Giuliano Tocci, MD, PhD, ESH Hypertension Specialist Centro per la Diagnosi e la Cura dell’Ipertensione Arteriosa, Cattedra di Cardiologia, Dipartimento di Medicina Clinica e Molecolare, Facoltà di Medicina e Psicologia Università di Roma Sapienza, Azienda Ospedaliera Sant’Andrea, Roma, Italia. E-mail: [email protected]E-mail: [email protected]
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Giuliano Tocci, MD, PhD, ESH Hypertension Specialist Centro per la Diagnosi e la Cura dell’Ipertensione Arteriosa, Cattedra di Cardiologia, Dipartimento.
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Centro per la Diagnosi e la Cura dell’Ipertensione Arteriosa, Cattedra di Cardiologia,
Dipartimento di Medicina Clinica e Molecolare, Facoltà di Medicina e PsicologiaUniversità di Roma Sapienza, Azienda Ospedaliera Sant’Andrea, Roma, Italia.
BP Stratification in Hypertensive Patients enrolled in Hypertension Surveys in Italy
n=1.831 n=3.739 n=3.374 n=15.904 n=13.297 n=2.081
N=52.71571%
22%
Volpe M, Tocci G, et al. J Hypertens 2007 Jul;25(7):1491-8
Resistant Hypertension
• Hypertension is usually defined resistant or refractory to treatment when a therapeutic plan that has included attention to lifestyle measures and the prescription of at least three drugs (including a diuretic) in adequate doses has failed to lower systolic and diastolic blood pressure to goal.
• According to this definition prevalence of resistant hypertension is relatively high (in ALLHAT 8% pts with 4 drugs and 15% with resistant hypertension).
• In such situations, referral to a specialist or a hypertension center should be considered, because resistant hypertension is recognized to be often associated with subclinical organ damage and a high or very high cardiovascular risk.
2007 ESH/ESC Hypertension Guidelines
Mancia G, et al. J Hypertens 2007;25:1105–1187
Epidemiologia dell‘Ipertensione Arteriosa in Italia
Schematic Representation of the Catheter Ablation of Renal Arteries
The Renal Denervation Procedure
• 4-6 focal treatments are delivered– 120 seconds per treatment– ≥5 mm between locations– Stable, unique locations– Circumferential coverage
• The catheter is pulled, rotated, and new location and prior treatment site are assessed
The blood pressure lowering effects of renal denervation in a real world population
of patients with uncontrolled hypertension: Early outcomes from the Global SYMPLICITY Registry
Felix Mahfoud et al. Expert consensus document from the ESC on
catheter-based RD, Eur Heart J April 2013
Michael Böhm, on behalf of the Global SYMPLICITY Registry Investigators Oral Comunication at ESC 2013 Congress
Purpose of the Registry
To document:• Long-term safety & effectiveness • Real world patient population with: • Hypertension and/or • Other diseases characterized by elevated sympathetic
drive
• Procedural technique
Global SYMPLICITY Registry
RationaleRationaleGlobal SYMPLICITY Registry
LA: 6
CA: 5
MEA: 11
WE: 116
ANZ: 11
C&EEU: 10
ASEAN: 10
Korea: 10
Current Activated Site LocationsGlobal SYMPLICITY Registry
p < 0.0001 for all time points except; p=0.0456 SBP ≥ 140 mm Hg, p=0.7611 DBP ≥ 140 mm Hg (12m);p=0.0677 SBP ≥ 160/150 mm Hg, p=0.7838 DBP ≥ 160/150 mm Hg (12m); p=0.0001 and p=0.0036 SBP ≥ 180/100 mm Hg (3m + 6m) and p=0.0007 and p=0.0017 DBP ≥ 180/100 mm Hg (3m + 6m) ** Sample size for >180/100 at 12 months too small to be shown (n=2)
Data on patients reaching 3 or 6 or 12 month follow up
Global SYMPLICITY Registry
Conclusions
• Excellent procedural and clinical safety profile in real world
• Treatment resembles current consensus
• Significant reduction in both Office and ambulatory BP
• Enrolment and analyses continue
Global SYMPLICITY Registry
Take-Home Message• Il trattamento dell’ipertensione arteriosa non controllata (o resistente) richiede l’impiego di
terapie di combinazione con diverse classi di farmaci.
• Tali terapie di combinazione dovrebbero essere:– Semplici– Razionali– A dosaggio “adeguato” (pieno)
• Studi clinici disponibili dimostrano come l’impiego di terapie di combinazione duplici o triplici (farmaco bloccante RAS, diuretico tiazidico e CCB diidropiridinico a dosaggio pieno) consentono di ottenere il controllo dei valori di PAS/PAD in oltre 70-80% dei pazienti trattati.
• Nel rimanente 20-30% l’impiego di farmaci di 4 scelta (antialdosteronici o inibitori diretti della renina) può consentire di ridurre ulteriormente i valori pressori e raggiungere il controllo dei valori pressori.
• Nei casi non responsivi alla terapia (o con documentate allergie o intolleranze), l’impiego della denervazione delle arterie renali rappresenta una opzione efficace, sicura e ben tollerata per ridurre i valori pressori e contribuire a raggiungere il controllo della pressione arteriosa.
How to improve BP control in daily clinical practice of hypertension?
Volpe M, et al. G Ital Cardiol (Rome) 2012 Dec;13(12):853-60Ipertensione Prev Cardiovasc 2013; in press
High Blood Press Cardiovasc Prev 2013 March: in press
How to manage difficult-to-treat patients with resistant hypertension?
Volpe M, et al. G Ital Cardiol (Rome) 2012 Dec;13(12):846-5Ipertensione Prev Cardiovasc 2013; in press
High Blood Press Cardiovasc Prev 2012 Dec;19(4):237-44