Hypertension & Healthcare

Biography

Biography: Tsioufis Kostas

Abstract

Resistant hypertension (RHTN) represents a very mixed group of patients with target organ damage and cardiovascular and renal disease but the causes of resistant hypertension (RHTN) are complex and multifactorial. Older age, diabetes, chronic kidney disease and obesity are the most common factors associated. Clinical assessment requires close follow-up and adherence to medication is of great importance but its clinical assessment in routine practice is challenging. Available evidence that some blood pressure (BP) lowering effect by Increase in the dose of existing drug treatments (especially diuretics) and addition of spironolactone in some cases. We have learned from renal denervation (RDN) clinical trials that BP response to RDN is characterized by huge variability and heterogeneity. Possible causes for that variability have been recognized procedural aspects (related to incomplete denervation), the studied population and the design of the study. In order to move forward, there is a need for conducting an appropriately designed trial to definitely resolve the uncertainties regarding the BP effects of RDN. So, according to a recently released paper in Eur Heart Journal, the following considerations for future RDN studies should be taken into account. • For the procedure: to use multi-electrode ablation system targeting the circumferential ablation • For the Study population : to include patients with moderate rather than resistant hypertension and to exclude patients with stiff large arteries (e.g. isolated systolic hypertension • For the study design : to perform wash out period only in highly experienced centers (safety concerns) and to consider sham procedure with renal angiography as potentially unethical ; to standardize concomitant antihypertensive therapy and to monitor drug adherence as potential confounder of BP response • For study outcomes : to use the change in ambulatory BP as a primary efficacy parameter