Renal denervation (RDN) is recommended for the management of arterial hypertension. The aim of this study was to assess the cost-effectiveness of RDN. A systematic review/meta-analysis was conducted to identify RDN cost-effectiveness studies. The Incremental Cost-Effectiveness Ratio (ICER) per one Quality-Adjusted Life Year (QALY) gained (the extra cost needed for one additional year of good quality life) was compared to the respective country-specific Willingness to Pay (WTP) Thresholds (the maximum ICER/QALY gained that is considered acceptable by a healthcare system or organization for an intervention to be deemed cost-effective). Nineteen studies (16 countries) were included, all in favor of RDN cost-effectiveness. Most studies (n = 12/19, 63%) were conducted after 2024, half in the context of European economic/healthcare systems. All studies implemented decision-analytic Markov models and compared RDN (mainly radiofrequency) plus standard of care (SoC) vs SoC alone. Meta-analysis of 7 studies indicated a pooled ICER/QALY gained 22209 €, compared to WTP Threshold 50000 €, thereby indicating the cost-effectiveness of RDN. Meta-analysis of 19 studies indicated a pooled ICER/QALY gained to WTP Threshold ratio of 0.31 (0.20, 0.44). In sensitivity analyses RDN was shown to be cost-effective in both resistant and uncontrolled hypertensive patients, especially in those with high cardiovascular risk and considering longer time horizons. Most studies were deemed to have a low risk of bias. In line with guidelines recommendations, RDN appears to be a cost-effective intervention across a variety of clinical scenarios, both for patients with resistant or uncontrolled hypertension and especially in young and/or high cardiovascular risk patients.Prospero Registration ID: CRD420251133996.

Approximately 795,000 people experience new or recurrent strokes in the United States each year; between 10 to 20% of these are spontaneous intracerebral hemorrhages (ICH). Uncontrolled hypertension is not only the most common cause of ICH but also a major risk factor for hematoma expansion. Resistant hypertension, defined as persistently elevated blood pressure despite the use of three or more antihypertensives of different classes, is common in patients with ICH. A long-acting calcium channel blocker, angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB), and a thiazide diuretic are generally considered the mainstay for the treatment of resistant hypertension. However, due to the risk of hyponatremia and worsening cerebral edema, thiazide diuretics should be avoided during the first few weeks of ICH. Recent evidence supports the use of a mineralocorticoid receptor antagonist. While resistant hypertension may be idiopathic, a workup of secondary causes should be pursued. Adequate and timely control of elevated blood pressure remains one of the main cornerstones of treatment in patients with ICH. Previous studies have revealed that resistant hypertension in patients with ICH is associated with longer ICU stays, a higher risk of recurrent stroke, and can contribute to renal, cardiac, and neurologic complications. This emphasizes the need for early initiation of oral antihypertensives and adequate blood pressure control at hospital discharge. Landmark studies have shown that early lowering of SBP to 130-150 mm Hg with smooth, sustained BP control is safe and may improve functional outcomes in patients with mild to moderate ICH. After initiating oral antihypertensives with a calcium channel blocker, an ACEi or ARB beta-blocker, and a mineralocorticoid receptor antagonist to maximally tolerated doses, the next line of antihypertensive treatment should be tailored to the patient's co-morbidities, and may include a beta-blocker, central alpha agonist, hydralazine, and minoxidil. In this review, we discuss the epidemiology of resistant hypertension in ICH and its molecular basis, diagnostic workup, and acute and long-term treatment. We present novel mechanisms implicated in hypertensive ICH, including ferroptosis, neuroinflammation, the CNS-gut microbiome axis, and novel therapeutics. We also propose a simple algorithm for the optimal pharmacological management of resistant hypertension in ICH.

Objectives Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension (HTN) despite the use of three or more antihypertensive medication classes or controlled HTN after treatment with four or more antihypertensive medication classes. The increasing prevalence of HTN as well as aTRH is mainly due to a lack of understanding about the disease, insufficient patient education programs, low economic status, etc., which might even lead to medication non-adherence. Assessing HTN knowledge, attitude, and practice (KAP) is crucial for controlling HTN. There is a paucity of information about KAP among aTRH patients in India. Therefore, this area has been targeted for specific assessment and interventions. The objective of the study is to evaluate KAP among aTRH patients. Material and Methods A total of 100 patients were recruited for this study, 50 patients aged ≥18 years with aTRH as cases and 50 patients aged ≥18 years with non-aTRH as controls. All participants were interviewed using a validated questionnaire, which had information regarding demographic profile, knowledge, attitude, and practices in management of HTN, and was administered by the investigator to the participants in the language understood by them. Results We observed that diabetes (26%) was the most common co-morbidity, followed by chronic kidney disease (CKD) (22%), obesity (22%), coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), and depression in the aTRH group. The total number of co-morbidities was higher in the aTRH group as compared to the non-aTRH. We found that the non-aTRH group had statistically significant better KAP mean score compared to aTRH patients (p <0.001). Conclusion We found that the KAP scores of the non-aTRH group were better than aTRH group, which explains their good blood pressure control. Hence, educating about HTN and its related attitudes and practices should be our primary goal to decrease the prevalence of aTRH and its related morbidities and mortalities.

Background: Cilnidipine, a fourth-generation calcium channel blocker with dual L- and N-type action, offers distinct benefits in hypertension, though varied cardiologist awareness and prescribing may limit optimal use. Methods: A cross-sectional survey was conducted among 416 practicing cardiologists across India between 17 April and 15 July 2025 to assess knowledge, perceptions, and prescribing preferences for cilnidipine in essential hypertension. A validated 20-item self-administered multiple-choice questionnaire captured mechanistic understanding and clinical perspectives following e-consent. Items addressed comparative advantages over other calcium channel blockers, effects on target organs, therapeutic applications (including combinations and patient subgroups), and metabolic benefits in metabolic syndrome. Responses were collected electronically and analyzed using descriptive statistics to summarize awareness and prescribing trends. Results: Most cardiologists (85.1%) identified cilnidipine’s dual L- and N-type blockade as its key differentiator from conventional CCBs. Over half recognized its superior nocturnal BP control (56.3%), reduced BP variability via autonomic stabilization (52.6%), and lowering of mean arterial pressure without reflex tachycardia (54.6%). A substantial proportion (64.2%) acknowledged reno-protective benefits over amlodipine, while 55.8% favored its use in elderly and resistant hypertensive patients. Notably, 61.0% recognized improved insulin sensitivity in metabolic syndrome. However, knowledge gaps remained regarding its effects on the RAAS and endothelial function. Conclusions: The survey reveals strong cardiologist awareness of cilnidipine’s sympatholytic, reno-protective, and hemodynamic benefits, alongside partial misconceptions regarding RAAS and endothelial effects. These findings underscore the need for ongoing clinical education and support cilnidipine’s role as a well-tolerated, organ-protective antihypertensive.

Background. The purpose was to determine prognostic factors of improving left ventricular diastolic function (LV DF) in resistant hypertension patients who received multicomponent antihypertensive therapy for three years. Materials and methods. One hundred and two patients with true resistant hypertension were included. They received triple fixed combination (renin-angiotensin-aldosterone system blocker/calcium antagonist/diuretic) to which the fourth drug (spironolactone, eplerenone, moxonidine, torasemide or nebivolol) has been added. The state of LV DF was evaluated at baseline and by the end of the study. Office and 24-h ambulatory blood pressure (BP) measurements, echocardiography, clinical characteristics, neurohumoral and proinflammatory status were assessed. Results. Impaired LV DF was detected in 75.5 % of patients. The first degree of LV diastolic dysfunction was observed more often, in 63.7 % of cases. The patients were divided into 2 groups: the first one included people without initial impairment of LV DF (n = 25), the second one consisted of those with LV diastolic dysfunction (n = 77). The latter were older, had a longer duration of hypertension, higher body mass index, 24-h urinary albumin excretion, office and 24-h ambulatory BP, they also more often (by 2 times) had disorders of circadian BP rhythm and concomitant diabetes. Left ventricular diastolic dysfunction in 100 % of cases was associated with severe LV hypertrophy, increased plasma concentration of inflammatory proteins (C-reactive protein, fibrinogen), cytokines (interleukin-6, tumor necrosis factor ), increased activity of leukocyte elastase, macrophage matrix metalloproteinase-12. The concentration in the blood of aldosterone, active renin, 24-h urinary excretion of metanephrines did not differ between the groups. Conclusions. Improvement and stabilization of LV DF occurred in parallel with regression of LV hypertrophy (normalization of LV mass index in 35.1 % of patients and its significant decrease in 64.9 %) against the background of a decrease in BP and in the proportion of patients with impaired circadian BP rhythm. The independent factors of the E/E' ratio were baseline plasma levels of aldosterone ( = 0.556, P = 0.0001), glucose ( = 0.366, P = 0.0001), active renin ( = –0.223, P = 0.004), 24-h urinary albumin excretion ( = 0.188, P = 0.016), age of patients ( = 0.192, P = 0.023). The odds of an improvement in LV DF increased by 3.7 times, if patients with resistant hypertension had no diabetes; LV hypertrophy regression occurred.

ABSTRACT Background Renal denervation (RDN) has emerged as a potential therapeutic option for resistant hypertension (HT), which remains a major clinical challenge due to poor blood pressure (BP) control despite optimized pharmacotherapy. This study aimed to assess the safety and effectiveness of catheter-based RDN in resistant hypertension patients, based on our center’s experience. Methods This retrospective, single-center study included 120 patients with resistant HT who were eligible for RDN and underwent the procedure using the Symplicity Spyral system between January 2023 and December 2024. Office systolic and diastolic BP were assessed at baseline and 6 months after RDN. The primary endpoint was the reduction in BP, while secondary endpoints included changes in the number of antihypertensive medications. Results At 6 months, office systolic BP decreased significantly from 156 ± 7.7 mmHg to 143 ± 3.7 mmHg, while diastolic BP declined from 93.5 ± 5.5 mmHg to 90 ± 3.9 mmHg (both p < 0.001). Median per-patient reductions were 13 mmHg systolic and 3.5 mmHg diastolic. The mean number of antihypertensive medications decreased from 4.88 ± 0.9 to 4.47 ± 1.1 (p < 0.001). Minor adverse events included acute kidney injury in two patients (1.7%) and femoral artery injury in one patient (0.8%). Conclusion Catheter-based RDN using the Symplicity Spyral system was safe and effective in reducing BP and medication burden in patients with resistant HT. These results support RDN as a potential therapeutic option in appropriately selected patients.

Natriuretic Peptide Receptor-1 Agonist for Resistant Hypertension: A Randomized Phase 2 Trial.

Objective: to assess the knowledge of resistant hypertensive patients before and after an educational intervention about the risk of chronic kidney disease. Method: A cross-sectional study, with ethical approval, conducted from January 2022 to October 2024, with 63 resistant hypertensive patients under outpatient care at a university in Rio de Janeiro. Data were collected in three stages: from medical records; through telemonitoring using the Screening for Occult Renal Disease questionnaire; and during face-to-face educational intervention. Descriptive statistics, Fisher's exact test, Mann-Whitney test, and Wilcoxon test were used for analysis. Results: age ≥ 70 years (41.3%), 49 (77.8%) predominantly female, time since diagnosis of hypertension ≥ 21 years (41.1%); 61 (96.8%) at risk for kidney disease. Regarding knowledge of complications, before the intervention, 41 (65%) reported being unaware of the risk. After the intervention, all study participants reported having such knowledge. Conclusion: it can be identified that knowledge was acquired after the educational intervention regarding the risk of developing chronic kidney disease.

Abstract Objective To compare the antihypertensive efficacy of antagonists of mineralocorticoid receptor (AMR) (spironolactone (SPR) or eplerenone (EPL)) and torasemide (TOR) as an add-on therapy in true resistant hypertensive (RH) patients. Design and methods: We studied 208 true RH patients treated with fixed-dose triple-combination in maximum tolerated doses and divided them into two groups (gr). The 1st gr. received AMR (SPR 25–50 mg or EPL 25-50 mg), the 2nd gr. TOR (5-10 mg) once daily for 12 weeks of each medication. Average doses of SPR (34.5±8.4 mg) and EPL (36.3±9.7 mg) were comparable (P &amp;gt; 0.05), average dose of TOR was (7.5±0.9 mg). Patients took the drugs consequently; office and 24-hour ambulatory BP were measured before and after each rotation of the drug. Serum potassium, eGFR, and potential side effects were monitored. Initial plasma aldosterone (PA) level, active renin concentration (ARC), and urinary sodium excretion (USE) were tested as predictors of BP response in multivariable analysis. Results The AMRs and TOR equally declined diastolic BP (office, average 24-h, day- and night-time DBP). AMRs were more effective than TOR in systolic BP (SBP) lowering: office SBP declined by 18.5 mm Hg vs 16.5 mm Hg (P = 0.02), average 24-h SBP by 11.9 mm Hg vs 8.8 mm Hg (P = 0.001), daytime SBP by 11.2 mm Hg vs 7.8 mm Hg (P = 0.001) on AMRs and TOR respectively. 36.7 % of RH patients achieved office and 24-hour ambulatory BP targets with AMRs and 29.6% with TOR (P = 0.001). After 12 weeks of treatment, plasma potassium level increased by 6.8 % (P = 0.001) on AMRs and did not change on TOR, although eGFR decreased on TOR by 6.8 % (P = 0.03). PA level (β = 0.433, P = 0.03), ARC (β= -0.296, P = 0.02), and 24-h USE (β= 0.421, P = 0.01) were the predictors of the BP-lowering effect of AMRs. Only PA level (β = 0.359, P = 0.03) predicted BP reduction under TOR treatment. Conclusions AMRs were more effective than TOR in lowering SBP and achieving target BP. The efficacy of AMRs was directly related to PA and USE levels and inversely related to ARC, while only PA level was a predictor of TOR's BP reduction. TOR can be recommended for RH patients with AMR intolerance, including high serum potassium levels, with monitoring of eGFR.

Abstract Background Hypertension remains a major risk factor for coronary heart disease, stroke, and other cardiovascular disease. Despite the availability of proven antihypertensive medications and recommended lifestyle modifications, many patients fail to reach optimal blood pressure (BP) control. Telemonitoring provides a scalable and cost-effective approach to reduce BP, but real-world evidence from integrated telemonitoring programs in clinical practice remain limited. Purpose This study aimed to evaluate the effect of the Dutch HartWacht telemonitoring program on mean BP values and the time to achieve BP control during 12 months. Methods This single-center retrospective cohort study assessed a group of therapy resistant hypertensive patients (systolic BP &amp;gt;140 mmHg and &amp;gt;3 antihypertensive medications) included in the HartWacht program. After enrollment, patients measured their BP twice a day for one week, followed by measurements once a week. A structured alarm system was implemented to identify BP elevations based on pre-defined thresholds. An orange alarm was triggered if systolic BP exceeded 140 mmHg or diastolic BP exceeded 90 mmHg, whereas a red alarm was triggered when systolic BP exceeded 180 mmHg or diastolic BP exceeded 110 mmHg. In the case of one red or two consecutive orange alarms, an eHealth team contacted the patient by phone to discuss lifestyle modification, and if necessary, arranged a consultation with a cardiologist for protocol-based medication adjustment. BP control was defined as a monthly mean BP &amp;lt;140/90 mmHg. Results A total of 352 patients (mean age 63.1±10.2 years; 158 (44.9%) female) were included in the current study. At baseline, mean BP was 158/91 mmHg and the mean follow up time was 324 days. At 1 month follow-up, the mean BP was 138/83 mmHg, with 49.4% (174/352) reaching BP control. At 12 months follow-up, the mean BP decreased to 133/82 mmHg with 64.9% (126/194) reaching BP control. Linear mixed model analysis demonstrated a significant decrease for both systolic and diastolic BP between month 1 and month 12 (p&amp;lt;0.001). The overall mean time to achieve initial BP control was 3.5 (95% CI 3.0 to 3.8) months. Conclusion Participation in the HartWacht eHealth program effectively reduced BP in the majority of therapy resistant hypertensive patients within a real-life clinical setting. Structured remote monitoring and timely intervention potentially improves long-term prognosis and reduces healthcare cost. These results highlight the potential of long-term BP monitoring as an integral component of hypertension management.

Resistant hypertension, defined as blood pressure &gt;130/80 mm Hg despite using ≥3 antihypertensive medications, is a well-recognized clinical entity. Patients with resistant hypertension are at an increased risk of cardiovascular disease including heart failure (HF) compared with those with more easily controlled hypertension. Many providers and patients alike are in desperate need of indicators that can help prevent and avoid symptomatic HF (Stage 3 AHA), or worse advanced HF (Stage 4 AHA). In early stages of HF in patients with Resistant Hypertension (RHTN) there have not been any investigations into biomarkers. We conducted a cross-sectional analysis of patients referred to the Hypertension Clinic at the University of Alabama at Birmingham. In this study we analyzed data of patients with RHTN, and compared it with patients with hypertension (HTN). Demographics, body mass index, and blood pressure measurement were taken. Patients underwent blood samples, urine collection, and cardiac MRI assessment. We found that RHTN patients had higher fat free mass (FFM) (139.1 ± 29.3 vs 125.5 ± 23.4lbs, p = 0.0236). RHTN patients had a higher waist to hip ratio (W/H) (0.95 ± 0.1 vs 0.9 ± 0.05, p = 0.029). RHTN patients had lower levels of potassium present in their blood (3.9 ± 0.4 vs 4.3 ± 0.48mmol/L, p&lt;0.001). RHTN patients had higher Urinary Aldosterone (U-Aldo) (13.4μg ±10.1 vs 9.3μg ± 6.1, p = 0.01449). RHTN patients also had higher aldosterone renin ratio (14.7 ± 16.9 vs 7.2 ± 4.6, p &lt; 0.001). RHTN patients’ BNP and ANP were higher (41 ± 74.2 vs 19.4 ± 18.2, p = 0.007) (82.4 ± 54 vs 54.6 ± 32.6, p = 0.012). Among all of the Cardiac MRI measurements the most significant were the left ventricular mass (LVM) (169.5 ± 46.25 vs 125.6 ± 29.75, p &lt; 0.001), the LVM end diastolic (LVM ED) (162.4 ± 44.4 vs 120.8 ± 27.1, p &lt; 0.001), the LVM end systolic (LVM ES) ( 177.3 ± 49.7 vs 130.5 ± 32.8, p &lt; 0.001), the LVM posterior wall (LVPW) (10.3 ± 2.6 vs 8.1 ± 1.4, p&lt; 0.001), and IVS (12.5 ± 2.5 vs 10.1± 1.4, p&lt; 0.001). There was no difference in age, BMI, serum creatinine, urinary Sodium, and urinary potassium. When analyzed by gender or race there was no difference between groups. In summary, aldosterone renin ratio and urinary aldosterone are potential biomarkers for patients with RHTN on a high Na diet with stage 2 HF. Underlying mechanisms including hemodynamics and endocrine dysregulation need further investigation in patients with stage 2 HF.

Obstructive sleep apnea (OSA) is a well-known risk factor for hypertension. Moderate-to-severe OSA is more likely to lead to resistant hypertension (RH) compared to the absence of moderate-to-severe OSA. Early identification of patients with OSA among those with RH is crucial for prioritizing diagnosis and reducing the burden. However, currently, there is a lack of specific tools for assessing the risk of moderate-to-severe OSA in patients with RH. In this retrospective cohort study conducted from October 2023 to August 2024, 659 patients with RH from the health examination center of a tertiary hospital in Northeast China completed polysomnography. Based on the polysomnography results, the participants were divided into a group without moderate-to-severe OSA (control group) and a moderate-to-severe OSA group. The sample was randomly divided into a development cohort (461 patients) and a validation cohort (198 patients), and the incidence of OSA in the two groups was comparable (P > 0.05). Relevant clinical data of patients with RH were collected. The Least Absolute Shrinkage and Selection Operator method was used to identify independent risk factors. Subsequently, three predictive models were developed based on ten variables, including waist circumference, waist-to-hip ratio, low-density lipoprotein, morning dry mouth, serum creatinine, homocysteine, drinking, cholesterol, triglycerides and smoking. Among these models, the random forest model showed excellent discrimination and calibration in development and validation cohorts. Additionally, decision curve analysis was performed on the random forest model, as well as the STOP-Bang questionnaire and the Berlin questionnaire, to evaluate their clinical benefits. Finally, Shapley Additive Explanations analysis clearly indicated that waist circumference was the most important factor in predicting comorbid moderate-to-severe OSA in RH patients.

Introduction Radiofrequency renal denervation (RF RDN) has been recommended as an adjunct therapeutic option for uncontrolled including resistant hypertension. This analysis sought to evaluate the cost-effectiveness of RF RDN treatment in the Dutch healthcare setting. Methods A previously published decision-analytic model was utilised to project outcomes over a lifetime horizon for RF RDN vs. standard of care (SoC). Data from the SPYRAL HTN-ON MED study informed the cohort characteristics and base case treatment effect modelled (−4.9 mmHg office-based systolic blood pressure (oSBP) reduction vs. sham), while alternate assumptions were explored in sensitivity analyses. Cost-effectiveness was evaluated against a burden of disease-determined threshold of €20,000 per quality-adjusted life year gained, according to Dutch guidelines. Results In the base case, ten-year clinical event risk reductions were 0.80 for stroke, 0.88 for myocardial infarction, 0.89 for angina pectoris and coronary heart disease, 0.72 for heart failure, 0.96 for end-stage renal disease, and 0.93 for all-cause death. Over lifetime and under the base case effect size, RF RDN resulted in increased costs of €4,137 (€46,769 (RF RDN) vs. €42,632 (SoC)) and quality-adjusted life years (QALY) of 0.61 (17.49 RF RDN vs. 16.88 SoC), with an incremental cost-effectiveness ratio (ICER) of €6,784 per QALY gained. RF RDN was highly cost-effective or dominant across the range of scenario and sensitivity analyses performed. Conclusion Over lifetime, RF RDN was found cost-effective in the Dutch healthcare system, with an ICER substantially below the applicable willingness-to-pay threshold, while providing meaningful reductions in clinical events for uncontrolled including resistant hypertension patients.

Introduction. Data from clinical trials suggest the effectiveness of renal denervation in improving cardiac function and exercise capacity in hypertensive patients with heart failure with preserved ejection fraction and reduced ejection fraction. The data presented are part of the literature review/results obtained within the institutional project with the acronym DIAFEREZIS. Aim. Comparative evaluation of the efficacy of renal denervation versus pharmacological treatment on exercise capacity and plasma NT-proBNP levels in patients with resistant hypertension, heart failure with preserved ejection fraction in association or without type 2 diabetes mellitus at two years of follow-up. Materials and methods. To achieve the research objectives, a prospective, open, randomized clinical trial was conducted that enrolled 250 eligible patients with resistant hypertension and heart failure with preserved ejection fraction. Patients were divided into two groups of 125 subjects each depending on the presence of type 2 diabetes mellitus, subsequently, each group was randomized into three evaluation groups in accordance with the treatment supplemented to the previously administered standardized one: groups I and IV - Moxonidine, groups II and V - Bisoprolol and patients in groups III and VI underwent renal denervation. Patients were evaluated for a period of 2 years. Results. Patients in all research groups demonstrated an authentic increase in the distance covered in the "6-minute walk" test already at 6 months of evaluation, this dynamic being comparable in the pharmacological and interventional treatment groups in patients without diabetes, while in the group of resistant hypertensive patients with type 2 diabetes, the group of patients undergoing RDN shows statistical superiority in improving this parameter. Increased at the initial stage in all six research groups, the plasma level of NT-proBNP recorded a statistical reduction when applying all three therapeutic approaches in both patients without and with type 2 diabetes already at 6 months of monitoring, the groups of patients undergoing RDN showing statistical superiority in improving this parameter, a notable event until the end of the surveillance period. Conclusions. Both pharmacological treatment with the SNS blockers Moxonidine and Bisoprolol, and the minimally invasive one with RDN improved the exercise capacity of patients with resistant hypertension, HF with preserved ejection fraction with or without type 2 diabetes mellitus already at 6 months of evaluation, the beneficial effect being amplified until the end of the surveillance period. Comparative analysis of the dynamics of the distance covered in the "6 min walk" test reveals a statistical superiority of RDN versus both pharmacotherapeutic regimens at the earlier stages in the group of patients with type 2 diabetes mellitus and starting with 12 months of evaluation in the group of non-diabetic patients, the trend manifesting until the end of the study. The authentic reduction of the plasma level of NT-proBNP was marked in all research groups from the first monitoring stage independently of the presence of type 2 diabetes mellitus when applying all three treatment schemes, RDN demonstrating a superior therapeutic efficiency compared to both therapeutic regimens.

ObjectiveObstructive sleep apnea is an independent risk factor for cardiovascular diseases, particularly resistant hypertension. For patients who are noncompliant or unable to tolerate continuous positive airway pressure therapy, surgical treatment may serve as a viable alternative. In this study, we evaluated the impact of multilevel sleep surgery on blood pressure levels in patients with resistant hypertension.MethodsThis is a bicentric retrospective observational study of 50 patients with severe obstructive sleep apnea and resistant hypertension who underwent multilevel targeted sleep surgery.ResultsClinical improvement was objectively confirmed by polygraphy performed 6 months after surgery, demonstrating a significant reduction in the mean Apnea-Hypopnea Index from 44.98 ± 14.94 to 22.16 ± 7.30 (P < 0.005). Furthermore, the adjusted mean preoperative systolic blood pressure decreased from 150 ± 14.77 to 124 ± 17.14 mmHg (P < 0.001), while diastolic blood pressure decreased from 94 ± 5.3 to 80 ± 7.2 mmHg (P < 0.001). Notably, 20 patients (40%) no longer required antihypertensive medication after surgery.DiscussionTo the best of our knowledge, this study is the first clinical trial to evaluate the efficacy of multilevel surgery in improving resistant systemic hypertension in patients with multilevel airway obstruction and severe obstructive sleep apnea syndrome.ConclusionsThis study highlights the potential of multilevel sleep surgery as an effective intervention for improving blood pressure control in patients with resistant hypertension and severe obstructive sleep apnea.

This study compares sequential nephron blockade (SNB) and renin-angiotensin system sequential blockade (RASSB) in patients with resistant hypertension (RHTN), evaluating central systolic pressure, arterial stiffness, pulse pressure (PP) and ambulatory blood pressure monitoring (ABPM). Seventy-two RHTN patients were randomly assigned to SNB (n = 35, 22 females, 13 males) or RASSB (n = 37, 22 females, 15 males). SNB included multiple diuretics (furosemide, spironolactone, hydrochlorothiazide) to enhance natriuresis and counter intra-renal compensatory mechanisms. RASSB employed stepwise renin-angiotensin system blockade using lisinopril, bisoprolol and losartan, even in patients already on valsartan. Office blood pressure reductions were significant in both groups (P < 0.0001). SNB: systolic blood pressure (SBP) from 174.5 to 127.0mmHg, diastolic blood pressure (DBP) from 105.3 to 78.11 mmHg. SBP from 178.4 to 134.4mmHg, DBP from 102.7 to 77.33 mmHg. ABPM confirmed 24-h reductions (P < 0.0001). SNB showed greater PP reduction (Δ = 22.99 vs 15.93 mmHg, P = 0.024) and central systolic pressure reduction (Δ = -10.3 vs -5.1mmHg, P = 0.036). RASSB produced a pronounced heart rate decrease (Δ = -12.4beats per minute, P < 0.0001). No treatment-related discontinuations occurred. SNB demonstrated superior efficacy in reducing central SBP and PP, while RASSB more effectively lowered heart rate. These distinct hemodynamic responses support individualized treatment strategies for patients with RHTN. gov identifier: NCT02832973.

The role of insomnia in the development of resistant hypertension in uncontrolled hypertensive patients with obstructive sleep apnea: A prospective study.

ABSTRACTResistant hypertension (RH) is characterized by uncontrolled blood pressure (BP) despite optimal antihypertensive treatment. This study investigated the clinical characteristics and target organ damage (TOD) in patients with RH, examining their relationships with BP and heart rate variability (HRV). Among 386 hypertensive patients—including those with RH, controlled hypertension, and inadequately treated hypertension—clinical data, laboratory results, and 24‐h ambulatory BP monitoring were analyzed. Patients with RH showed higher body mass index, blood glucose, serum uric acid levels, and longer hypertension duration compared to other groups. Notably, in patients with uncontrolled RH, markers of TOD such as urinary albumin‐creatinine ratio and pulse wave velocity measures were significantly elevated. Multivariate regression revealed that earlier onset of hypertension, elevated serum uric acid and creatinine, and increased arterial stiffness independently predicted RH. Additionally, TOD indicators were closely correlated with 24‐h systolic and diastolic BP as well as HRV parameters. Increased BP variability and arterial stiffness were identified as important factors contributing to TOD, suggesting a bidirectional relationship that may hasten disease progression. These findings emphasize that RH is strongly associated with severe TOD, particularly when BP remains uncontrolled. Effective management of both BP levels and their variability is essential to reduce TOD, and further studies are needed to clarify underlying mechanisms and improve therapeutic strategies.

Resistant arterial hypertension (RHTN) has been associated with sympathetic hyperactivity, which represents a significant challenge in the management and treatment of arterial hypertension. In the present study, autonomic modulation was analysed in hypertensive, resistant hypertensive, and refractory hypertensive patients, compared to a group of apparently healthy normotensive individuals. Participants with resistant hypertension were included only after the exclusion of secondary hypertension and pseudo-resistance diagnoses. Heart rate variability (HRV) analysis included parameters from the time domain, frequency domain, and nonlinear methods, providing a comprehensive assessment of global autonomic modulation. The results demonstrated a significant reduction in global HRV across all three hypertensive groups, evidenced by decreases in parameters from the time domain, frequency domain and nonlinear methods. Furthermore, a concomitant reduction in the low- and high-frequency components was observed, with the decrease in the high-frequency component being more pronounced. These findings challenge the traditional view of isolated sympathetic hyperactivity in hypertension. Instead, the results reveal a relative predominance of sympathetic function due to the more marked attenuation of parasympathetic activity. These results underscore the need to reinterpret autonomic dysfunction in arterial hypertension, particularly in its more severe forms, as a global loss of autonomic modulation.

Objective: Abnormal phosphate (Pi) homeostasis is associated with inflammation, vascular calcification, and endothelial dysfunction in patients with chronic kidney disease (CKD). Apparent treatment resistant hypertension (ATRH) is common and associated with high risk of cardiovascular disease and mortality in CKD. We studied the associations of Pi indices with risk of ATRH in CKD patients.Design and method: The CRIC Study recruited 3939 CKD participants without liver cirrhosis in the US. After excluding participants with missing ATRH information at baseline, 3556 participants were included in this analysis. ATRH was assessed at the baseline visit and defined as systolic blood pressure (BP) greater than or equal to 140 mm Hg or diastolic BP greater than or equal to 90 mm Hg while taking greater than or equal to 3 antihypertensive medications or systolic BP less than 140 mm Hg and diastolic BP less than 90 mm Hg while taking greater than or equal to 4 antihypertensive medications. Pi overload index was calculated as [serum Pi x (urinary Pi-to-creatinine ratio) x alkaline phosphatase (ALP- a marker reflecting bone turnover)] to synergistically reflect the effect of high Pi intake on serum Pi, kidneys, and bones. Logistic regression models were used to examine the multivariable associations of baseline Pi overload index, serum Pi, FGF23, parathyroid hormone (PTH), and urinary Pi-to-creatinine ratio with ATRH, adjusting for age, sex, race/ethnicity, body mass index, physical activity, weekly drinking, 24-hour urinary sodium, eGFR, use of diuretics, use of non-steroidal anti-inflammatory drugs, HbA1c, interleukin-6, tumor necrosis factor alpha, and transforming growth factor beta. Results: There were 1241 participants with ATRH. The average age was 61 years for those with ATRH and 59 for those without. Among those with ATRH, 62% were men and 47% were Black. There were independent, dose-response associations of Pi indices with ATRH (Table). Conclusions: These findings suggest that Pi overload is independently associated with ATRH. Maintaining normal Pi homeostasis may improve blood pressure control and related clinical outcomes. Future studies are warranted to confirm these findings.