Treatment Of Refractory Hypertension Research Articles

Oral Minoxidil for Hair Loss: Update and Perspectives

Minoxidil was first introduced in the 1970s as a treatment for refractory hypertension.[1][1] Due to its side-effect profile, its use is reserved for hypertension that has not responded to conventional multidrug regimens.[1][1],[2][2] Tachycardia, fluid retention, and generalized hypertrichosis are

Clinical Effect of Renal Arterial Sympathetic Radiofrequency Ablation on Secondary Hypertension.

Sympathetic hyperactivity is one of the main mechanisms of secondary hypertension. Reducing renal sympathetic activity through surgery can effectively reduce blood pressure. Many cases have shown that renal denervation (RDN) can selectively block renal artery sympathetic nerve activity to control refractory hypertension. This surgery is a minimally invasive surgery, and the risk of surgery-related adverse events is significantly reduced compared with surgery. Therefore, the purpose of this study is to explore the efficacy of radiofrequency ablation of renal artery sympathetic nerve in the treatment of secondary hypertension. Eight patients with secondary hypertension diagnosed by the cardiovascular department of our hospital and treated with RDN were followed up for 3-18 months, of which 5 cases were followed up for more than 12 months and 8 cases were followed up for more than 3 months. Eight patients were treated with radiofrequency ablation of renal artery catheter. The parameters such as preoperative blood pressure, antihypertensive drugs, organ function, intraoperative ablation resistance, power, time, and temperature were determined. The related changes of blood pressure, antihypertensive drugs, and visceral function and the occurrence of side effects at 1 week and 1, 3, 6, and 12 months after operation were related to the operation. In conclusion, RDN has a significant clinical effect in the treatment of refractory hypertension, with stable postoperative blood pressure drop, reduced drug dosage, and less side effects.

Clinical Observation of Tibetan and Western Medicine in the Treatment of Refractory Hypertension

Clinical Observation of Tibetan and Western Medicine in the Treatment of Refractory Hypertension

Research Progress on Refractory Hypertension in Traditional Chinese Medicine

At present, the mortality rate and disability rate caused by cardiovascular and cerebrovascular diseases are very high in China. Individuals with refractory hypertension are at a greater risk of developing chronic kidney disease, heart failure, stroke and myocardial infarction. Therefore, how to effectively control blood pressure and identify the cause of refractory hypertension is a problem that medical workers need to solve, and it is also the key to prevent cardiovascular disease. In recent years, the government actively supports the development of traditional Chinese medicine. Since the curative effect of traditional Chinese medicine is recognized by the public, the prospect of traditional Chinese medicine in the prevention and treatment of refractory hypertension is considerable, and it is expected to become the main key research direction in the future.

Potential Deep Brain Stimulation Targets for the Management of Refractory Hypertension.

Hypertension is the single greatest contributor to human disease and mortality affecting over 75 million people in the United States alone. Hypertension is defined according to the American College of Cardiology as systolic blood pressure (SBP) greater than 120 mm Hg and diastolic blood pressure (DBP) above 80 mm Hg measured on two separate occasions. While there are multiple medication classes available for blood pressure control, fewer than 50% of hypertensive patients maintain appropriate control. In fact, 0.5% of patients are refractory to medical treatment which is defined as uncontrolled blood pressure despite treatment with five classes of antihypertensive agents. With new guidelines to define hypertension that will increase the incidence of hypertension world-wide, the prevalence of refractory hypertension is expected to increase. Thus, investigation into alternative methods of blood pressure control will be crucial to reduce comorbidities such as higher risk of myocardial infarction, cardiovascular accident, aneurysm formation, heart failure, coronary artery disease, end stage renal disease, arrhythmia, left ventricular hypertrophy, intracerebral hemorrhage, hypertensive enchaphelopathy, hypertensive retinopathy, glomerulosclerosis, limb loss due to arterial occlusion, and sudden death. Recently, studies demonstrated efficacious treatment of neurological diseases with deep brain stimulation (DBS) for Tourette’s, depression, intermittent explosive disorder, epilepsy, chronic pain, and headache as these diseases have defined neurophysiology with anatomical targets. Currently, clinical applications of DBS is limited to neurological conditions as such conditions have well-defined neurophysiology and anatomy. However, rapidly expanding knowledge about neuroanatomical controls of systemic conditions such as hypertension are expanding the possibilities for DBS neuromodulation. Within the central autonomic network (CAN), multiple regions play a role in homeostasis and blood pressure control that could be DBS targets. While the best defined autonomic target is the ventrolateral periaqueductal gray matter, other targets including the subcallosal neocortex, subthalamic nucleus (STN), posterior hypothalamus, rostrocaudal cingulate gyrus, orbitofrontal gyrus, and insular cortex are being further characterized as potential targets. This review aims to summarize the current knowledge regarding neurologic contribution to the pathophysiology of hypertension, delineate the complex interactions between neuroanatomic structures involved in blood pressure homeostasis, and then discuss the potential for using DBS as a treatment for refractory hypertension.

Hipertensão resistente: abordagem clínica

Hipertensão arterial resistente é definida como a pressão arterial de consultório não controlada, apesar do uso de três ou mais anti-hipertensivos, incluindo, preferencialmente, um diurético. Indivíduos em uso de quatro ou mais medicamentos com controle pressórico também são considerados hipertensos resistentes. Por sua vez, hipertensão refratária é a pressão arterial não controlada, apesar do uso de cinco ou mais drogas, incluindo um tiazídico de ação prolongada e um antagonista da aldosterona. Sua prevalência vem crescendo com o envelhecimento da população e o avanço da obesidade, estando relacionada às altas taxas de morbidade e mortalidade de origem cardiovascular e renal. A abordagem diagnóstica se baseia em quatro pontos: afastar pseudorresistência, identificar o fenômeno do jaleco branco, investigar causas secundárias e identificar lesões subclínicas para estratificação do risco cardiovascular. O objetivo terapêutico é o controle da pressão arterial de 24 horas. Mudanças de estilo de vida devem ser implementadas e as três primeiras drogas devem incluir um diurético adequado, um inibidor do sistema renina-angiotensina-aldosterona e um bloqueador de canais de cálcio. Persistindo o descontrole pressórico, adicionamos a quarta droga: espironolactona. Quanto aos hipertensos refratários, novas modalidades terapêuticas vêm sendo desenvolvidas, como a denervação renal e a estimulação do barorreflexo.

Radiosurgical Ablation of the Renal Nerve in a Porcine Model: A Minimally Invasive Therapeutic Approach to Treat Refractory Hypertension.

BackgroundHypertension is strongly associated with cardiovascular diseases such as heart failure, stroke, kidney disease, and has been correlated with an increased risk for heart attack. Current treatment regimens for hypertension are highly inadequate, with reports indicating that only 50.1% of the clinical population with the disease has their blood pressure under control.ObjectiveTo study the feasibility of using minimally invasive radiosurgery to ablate the renal nerves as a novel treatment for refractory hypertension, and to assess the safety and efficacy of such an approach.MethodsA Hanford porcine (miniswine) model (N = 6) was used to investigate the feasibility of using the CyberHeart radiosurgical platform (CyberHeart Inc., Mountain View, CA, USA) to create safe renal nerve ablations. Norepinephrine (NE) levels were measured pre and post treatment. Additionally, renal nerve and arterial histology were studied to examine effect.ResultsPlasma norepinephrine levels showed a decrease over the six-month time point. Urea, nitrogen, and creatinine levels showed no changes post procedure. Histology documented no significant arterial injury in targeted areas. Renal nerves documented histologic change consistent with nerve ablation.ConclusionCyberHeart radiosurgery of the renal nerve is feasible and resulted in norepinephrine reduction and renal nerve injury consistent with radiosurgical targeted ablation.

Refractory Hypertension Controlled with the Niemtzow Dry Mouth Acupuncture Protocol

Abstract Background: Acupuncture for treating hypertension is clearly not in the mainstream of allopathic medicine. Even literature about acupuncture energetics, neuroanatomical acupuncture, and western medical acupuncture do not mention treatment of hypertension. The aim of this article is to describe a potentially new treatment for refractory hypertension. Case: A 48-year-old woman with severe hypertension refractory to 6 allopathic medications. She also had dry mouth, for which she had sought treatment. The Niemtzow acupuncture protocol for dry mouth was applied to treat that condition. Results: The patient had repeated normal blood pressure readings after using the Niemtzow dry mouth acupuncture protocol to treat her dry mouth. Conclusions: The Niemtzow dry mouth acupuncture protocol needs further research to determine its value as a hypertension treatment modality.

Computer‐Assisted Anatomical Dissection (CAAD) of the Renal Plexus to Refine Renal Denervation in the Treatment of Refractory Hypertension

ContextRadioFrequency (RF) renal denervation is an emerging treatment of refractory arterial hypertension with various possible approaches: endovascular, endourologic, laparoscopic. Results and adverse events remain controversial. Theoretical safety and efficiency of all of the approaches deserve to be addressed with special insight into the anatomy of the renal plexus and hilar structures. The objective was to describe the location and distances between nerve fibers and renal vasculature.MethodsSagittal serial sections were performed in 4 human fetuses and 10 adult bodies were dissected. In fetuses, sections were stained by Masson's trichrome, HE, and immunostained by PS100 neuronal antibody. The nature of renal plexus fibers was investigated by adrenergic (TH) and somatic (PMP22) labelings. In cadavers, the distances between nerve fibers and arteries were measured at the renal ostium, at mid‐artery, at the hilum of the kidney, and were statistically compared (one‐way repeated measures ANOVA). 3D reconstructions were performed from the digitized serial sections obtained in fetuses.ResultsThe renal plexus can be described as a guying contained in an hourglass shape centered on the renal artery. The isthmus of this hourglass corresponds to the hilum of the kidney and is a mandatory waypoint of afferent and efferent renal plexus. At this level, the nerves are at the closest location of arterial branches (11 mm at the renal ostium, 6.5 mm at mid‐artery and 2 mm at the hilum of the kidney; p<0.001). The sectorial distribution of the nerves around the renal artery is heterogeneous and fibers predominate on the superior aspect. Nerve fibers are autonomic (PMP22−) and adrenergic‐sympathetic (TH+). With an animated 3D reconstruction, it is possible to analyze the relationship between renal plexus, vasculature and urinary tract, and the potential risks of various denervation techniques.ConclusionCAAD in fetuses identified the renal hilum as the theoretical preferential site for renal denervation. To optimize endovascular denervation in future clinical studies, a compromise should be sought between the size of the RF probe and the arteries’ diameter. There is an opening to laparoscopic surgical denervation.Support or Funding InformationNone

Catheter-based renal sympathetic denervation: a real therapeutic prospect for the treatment of refractory hypertension?

Not available

TCT-217 Pathologic Insight Into Nerve Injury in Swine Treated with Ultrasound Renal Artery Denervation System

Selective renal nerve denervation (RND) constitutes a minimally invasive approach for treatment of refractory hypertension. Ultrasound energy consisting of high-frequency sound waves emitted circumferentially [PARADISE ReCor Medical] was used to ablate renal nerve activity. Post-treatment

The efficacy of surgical treatment for refractory ocular hypertension glaucoma

Objective To provide instruction for clinical treatment by investigating the efficacy of surgical treatment for refractory ocular hypertension glaucoma.Methods g4 patients who bad undergone surgery for refractory ocular hypertension glaucoma during the period of January 2007 to December 2011 in our hospital were included in this study.Intraocular pressure and incidence of complications were observed before and after treatment.Results Intraocular pressure decreased significantly in all the patients after the treatment,with a significant statistical difference ( P＜ 0.05 ).After treatment,22.55％of the patients had visual acuity of ＜ 0.03,62.75％ had 0.02 to 0.3,and 14.70％ had ＞ 0.3,revealing significant improvement ( P ＜ 0.05 ).No severe complications occurred.Conclusions Surgical treatment for refractory ocular hypertension glaucoma is efficacious and has a lower rate of complications.It is worth popularizing clinically. Key words: Ocular hypertensionglaucoma; Surgery; Efficacy; Complications

Safety and Efficacy of Eplerenone in the Management of Essential Hypertension

Suppression of the Renin-Angiotensin-Aldosterone system (RAAS) is an established intervention in the management of cardiovascular disease. Large, randomized controlled trials have provided a sound evidence base for the use of mineralocorticoid receptor antagonists to block the end product of the RAAS in the treatment of heart failure. However, the place for mineralocorticoid blockade in the treatment of hypertension is less well defined and lacking a strong evidence base. The main indication for the use of this strategy in hypertension is as a third line agent in the treatment of refractory hypertension. The most widely used mineralocorticoid receptor antagonist, spironolactone, is associated with dose related sexual side effects, limiting its use in clinical practice. Eplerenone, the selective mineralocorticoid receptor antagonist, is a promising cardiovascular drug licensed for the treatment of heart failure in Europe and heart failure and hypertension in the USA. It effectively blocks the mineralocorticoid receptor without the unpleasant sexual side effect profile of spironolactone. We review the use of eplerenone, a selective mineralocorticoid receptor antagonist in the treatment of hypertension; discuss its mechanism of action, safety profile as well as its current place in therapy.

Effect of a Multidisciplinary Clinic for the Treatment of Refractory Hypertension

Effect of a Multidisciplinary Clinic for the Treatment of Refractory Hypertension

Spironolactone in the treatment of refractory hypertension

In 5 to 10% of patients (pts) the hypertension is resistant to conventional pharmacological therapy. To assess the efficacy and safety of spironolactone in pts with refractory hypertension treated with at least two other anti-hypertensive drugs. We used spironolactone in a total of 60 pts who were referred to our department for treatment of refractory hypertension. Criteria for inclusion in this study were: 1- Primary hypertension >12 months, treated with at least two anti-hypertensive drugs;2- SBP≥50 mm Hg or DBP ≥95 mm Hg measured by 24 h ambulatory blood pressure monitoring (ABPM). Criteria for exclusion: 1- Creatinine >1,5 mg/dL; 2 - K+ level > 5 mEq/l. 3- Prior intake of spironolactone. Spironolactone (1mg/Kg/day) was given to all pts; this drug could be taken in association with other anti-hypertensive drugs, with the exception of ACE inhibithors and angiotensin antagonists, that were stopped prior to the beginning of the study. Creatinine and K+ levels were monitored during the follow-up (3 and 6 months). 54 of 60 pts (90%) presented ABPM < 150/ 90 mm Hg after 30 days of treatment with spironolactone (table I): ABPM Before and After Spironolactone ABPM Before and After Spironolactone After 6 months, 12 patients were controlled only with spironolactone alone (dosage of 50-75 mg/day), 36 required 2 anti-hypertensive drugs and 13 required three drugs. Spironolactone was decreased (from 75 to 25 mg/day) in 3 males due to gynaecomasty. The drug was stopped in 1 pts due to increased creatinine and K+ level ( respectively 2.4 mg/dL and 6.1. mEq/l). These findings confirm the efficacy and safety of spironolactone in the treatment of refractory hypertension. See Table 2. ABPM -p<0.001 ABPM -p<0.001

Contemporary management of refractory hypertension.

Refractory or resistant hypertension is conventionally defined as systolic or diastolic blood pressure that remains uncontrolled despite sustained therapy with at least three different classes of antihypertensive agents. Refractory hypertension is estimated to affect less than 5% of the general population with hypertension; however, its prevalence increases with increasing severity of blood pressure. Patients presenting with refractory hypertension usually have progressed from mild, to moderate, to severe hypertension because of lack of or inadequate treatment. Other common contributing factors include obesity, medical nonadherence, suboptimal medical regimens, excessive dietary salt ingestion, secondary forms of hypertension, sleep apnea, and ingestion of substances that interfere with treatment. Combination therapy that includes appropriate doses of a diuretic is recommended for treatment of refractory hypertension. Use of fixed-dose combinations enhances compliance through cost savings, more convenient dosing, and reduced pill burdens.

Bilateral nephrectomy: the best, but often overlooked, treatment for refractory hypertension in hemodialysis patients

Bilateral nephrectomy for treatment of refractory hypertension in chronic hemodialyzed patients has been infrequently carried out. We analyzed the benefits of this operation on blood pressure, clinical state, drug treatment, and quality of life. In 10 hemodialyzed patients with refractory hypertension, systolic (SBP) and diastolic (DBP) blood pressure were measured 1 month before nephrectomy bilateral and 3, 6, 9, and 12 months after. In addition, the use of antihypertensive drugs before and after surgery was evaluated. Four patients had SBP and DBP values characteristic of malignant hypertension. In all 10 patients hypertension responded neither to reduction of plasma volume by ultrafiltration nor to multiple antihypertensive drug therapy. Hypertensive crises were associated with cerebral hemorrhage in two patients, severe encephalopathy with persistent neural dysfunction in one patient, and encephalopathy and diplopia in another. Three months after bilateral nephrectomy blood pressure decreased significantly ( P < .005) and was normal in nine patients. In one noncompliant patient with intradialytic body weight increases of nearly 10%, blood pressure was still elevated. Malignant or drug-resistant hypertension with hypertensive crises is an indication for bilateral nephrectomy. The clinical state and quality of life improved in all patients in the present study and antihypertensive treatment is no longer necessary.

Clinical Applications of Angiotensin-Converting Enzyme Inhibitors

Although only recently introduced, angiotensin-converting enzyme inhibitors have been utilized to treat a wide variety of clinical disorders. Their uses to date, approved by the Food and Drug Administration, have been in the treatment of refractory hypertension and congestive heart failure. However, they have been evaluated with mixed results in numerous other conditions in which the renin-angiotensin-aldosterone system may play a role. Their current status in the treatment of hypertension, congestive heart failure, and these other conditions is reviewed.

Captopril combined with minoxidil, beta-blocker and furosemide in the treatment of refractory hypertension.

14 patients with refractory hypertension did not respond either to captopril, an angiotensin II converting enzyme inhibitor, combined with a diuretic, a beta-blocker and hydralazine or minoxidil, a potent vasodilator, but they did respond to the combination of captopril, minoxidil, furosemide and a beta-blocker. There were no disturbing side effects from this combination. There may be a synergistic effect between captopril and minoxidil in the treatment of refractory hypertension. The combination is an interesting and novel method of treating patients with refractory hypertension.

Interaction of Minoxidil and Captopril in the Treatment of Refractory Hypertension

A case of severe hypertension resistant to multiple drug therapy was controlled with minoxidil, captopril, and propranolol hydrochloride after treatment with these drugs alone or in other combinations had failed. Hyperreninemic hypoaldosteronism with hyperkalemia and acidosis developed after captopril administration was started.