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  1. Article ; Online: Renal denervation in patients with chronic kidney disease: current evidence and future perspectives.

    Schmieder, Roland E

    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

    2022  Volume 38, Issue 5, Page(s) 1089–1096

    Abstract: Supported by several high-quality randomized controlled trials and registry analyses, catheter-based renal denervation is becoming an important adjunctive treatment modality for the safe and efficacious treatment of hypertension besides lifestyle ... ...

    Abstract Supported by several high-quality randomized controlled trials and registry analyses, catheter-based renal denervation is becoming an important adjunctive treatment modality for the safe and efficacious treatment of hypertension besides lifestyle modifications and antihypertensive medication. Renal denervation is of particular interest to nephrologists as the intervention may provide additional benefits to hypertensive people with chronic kidney disease (CKD), a condition typically characterized by sympathetic hyperactivity. A growing body of clinical evidence supports the safety and efficacy of renal denervation in this difficult-to-control population. In addition, preclinical and clinical research works indicate potential nephroprotective effects in CKD patients. The current review examines recent research on renal denervation with a focus on renal disease and assesses the latest findings and their implications from a nephrologist's perspective.
    MeSH term(s) Humans ; Kidney ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/surgery ; Hypertension ; Antihypertensive Agents/therapeutic use ; Treatment Outcome ; Denervation ; Sympathectomy ; Blood Pressure
    Chemical Substances Antihypertensive Agents
    Language English
    Publishing date 2022-06-10
    Publishing country England
    Document type Review ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 90594-x
    ISSN 1460-2385 ; 0931-0509
    ISSN (online) 1460-2385
    ISSN 0931-0509
    DOI 10.1093/ndt/gfac189
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Book ; Online ; E-Book: Interventional therapies for secondary and essential hypertension

    Tsioufis, Costas / Schmieder, Roland E. / Mancia, Giuseppe

    (Updates in hypertension and cardiovascular protection)

    2016  

    Author's details Costas Tsioufis, Roland E. Schmieder, Giuseppe Mancia editors
    Series title Updates in hypertension and cardiovascular protection
    Keywords Hypertension / therapy ; Renal Artery / innervation ; Sympathectomy
    Language English
    Size 1 Online-Ressource (x, 363 Seiten), Illustrationen, Diagramme
    Publisher Springer
    Publishing place Cham
    Publishing country Switzerland
    Document type Book ; Online ; E-Book
    Remark Zugriff für angemeldete ZB MED-Nutzerinnen und -Nutzer
    HBZ-ID HT019451578
    ISBN 978-3-319-34141-5 ; 9783319341408 ; 3-319-34141-3 ; 3319341405
    Database ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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  3. Article ; Online: Renal denervation: where do we stand and what is the relevance to the nephrologist?

    Schmieder, Roland E

    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

    2020  Volume 37, Issue 4, Page(s) 638–644

    Abstract: Catheter-based renal denervation to reduce high blood pressure (BP) has received well-deserved attention after a recent series of sham-controlled trials reported significant antihypertensive efficacy and very favourable tolerability and safety of the ... ...

    Abstract Catheter-based renal denervation to reduce high blood pressure (BP) has received well-deserved attention after a recent series of sham-controlled trials reported significant antihypertensive efficacy and very favourable tolerability and safety of the intervention. This emerging treatment option is of high relevance to nephrologists. Patients with chronic kidney disease (CKD) are at elevated risk of cardiovascular adverse events and often present with hypertension, which is very difficult to control with medication. Renal denervation promises a new tool to reduce BP and to prevent loss of renal function in this population. The current review considers the role of the kidney and neurohormonal activation in the development of hypertension and the rationale for renal denervation. The current state of the evidence for the effectiveness and tolerability of the procedure is considered from the nephrologists' perspective, with a focus on the potential future role of renal denervation in the management of CKD patients with hypertension.
    MeSH term(s) Antihypertensive Agents/therapeutic use ; Blood Pressure ; Denervation/methods ; Female ; Humans ; Hypertension ; Kidney ; Male ; Nephrologists ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/surgery ; Sympathectomy/methods ; Treatment Outcome
    Chemical Substances Antihypertensive Agents
    Language English
    Publishing date 2020-11-12
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 90594-x
    ISSN 1460-2385 ; 0931-0509
    ISSN (online) 1460-2385
    ISSN 0931-0509
    DOI 10.1093/ndt/gfaa237
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: The authors reply.

    Ott, Christian / Schmieder, Roland E

    Kidney international

    2022  Volume 101, Issue 4, Page(s) 830–832

    Language English
    Publishing date 2022-02-12
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 120573-0
    ISSN 1523-1755 ; 0085-2538
    ISSN (online) 1523-1755
    ISSN 0085-2538
    DOI 10.1016/j.kint.2022.01.026
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    Zs.A 797: Show issues Location:
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  5. Article ; Online: Diagnosis and treatment of arterial hypertension 2021.

    Ott, Christian / Schmieder, Roland E

    Kidney international

    2021  Volume 101, Issue 1, Page(s) 36–46

    Abstract: In the last 4 years, several evidence-based, national, and international guidelines on the management of arterial hypertension have been published, mostly with concordant recommendations, but in some aspects with discordant opinions. This in-depth review ...

    Abstract In the last 4 years, several evidence-based, national, and international guidelines on the management of arterial hypertension have been published, mostly with concordant recommendations, but in some aspects with discordant opinions. This in-depth review takes these guidelines into account but also addresses several new data of interest. Although being somewhat obvious and simple, accurate blood pressure (BP) measurement with validated devices is the cornerstone of the diagnosis of hypertension, but out-of-office BP measurements are of crucial importance as well. Simplified antihypertensive drug treatment such as single-pill combinations enhances the adherence to medication and speeds up the process of getting into the BP target range, a goal not so far adequately respected. Recommended (single-pill) combination therapy includes diuretics as part of the first step of antihypertensive therapy, and updated analysis does not provide evidence to exclude diuretics from this first step because of the recently discussed potential risk of increasing cancer incidence. Target BP goals need to be individualized, according to comorbidities, hypertension-mediated organ damage, coexistence of cardiovascular risk factors (including age), frailty in older patients, and individual tolerability. There are also concordant recommendations in the guidelines that an office BP between 120 and 140 mm Hg systolic and between 70 and 80 mm Hg diastolic should be achieved. The BP target of Kidney Disease: Improving Global Outcomes for hypertensive patients with chronic kidney disease are not applicable for clinical practice because they heavily rely on 1 study that used a study-specific, nontransferable BP measurement technique and excluded the most common cause of chronic kidney disease, namely, diabetic nephropathy. Actual data even from a prospective trial on chronotherapy have to be disregarded, and antihypertensive medication should not be routinely dosed at bedtime. Rigorously conducted trials justify the revival of renal denervation for treatment of (at least, but not only) uncontrolled and treatment-resistant hypertension.
    MeSH term(s) Aged ; Antihypertensive Agents/therapeutic use ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory/methods ; Humans ; Hypertension/diagnosis ; Hypertension/drug therapy ; Hypertension/epidemiology ; Prospective Studies
    Chemical Substances Antihypertensive Agents
    Language English
    Publishing date 2021-10-29
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 120573-0
    ISSN 1523-1755 ; 0085-2538
    ISSN (online) 1523-1755
    ISSN 0085-2538
    DOI 10.1016/j.kint.2021.09.026
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  6. Article ; Online: Editorial comment: Renal denervation.

    Schmieder, Roland E / Bosch, Agnes

    Hypertension research : official journal of the Japanese Society of Hypertension

    2021  Volume 45, Issue 2, Page(s) 241–243

    MeSH term(s) Denervation ; Kidney
    Language English
    Publishing date 2021-12-16
    Publishing country England
    Document type Editorial ; Comment
    ZDB-ID 1175297-x
    ISSN 1348-4214 ; 0916-9636
    ISSN (online) 1348-4214
    ISSN 0916-9636
    DOI 10.1038/s41440-021-00808-w
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  7. Book ; Online ; Thesis: Effect of empagliflozin on ketone bodies in patients with stable chronic heart failure

    Pietschner, Robert [Verfasser] / Schmieder, Roland E. [Akademischer Betreuer] / Schmieder, Roland E. [Gutachter]

    2022  

    Author's details Robert Pietschner ; Gutachter: Roland E. Schmieder ; Betreuer: Roland E. Schmieder
    Keywords Medizin, Gesundheit ; Medicine, Health
    Subject code sg610
    Language English
    Publisher Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)
    Publishing place Erlangen
    Document type Book ; Online ; Thesis
    Database Digital theses on the web

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  8. Article ; Online: Novel approaches to management of hypertension.

    Bosch, Agnes / Schmieder, Roland E

    Current opinion in nephrology and hypertension

    2020  Volume 30, Issue 1, Page(s) 54–62

    Abstract: Purpose of review: Of the roughly 1.4 billion people with hypertension worldwide, only about one in seven has their blood pressure (BP) successfully treated and adequately controlled. This review will focus on new therapeutic approaches of hypertension.! ...

    Abstract Purpose of review: Of the roughly 1.4 billion people with hypertension worldwide, only about one in seven has their blood pressure (BP) successfully treated and adequately controlled. This review will focus on new therapeutic approaches of hypertension.
    Recent findings: Several recent clinical studies and guidelines have favoured the assessment of target organ damage and cardiovascular risk scores for the diagnosis and treatment approach of hypertension. Paradigm shifts recommended in the guidelines are the initiation of antihypertensive treatment with combination (not mono) therapy and the recommendation of single-pill combinations (SPC), which improve adherence and result in rapid and effective BP control. In clinical trials with optimized design and renal denervation (RDN) technology, the biological proof of concept has been established. Consistent, durable ambulatory and office BP reductions without procedure associated serious adverse events have been documented. The challenges are now to identify patients who respond best to interventional treatment.
    Summary: Major key points in the treatment strategy for hypertension are: individualization of the therapy according to total cardiovascular risk, combination therapy as initial step, recommendation of SPC and RDN as promising interventional therapy.
    MeSH term(s) Antihypertensive Agents/therapeutic use ; Baroreflex ; Cardiovascular Diseases/etiology ; Cardiovascular Diseases/prevention & control ; Drug Combinations ; Drug Therapy, Combination ; Electric Stimulation Therapy ; Humans ; Hypertension/complications ; Hypertension/diagnosis ; Hypertension/drug therapy ; Hypertension/therapy ; Kidney/innervation ; Medication Adherence ; Prognosis ; Risk Assessment ; Sympathectomy ; Treatment Outcome
    Chemical Substances Antihypertensive Agents ; Drug Combinations
    Language English
    Publishing date 2020-11-11
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1151092-4
    ISSN 1473-6543 ; 1535-3842 ; 1062-4813 ; 1062-4821
    ISSN (online) 1473-6543 ; 1535-3842
    ISSN 1062-4813 ; 1062-4821
    DOI 10.1097/MNH.0000000000000668
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    Zs.A 3686: Show issues Location:
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  9. Article ; Online: Cost-effectiveness of catheter-based radiofrequency renal denervation for the treatment of uncontrolled hypertension: an analysis for the UK based on recent clinical evidence.

    Sharp, Andrew S P / Cao, Khoa N / Esler, Murray D / Kandzari, David E / Lobo, Melvin D / Schmieder, Roland E / Pietzsch, Jan B

    European heart journal. Quality of care & clinical outcomes

    2024  

    Abstract: Aims: Catheter-based radiofrequency renal denervation (RF RDN) has recently been approved for clinical use in the European Society of Hypertension guidelines and by the US FDA. This study evaluated the lifetime cost-effectiveness of RF RDN using ... ...

    Abstract Aims: Catheter-based radiofrequency renal denervation (RF RDN) has recently been approved for clinical use in the European Society of Hypertension guidelines and by the US FDA. This study evaluated the lifetime cost-effectiveness of RF RDN using contemporary evidence.
    Methods and results: A decision-analytic model based on multivariate risk equations projected clinical events, quality-adjusted life years (QALYs) and costs. The model consisted of seven health states: hypertension alone, myocardial infarction (MI), other symptomatic coronary artery disease, stroke, heart failure (HF), end-stage renal disease, and death. Risk reduction associated with changes in office systolic blood pressure (oSBP) was estimated based on a published meta-regression of hypertension trials. The base case effect size of -4.9 mmHg oSBP (observed vs. sham control) was taken from the SPYRAL HTN-ON MED trial of 337 patients. Costs were based on NHS England data. The incremental cost-effectiveness ratio (ICER) was evaluated against the NICE cost-effectiveness threshold of £20 000-30 000 per QALY gained. Extensive scenario and sensitivity analyses were conducted, including the ON-MED subgroup on three medications and pooled effect sizes. RF RDN resulted in a relative risk reduction in clinical events over 10 years (0.80 for stroke, 0.88 for MI, 0.72 for HF), with an increase in health benefit over a patient's lifetime, adding 0.35 QALYs at a cost of £4 763, giving an ICER of £13 482 per QALY gained. Findings were robust across tested scenarios.
    Conclusion: Catheter-based radiofrequency RDN can be a cost-effective strategy for uncontrolled hypertension in the UK, with an ICER substantially below the NICE cost-effectiveness threshold. Funding: Medtronic Inc.
    Language English
    Publishing date 2024-01-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 2823451-0
    ISSN 2058-1742 ; 2058-5225
    ISSN (online) 2058-1742
    ISSN 2058-5225
    DOI 10.1093/ehjqcco/qcae001
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  10. Article ; Online: Managing Treatment-Resistant Patients.

    Schmieder, Roland E

    High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension

    2015  Volume 22 Suppl 1, Page(s) S11–3

    Abstract: Treatment-resistant hypertension (TRH) has a prevalence of approximately 10-20 %, and up to 5 % of patients with TRH experience a major cardiovascular or cerebrovascular event each year. Effective management of real TRH is important but can present a ... ...

    Abstract Treatment-resistant hypertension (TRH) has a prevalence of approximately 10-20 %, and up to 5 % of patients with TRH experience a major cardiovascular or cerebrovascular event each year. Effective management of real TRH is important but can present a significant clinical challenge. Utilisation of treatment options that maximise treatment compliance is recommended, particularly combinations that have supporting data from clinical studies. Renal denervation can be considered for a subset of truly resistant patients.
    MeSH term(s) Antihypertensive Agents/therapeutic use ; Blood Pressure/drug effects ; Drug Resistance ; Drug Therapy, Combination ; Humans ; Hypertension/diagnosis ; Hypertension/drug therapy ; Hypertension/epidemiology ; Hypertension/physiopathology ; Kidney/innervation ; Sympathectomy ; Treatment Outcome
    Chemical Substances Antihypertensive Agents
    Language English
    Publishing date 2015-07
    Publishing country New Zealand
    Document type Journal Article ; Review
    ZDB-ID 1236337-6
    ISSN 1179-1985 ; 1120-9879
    ISSN (online) 1179-1985
    ISSN 1120-9879
    DOI 10.1007/s40292-015-0098-z
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