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DOI 10.34014/2227-1848-2024-2-6-17

MODERN VIEW ON RADIOFREQUENCY DENERVATION OF RENAL ARTERIES

R.R. Galimov1, A.N. Molchanov2, A.G. Gorgun1, P.I. Pavlov1, M.V. Malkhas'yan1

1 District Clinical Hospital, Khanty-Mansiysk, Russia;

2 Khanty-Mansiysk State Medical Academy, Khanty-Mansiysk, Russia

 

Today, arterial hypertension is one of the most important health problems. It is also the main cause of cardiovascular complications and death. Despite significant success of modern antihypertensive pharmacotherapy, 10 % of the entire patient population with high blood pressure have extremely low sensitivity to core drugs aimed at BP correction. According to large clinical studies, the risk of myocardial infarction, stroke and other adverse cardiovascular outcomes in individuals with resistant hypertension is several times higher than in patients with controlled blood pressure.

The purpose of this work is to analyze scientific literature on the history of development, effectiveness and safety of catheter radiofrequency denervation of renal arteries in patients with resistant arterial hypertension.

The authors used articles from Pubmed, eLIBRARY, etc. for their analysis.

The results of clinical studies show that patients with resistant arterial hypertension, in contrast to patients with controlled blood pressure, have more pronounced sympathetic activity. Hyperactivity of this part of the nervous system may be one of the main pathogenetic factors causing development of resistance to pharmacotherapy. Thus, radiofrequency renal denervation, modulating the tone of the sympathetic nervous system, is of particular interest.

Key words: renal denervation, resistant arterial hypertension, ablation.

 

Conflict of interest. The authors declare no conflict of interest.

Author contributions

Research concept and design: Galimov R.R., Molchanov A.N., Gorgun A.G.

Literature search: Galimov R.R., Molchanov A.N., Gorgun A.G., Malkhas'yan M.V.

Text writing and editing: Galimov R.R., Molchanov A.N., Gorgun A.G., Pavlov P.I.

 

References

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  2. Stuart M. Masterminds of Ardian: An Interview With Inventors Mark Gelfand and Howard Levin. Start-Up. 2011.

  3. Kandzari D., Böhm M., Mahfoud F. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet. 2018; 391 (10137): 2346–2355.

  4. Böhm M., Kario К., Kandzari D.E., Mahfoud F. SPYRAL HTN-OFF MED Pivotal Investigators. Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial. Lancet. 2020; 2 (395): 1444–1451.

  5. Mahfoud F., Kandzari D.E., Kario K., Townsend R.R., Weber M.A., Schmieder R.E., Tsioufis K., Pocock S., Dimitriadis K., Choi J.W., East C., D'Souza R., Sharp A.S.P., Ewen S., Walton A., Hopper I., Brar S., McKenna P., Fahy M., Bohm M. Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial. Lancet. 2022; 399 (10333): 1401–1410.

  6. Esler M.D., Lambert G., Jennings G. Increased regional sympathetic nervous activity in human hypertension: causes and consequences. J Hypertens Suppl. 1990; 8: 53–57.

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  23. Bhatt D.L., Kandzari D.E., O’Neill W.W. A controlled trial of renal denervation for resistant hypertension. New England Journal of Medicine. 2014; 370 (15): 1393–1401.

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  39. Sievert H., Schofer J., Ormiston J., Hope U.C., Meredith I.T. Bipolar Radiofrequency Renal Denervation with the Vessix Catheter in Patients with Resistant Hypertension: 2-year Results from the REDUCE-HTN Trial. J Hum Hypertens. 2017; 31 (5): 366–368.

  40. Kandzari D.E., Kario K., Mahfoud F. The SPYRAL HTN Global Clinical Trial Program: Rationale and design for studies of renal denervation in the absence (SPYRAL HTN OFF-MED) and presence (SPYRAL HTN ON-MED) of antihypertensive medications. Am Heart J. 2016; 171: 82–91.

  41. Böhm M., Kario К., Kandzari D.E., Mahfoud F. SPYRAL HTN-OFF MED Pivotal Investigators. Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial. Lancet. 2020; 2 (395): 1444–1451.

  42. Townsend R.R., Mahfoud F., Kandzari D.E. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet. 2017; 390: 2160–2170.

  43. Weber M.A., Schmieder R.E., Kandzari D.E., Townsend R.R., Mahfoud F., Tsioufis K., Kario K., Pocock S., Tatakis F., Ewen S., Choi J.W., East C., Lee D.P., Ma A., Cohen D.L., Wilensky R., Devireddy C.M., Lea J.P., Schmid A., Fahy M., Böhm M. Hypertension urgencies in the SPYRAL HTN-OFF MED Pivotal trial. Clin Res Cardiol. 2022; 111 (11): 1269–1275.

  44. Kandzari D., Böhm M., Mahfoud F. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet. 2018; 391 (10137): 2346–2355.

  45. Mahfoud F., Kandzari D.E., Kario K., Townsend R.R., Weber M.A., Schmieder R.E., Tsioufis K., Pocock S., Dimitriadis K., Choi J.W., East C., D'Souza R., Sharp A.S.P., Ewen S., Walton A., Hopper I., Brar S., McKenna P., Fahy M., Bohm M. Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial. Lancet. 2022; 399 (10333): 1401–1410.

  46. Vakhrushev A.D., Emel'yanov I.V., Lebedev D.S., Alieva A.S. Radiochastotnaya renal'naya denervatsiya: tekhnicheskie aspekty razlichnykh metodov i bezopasnost' [Radiofrequency renal artery denervation: Technical issues of different approaches and safety]. Arterial'naya gipertenziya. 2020; 5 (26): 543–551 (in Russian).

  47. Schmieder R.E., Mahfoud F., Mancia G. European Society of Hypertension position paper on renal denervation 2021. J Hypertens. 2021; 39: 1733–1741.

  48. Barbato E., Azizi M., Schmieder R.E. Renal Denervation in the Management of Hypertension in Adults: A Clinical Consensus Statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2023; 44 (15).

  49. Roland Schmieder, Michel Burnier, Cara East, Konstantinos Tsioufis, Sean Delaney. Renal Denervation: A Practical Guide for Health Professionals Managing Hypertension. Interventional Cardiology. 2023; 18: e06.

  50. Mancia G., Kreutz R., Brunström M., Burnier M., Grassi G. 2023 ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023; 41.

Received October 16, 2023; accepted February 28, 2024.

 

Information about the authors

Galimov Rustam Ramisovich, Doctor of X-ray Endovascular Diagnostics and Treatment, District Clinical Hospital. 628012, Russia, Khanty-Mansiysk, Kalinin St., 40; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-3619-9483

Molchanov Andrey Nikolaevich, Doctor of Sciences (Medicine), Professor, Chair of Hospital Surgery, Khanty-Mansiysk State Medical Academy. 628011, Russia, Khanty-Mansiysk, Mira St., 40; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-7656-891X

Gorgun Ales' Grigor'evich, Doctor of X-ray Endovascular Diagnostics and Treatment, District Clinical Hospital. 628012, Russia, Khanty-Mansiysk, Kalinin St., 40; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0009-0001-2776-7725

Pavlov Prokhor Igorevich, Candidate of Sciences (Medicine), Head of the Department of X-ray Surgical Methods of Diagnostics and Treatment, District Clinical Hospital. 628012, Russia, Khanty-Mansiysk, Kalinin St., 40; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0009-0008-8506-9651

Malkhas'yan Maksim Viktorovich, Surgeon, Department of X-ray Surgical Methods of Diagnostics and Treatment, District Clinical Hospital. 628012, Russia, Khanty-Mansiysk, Kalinin St., 40; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0009-0002-2912-3808

 

For citation

Galimov R.R., Molchanov A.N., Gorgun A.G., Pavlov P.I., Malkhas'yan M.V. Sovremennyy vzglyad na tekhnologiyu radiochastotnoy denervatsii pochechnykh arteriy [Modern view on radiofrequency denervation of renal arteries]. Ul'yanovskiy mediko-biologicheskiy zhurnal. 2024; 2: 6–17. DOI: 10.34014/2227-1848-2024-2-6-17 (in Russian).

 

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УДК 616.136.7

DOI 10.34014/2227-1848-2024-2-6-17

СОВРЕМЕННЫЙ ВЗГЛЯД НА ТЕХНОЛОГИЮ РАДИОЧАСТОТНОЙ ДЕНЕРВАЦИИ ПОЧЕЧНЫХ АРТЕРИЙ

Р.Р. Галимов1, А.Н. Молчанов2, А.Г. Горгун1, П.И. Павлов1, М.В. Малхасьян1

1 БУ ХМАО-Югры «Окружная клиническая больница», г. Ханты-Мансийск, Россия;

2 БУ ВО ХМАО-Югры «Ханты-Мансийская государственная медицинская академия», г. Ханты-Мансийск, Россия

 

Артериальная гипертензия на сегодняшний день остается одной из важнейших проблем здравоохранения и играет ведущую роль в развитии сердечно-сосудистых осложнений и смерти. Несмотря на значительные успехи современной антигипертензивной фармакотерапии, у 10 % всей популяции пациентов с повышенным артериальным давлением отмечается экстремально низкая чувствительность к основным лекарственным препаратам, направленным на его коррекцию. По данным крупных клинических исследований, риск инфаркта миокарда, инсульта и других основных неблагоприятных сердечно-сосудистых исходов у данных лиц с резистентной формой артериальной гипертензии в несколько раз выше, чем у пациентов с контролируемыми цифрами артериального давления.

Цель настоящей работы – анализ научной литературы по вопросам истории развития, эффективности и безопасности применения методики катетерной радиочастотной денервации почечных артерий у пациентов с резистентной формой артериальной гипертензии.

В качестве источников информации использовались данные электронных библиотек Pubmed, eLIBRARY и др.

Результаты клинических исследований показывают, что у пациентов с резистентной артериальной гипертензией, в отличие от больных с контролируемыми цифрами артериального давления, отмечается более выраженная симпатическая активность. Гиперактивность этой части нервной системы может быть одним из основных патогенетических факторов, играющих ведущую роль в механизме формирования резистентности к фармакотерапии. Таким образом, радиочастотная ренальная денервация, являясь одним из методов модуляции тонуса симпатической нервной системы, представляет особый интерес.

Ключевые слова: ренальная денервация, резистентная артериальная гипертензия, аблация.

 

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Вклад авторов

Концепция и дизайн исследования: Галимов Р.Р., Молчанов А.Н., Горгун А.Г.

Литературный поиск: Галимов Р.Р., Молчанов А.Н., Горгун А.Г., Малхасьян М.В.

Написание и редактирование текста: Галимов Р.Р., Молчанов А.Н., Горгун А.Г., Павлов П.И.

 

Литература

  1. Агаева Р.А., Данилов Н.М., Щелкова Г.В., Матчин Ю.Г. Новые возможности ренальной денервации. Терапевтический архив. 2020; 6 (92): 84–88.

  2. Stuart M. Masterminds of Ardian: An Interview With Inventors Mark Gelfand and Howard Levin. Start-Up. 2011.

  3. Kandzari D., Böhm M., Mahfoud F. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet. 2018; 391 (10137): 2346–2355.

  4. Böhm M., Kario К., Kandzari D.E., Mahfoud F. SPYRAL HTN-OFF MED Pivotal Investigators. Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial. Lancet. 2020; 2 (395): 1444–1451.

  5. Mahfoud F., Kandzari D.E., Kario K., Townsend R.R., Weber M.A., Schmieder R.E., Tsioufis K., Pocock S., Dimitriadis K., Choi J.W., East C., D'Souza R., Sharp A.S.P., Ewen S., Walton A., Hopper I., Brar S., McKenna P., Fahy M., Bohm M. Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial. Lancet. 2022; 399 (10333): 1401–1410.

  6. Esler M.D., Lambert G., Jennings G. Increased regional sympathetic nervous activity in human hypertension: causes and consequences. J Hypertens Suppl. 1990; 8: 53–57.

  7. Esler M.D. The 2010 Paton Lecture. The sympathetic nervous system through the ages: From Thomas Willis to resistant hypertension. Exp Physiol. 2011; 96: 611–622.

  8. Atherton D.S., Deep N.L., Mendelsohn F.O. Micro-anatomy of the renal sympathetic nervous system:a human postmortem histologic study. Clin Anat. 2012; 25: 628–633.

  9. Гапон Л.И., Микова Е.В., Савельева Н.Ю., Копылова Л.Н. Гипотензивный эффект радиочастотной денервации почечных артерий у пациентов с резистентной артериальной гипертонией. Клиническая практика. 2017; 3 (31): 3–9.

  10. Marian K., Zarins Z.D. Catheter-based renal sympathetic denervation: chronic preclinical evidence for renal artery safety. Clin Res Cardiol. 2011; 100 (12): 1095–1101.

  11. Schlaich M.P., Krum H., Sobotka P.A., Esler M.D. Renal denervation and hypertension. Am J Hypertens. 2011; 24 (6): 635–642.

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

  13. Symplicity HTN-1 Investigators. Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months. Hypertension. 2011; 57 (5): 911–917.

  14. Krum H., Schlaich M.P., Bohm M. Percutaneous renal denervation in patients with treatment-resistant hypertension: final 3-year report of the Symplicity HTN-1 study. Lancet. 2014; 383 (9917): 622–629.

  15. Esler M.D., Krum H., Sobotka P.A. Symplicity HTN-2 Investigators. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN- 2 Trial): a randomised controlled trial. Lancet. 2010; 376 (9756): 1903–1909.

  16. Esler M.D., Böhm M., Sievert H. Catheter-based renal denervation for treatment of patients with treatment-resistant hypertension: 36-month results from the SYMPLICITY HTN-2 randomized clinical trial. Eur Heart J. 2014; 35 (26): 1752–1759.

  17. Brachmann J., Schnupp S., Blüm B. Renal Denervation: A New Approach to an Old Problem. Card Electrophysiol Clin. 2012; 4 (3): 447–454.

  18. Kara K., Bruck H., Kahlert P., Plicht B., Mahabadi A.A., Konorza T., Erbel R. Renale Denervierung: Atueller Stand und Perspektiven. Herz. 2012; 37 (7): 746–753.

  19. Mafeld S., Vasdev N., Haslam P. Renal denervation for treatment-resistant hypertension. Ther Adv Cardiovasc Dis. 2012; 6 (6): 245–258.

  20. Mahfoud F. Predictors of nonresponse to renal denervation in a real world population of patients with uncontrolled hypertension: Analysis of the Global SYMPLICITY Registry. EuroPCR. 2014.

  21. Böhm M. Global SYMPLICITY Registry Investigators. Renal denervation reduces office and ambulatory heart rate in patients with uncontrolled hypertension: 12-month outcomes from the global SYMPLICITY registry. J Hypertens. 2016; 34: 2480–2486.

  22. Schmieder R.E., Mahfoud F., Mancia G., Narkiewicz K., Ruilope L., Hutton D.W., Cao K.N., Hettrick D.A., Fahy M., Schlaich M.P., Böhm M., Pietzsch J.B. Clinical event reductions in high-risk patients after renal denervation projected from the global SYMPLICITY registry. Eur Heart J Qual Care Clin Outcomes. 2023; 9 (6): 575–582.

  23. Bhatt D.L., Kandzari D.E., O’Neill W.W. A controlled trial of renal denervation for resistant hypertension. New England Journal of Medicine. 2014; 370 (15): 1393–1401.

  24. Bakris G.L., Townsend R.R., Flack J.M., Brar S.J. SYMPLICITY HTN-3 Investigators. 12-month blood pressure results of catheter-based renal artery denervation for resistant hypertension: the SYMPLICITY HTN-3 trial. Am Coll Cardiol. 2015; 65: 1314–1321.

  25. Kjeldsen S.E., Narkiewicz K., Oparilet S. Blood pressure lowering effect of renal sympathetic denervation or placebo? building expectations for Symplicity-HTN 3. Blood Press. 2013; 22 (5): 279–281.

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Поступила в редакцию 16.10.2023; принята 28.02.2024.

 

Авторский коллектив

Галимов Рустам Рамисович – врач рентгенэндоваскулярной диагностики и лечения, БУ ХМАО-Югры «Окружная клиническая больница». 628012, Россия, г. Ханты-Мансийск, ул. Калинина, 40; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-3619-9483

Молчанов Андрей Николаевич – доктор медицинских наук, профессор кафедры госпитальной хирургии, БУ ВО ХМАО-Югры «Ханты-Мансийская государственная медицинская академия». 628011, Россия, г. Ханты-Мансийск, ул. Мира, 40; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-7656-891X

Горгун Алесь Григорьевич – врач рентгенэндоваскулярной диагностики и лечения, БУ ХМАО-Югры «Окружная клиническая больница». 628012, Россия, г. Ханты-Мансийск, ул. Калинина, 40; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0009-0001-2776-7725

Павлов Прохор Игоревич – кандидат медицинских наук, заведующий отделением рентгенохирургических методов диагностики и лечения, БУ ХМАО-Югры «Окружная клиническая больница». 628012, Россия, г. Ханты-Мансийск, ул. Калинина, 40; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0009-0008-8506-9651

Малхасьян Максим Викторович – врач-хирург отделения рентгенохирургических методов диагностики и лечения, БУ ХМАО-Югры «Окружная клиническая больница». 628012, Россия, г. Ханты-Мансийск, ул. Калинина, 40; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0009-0002-2912-3808

 

Образец цитирования

Галимов Р.Р., Молчанов А.Н., Горгун А.Г., Павлов П.И., Малхасьян М.В. Современный взгляд на технологию радиочастотной денервации почечных артерий. Ульяновский медико-биологический журнал. 2024; 2: 6–17. DOI: 10.34014/2227-1848-2024-2-6-17.