renal denervation WIN2011 Abbott.PPT - Radial Frequency Ablation for Hypertension Treatment Help or Hype J Dawn Abbott M.D F.A.C.C F.S.C.A.I Director

renal denervation WIN2011 Abbott.PPT - Radial Frequency...

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Radial Frequency Ablation for Hypertension Treatment: Help or Hype? J. Dawn Abbott, M.D., F.A.C.C., F.S.C.A.I. Director, Interventional Cardiology Fellowship Assistant Professor of Medicine Brown Medical School Division of Cardiology, Rhode Island Hospital
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Disclosure Information The following relationships exist related to this presentation: None Off label use of products will be discussed in this presentation. -Investigational Devices
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Arterial Hypertension Most frequent cause of death worldwide 20mmHg increase in BP doubles cardiovascular mortality > 80% of patients with arterial hypertension are not treated adequately or can not be treated adequately 20-30% of patients with HTN have or will develop resistant HTN Resistant HTN-failure to achieve goal BP (140/90, 130/80 DM/CKD) when adhering to maximally tolerated doses of 3 drugs including a diuretic. Reduction of systolic blood pressure by 10 mmHg reduces the risk of stroke by 30%
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Role of Kidney in Blood Pressure Regulation The kidney plays a pivotal role in BP regulation through sodium, volume, renin modulation, and renal-sympathetic neuronal interactions. Renal sympathetic efferent and afferent nerves contribute to the pathogenesis of hypertension.
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Regulators of Renal Efferent Nerves Central sympathetic nervous system Aortic and carotid baroreflexes Cardiac stretch receptors with vagal afferents Renorenal reflexes that alter the level of efferent nerve activity in the contralateral kidney Kidney is the recipient of sympathetic signals via the renal efferent nerves Increases renin release Activation of RAAS system Increases sodium retention Decreases Renal blood flow
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Essential HTN and CKD Hypertrophy Arrhythmia O2 consumption Heart failure Vasoconstriction Arteriosclerosis Renin- release NaCL-retention Renal blood flow Renal Afferent Nerves Insulin resistance
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