Resistant hypertension is defined as persistent
elevation of BP above goal despite concurrent use of 3 antihypertensive agents.
Each drug from different class with one being diuretic. Hypertension controlled
with four or more drug is also considered resistant hypertension.
Kidneys are richly supplied by sympathetic nerves,
brain impulse induce vasoconstriction by release of rennin
In 1938 Thoracolumbar splanchnicectomy was
introduced as a treatment for hypertension, a particularly invasive surgical
procedure involving resection of splanchnic innervation to the kidneys. Those
treated surgically versus those declined for surgery and treated medically,
5-year mortality rates were 19% and 54%, respectively.
Adavantesia of arteries of kidney contain both efferent
and afferent by damaging these nerves brain and kidney crosstalk be prevention
Three modalities of RSD are
Simplicity 1 and Simplicity HTN -2 trail demonstrated
benefit of RSD in resistant hypertension. And no risk of renal artery stenosis
as well no sympatric reinnervation. Two year follow-up has shown no loss of
control of blood pressure
Following RSD office BP reduction is more than home
measurement probably because of excess sympathetic flow in office.
Labels: Hypertension, Intermediate Level, Invasive Cardiology