Como la denervacion renal sirve para tratar hipertensos severos

1. DENERVACION RENAL
PERCUTANEA E HIPERTENSION
ARTERIAL RESISTENTE

5. Kearney PM, et al. J Hypertens. 2004; 22:11-19.

6. Calhoun DA, et al. Circulation. 2008;117:e510-e526
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8. Date of download:
6/15/2013
Copyright © The American College of Cardiology.
All rights reserved.
From: Renal Denervation for Hypertension
J Am Coll Cardiol Intv. 2012;5(3):249-258. doi:10.1016/j.jcin.2011.12.011
The Renal SNS
NTS = solitary tract nucleus; PVN = paraventricular nucleus; RVLM = rostral ventrolateral medulla.
Figure Legend:

9. Adapted from Smith P, et al. Am J Hypertens. 2004; 17:217-222.

10. Activación Renal
Simpática en
pacientes
hipertensos
Esler et M al. Clin Exp
Hyper 1984

11. Hypertension. 2009;54:1195-1201.

26. M. Mazor, TCT 2012

27. M. Joner, TCT 2012

28. M. Joner, TCT 2012

30. First-in-Man (AU)
Series of Pilot Studies
(EU, US & AU)
Symplicity HTN-2
Initial RCT
(EU & AU)
SYMPLICITY HTN-3
US Pivotal Trial (US)
Global SYMPLICITY
Registry
(Approved Regions)
Expand HTN Indication
(Approved Regions)
Post-Market Registry
(US)
SYMPLICITY HF
Symplicity HTN-1
Pilot Studies in
New Indications
(Approved Regions)
Trials under way
SYMPLICITY Clinical Trial Program follows over 5000
patients across multiple indications
c

31. Medtronic

32. Symplicity HTN-1 Investigators, Hypertension 2011

35. Schlaich M, TCT 2012

36. • Purpose: To demonstrate the effectiveness of catheter-based renal
denervation for reducing blood pressure in patients with uncontrolled
hypertension in a prospective, randomized, controlled, clinical trial
• Patients: 106 patients randomized 1:1 to treatment with renal
denervation vs. control
• Clinical Sites: 24 centers in Europe, Australia, & New Zealand (67% were
designated hypertension centers of excellence)
36
Symplicity HTN-2
Symplicity HTN-2 Investigators. Lancet. 2010;376:1903-1909.
Lancet. 2010;376:1903-1909.

37. Symplicity HTN-2 Investigators, Lancet 2010

38. Symplicity HTN-2 Investigators, Lancet 2010

39. Symplicity HTN-2 Investigators, Lancet 2010

40. Symplicity HTN-1 Investigators, Hypertension 2011

42. Symplicity HTN-2 Investigators, Lancet 2010

43. Symplicity HTN-2 Investigators, Lancet 2010

44. Symplicity HTN-2 Investigators, Lancet 2010

45. Vonend et al, Lancet 2012

46. Ott et al, Clin J Am Soc Nephrol 2013

47. RRI = (V max sys – V max endiast) / V max sys
Mahfoud et al, Hypertension 2012

48. Mahfoud et al, Hypertension 2012
Normal: <20 mg/l, microalbuminuria: 20-200 mg/l, macroalbuminuria: >200 mg/l

50. Mahfoud F et al., Circulation 2011

51. REACH-Pilot, Davies JE, Francis DP et al. IJC 2012
OLOMOUC I Study, ESC 2012

52. Witkowski A et al, Hypertension 2011

55. 11

56. CONCLUSIONES
1. La Hipertensión Arterial Resistente es una
condición de difícil manejo clínico y de alta
morbi-mortalidad.
2. La eliminación de los nervios simpáticos renales
produce una caída sostenida de la presión a
lo largo de tres años.
3. La denervación renal por vía percutánea es un
procedimiento seguro y efectivo para eliminar
los nervios simpáticos renales.
4. Disponemos de los recursos para iniciar nuestra
propia experiencia nacional.