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The Management of Patients with Heart Failure with Preserved Ejection Fraction (HFpEF)
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Jodie L. Kenes, Richard B. Stacey, Bharathi Upadhya
Cardiac contractility modulation devices deliver a strong electrical current during the refractory period into the septum, thus triggering molecular remodeling. A recent case series in HFpEF found that soon after initiating cardiac contractility modulation, patients experienced improvements in NYHA class, functional capacity, and HRQOL and showed significant reductions in the diastolic filling index.52 Baroreflex activation therapy, which is produced by stimulating the carotid sinuses using an implanted device (Rheos, CVRx, Maple Grove, MN, USA), is being studied for the treatment of hypertension. The safety and efficacy of baroreflex activation therapy in HFpEF is being examined in the HOPE4HF (Hope for Heart Failure: NCT00957073) trial.53 Renal denervation, which improved LV hypertrophy (LVH) and diastolic LV function in a small series with refractory hypertension,54 was investigated in the Renal Denervation in HF with Preserved EF (RDT-PEF) trial; however, the study appeared statistically underpowered (Table 15.2).52
Hypertension
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Outside of the United States in places such as Australia and Europe, percutaneous catheter-based radiofrequency ablation is performed (on an experimental level only) for the sympathetic renal artery nerves, to treat resistant hypertension. The procedure is controversial in its effectiveness, and is only done by specialists with widespread experience. Another option is stimulation of the carotid baroreceptor with a surgically implanted device. It is placed around the carotid body, and an attached battery stimulates the baroreceptor. In a dose-dependent method, BP is lowered. Studies have shown that baroreflex activation therapy is effective for persistent reduction in office-measured BP for those with resistant hypertension. There are no major safety issues that have been seen. However, the American Heart Association and American College of Cardiology have not approved the procedure for the management of resistant hypertension as of 2021.
Heart failure with preserved ejection fraction in older adults
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Bharathi Upadhya, Dalane W. Kitzman
Baroreflex activation therapy (BAT) produced by stimulating the carotid sinuses using an implanted device (Rheos) is being studied for the treatment of HTN, a key, frequent precursor to and comorbidity in HFpEF. A trial testing the potential benefit and safety of BAT for HFpEF, the HOPE4HF trial (NCT00957073) (196), is underway.
Emerging drugs for the treatment of diabetic nephropathy
Published in Expert Opinion on Emerging Drugs, 2022
Yoon Kook Kim, Xinyuan Ning, Kashif M. Munir, Stephen N. Davis
In addition to drugs, there are investigations underway in search for other therapeutic options. Given the important role of hypertension (and more specifically the hemodynamics of the kidneys) in overall renal health, antihypertensive therapy with renal denervation devices or baroreflex activation therapy is also being investigated [21–23]. These advances and continued efforts testify to the significant strides made in the management of diabetic nephropathy; however, the overall burden of diabetic nephropathy is still large. Given our current understanding of the heterogeneous nature of the pathophysiology of diabetic nephropathy, there are other likely therapeutic targets that address uncharted pathways of diabetic nephropathy, and investigations to find these novel drugs continue. With some of these emerging drugs and ongoing research, one may aim to not only slow the progression of diabetic nephropathy but potentially also reverse or halt it.
Proteomics and personalized medicine: a focus on kidney disease
Published in Expert Review of Proteomics, 2019
Justyna Siwy, Harald Mischak, Petra Zürbig
Due to the fact that blood pressure (BP) control plays an important part in kidney health, hypertensive drugs (like ACE inhibitors or angiotensin receptor blockers) have been used in the treatment of CKD. A similar organoprotective effect for the kidneys was investigated using baroreflex activation therapy (BAT) for the treatment of resistant hypertension [58]. Urine samples of patients with resistant hypertension who were treated with BAT, were analyzed with the use of CKD273 at baseline and after 6 months of therapy. A significant decrease in BP and a strong correlation of CKD273 and eGFR at baseline was determined. There were no significant changes in CKD273 scores between baseline and after 6 months of BAT. However, after stratification regarding the BP response, the CKD273 scores significantly decreased after BAT in patients with systolic BP reduction of ≥5 mm Hg. Therefore, the potential nephroprotective effects of BAT in patients with sufficient BP response could be revealed with CKD273.
Efficacy and safety of baroreflex activation therapy for treatment of resistant hypertension: a systematic review and meta-analysis
Published in Clinical and Experimental Hypertension, 2018
Wang Chunbin, Shiquan Fu, Huang Jing
The underlying mechanism of RH is unclear and seems to be multifactorial. The over-activation of the sympathetic nervous system (SNS) contributes to the pathogenesis of RH (5,6). In response to the need for more effective BP-lowering therapies targeting the SNS, especially for patients with resistant hypertension, device-driven therapy approaches are an area of intense development and investigation and include renal denervation therapy (RDN) and Baroreflex Activation Therapy (BAT) (7).