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Novel targets in hypertension


Devices for hypertension: renal nerve ablation Henry Krum (Melbourne) gave a presentation on the rationale and effectiveness or renal nerve denervation using the Symplicity® Catheter System. He described the technique and reviewed the data previously published (Lancet in 2009; 373: 1275–81). Total body and renal spillover noradrenaline were attenuated as was sympathetic nerve activity. He then described further studies that had been done showing the effectiveness of this technique. BP reductions were significant and maintained at 12 months (-24/-11mmhg n=63) and over 2 years (-33/-15mmHg n=17) with no evidence of procedure related renal artery stenosis. There was some early evidence of organ protection. The Symplicity HT-2 trial of 110 subjects will report later this year.

Baroreceptors, the forgotten target: carotid sinus stimulation.
Prof Abraham Kroon (Maastricht) described the rationale for carotid sinus stimulation. He presented early data in animals and then described the technique in humans. An implantable, programmable stimulator feeds claw-like electrodes wrapped around both carotid sinuses. Stimulation caused rapid reduction in blood pressure which rapidly reversed on cessation of stimulation. The device was reported to work chronically and have an acceptable complication rate. (Note: copyright for this presentation was not transferred to the ESC so the presenter’s slides were unavailable for review by the author.)

Endothelin receptor antagonists – the comeback kid.
Prof Frank Ruschitzka (Zurich) reviewed the endothelin antagonists. He presented data from the HEAT and HEAT-2 trials, the EARTH trial and the DORADO trial of the selective ETA antagonist darusentan in resistant hypertension recently published in the Lancet. He then described the outcome of the larger DORADO-AC trial, of 849 patients a comparison between darosentan and guanfacine, which unfortunately missed its primary endpoint. He reported that Gilead had decided that darosentan would no longer continue development. Prof Ruschitzka has recently authored a paper entitled “Endothelin antagonists: lost in translation” (Curr Hypertens Rep 2010;12:1–3).

Immunological approach: what can we expect?
Prof Jürg Nussberger (Lausanne) described a vaccine (CYT006-Ang Qb) against angiotensin II, the preliminary results of which had previously been published (Lancet 2008; 371: 821–27). Larger studies have now been done but the mean 24h BP effects were modest even with the 300mg dose given up to 3 times. This study reported significant if mild side effects from the injection and mild influenza symptoms. It remains to be seen whether the BP effect will be sufficient to gain a license. (Note: copyright for this presentation was not transferred to the ESC so the presenter’s slides were unavailable for review by the author).




Novel targets in hypertension
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.