathetic Nerve Modulation, Renal Denervation, Uncontrolled High Blood Pressure and Hypertension.

Contact Information : 

Nima Shah 

718-701-0916
editor@rdnworld.org
www.renaldenervationworld.org

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