1. Thomas F. Lüscher, FESC, FAHA, FRCP
CRT 2017, Washington, DC, USA
How do I Treat Today‘s Patient with Resistant Hypertension in My Practice?
Thomas F. Lüscher, FESC, FAHA, FRCP
Professor and Chairman of Cardiology and Director, Center for Molecular Cardiology, University and University Hospital Zurich

2. Boston Scientific Research Grant Medtronic Research Grant
CRT 2017, Washington, DC, USA
Disclosure:
Boston Scientific Research Grant
Medtronic Research Grant
St. Jude Educational Grant

4. Managing Treatment-Resistant Hypertension: Basics for the Definition
Life Style Changes
Antihypertensive Drugs
Exercise
Weight Loss
Moderate Salt Diet
Potassium Supplementation
Calcium Antagonist
ACE-Inhibitor or ARB
Chlorthalidone or Torasemid

5. Managing Treatment-Resistant Hypertension:
Confirmation by 24h Ambulatory BP Measurement

7. Managing Treatment-Resistant Hypertension:
Excluding Systolic Hypertension

8. Managing Treatment-Resistant Hypertension:
Excluding Secondary Hypertension
Clinical:
BMI
Body shape
Murmur
Diet
Imaging:
Ultrasound
CR Scan
Angiography
Renal artery stenosis
Conn‘s Syndrome
Cushing syndrome
Pheochromocytoma
Aortic Isthmus stenosis
Hormone Mea- surements:
PRA
Aldosterone
Cortisol
Metanephrine

9. Anatomy Access Guiding catheter Device
Managing Treatment-Resistant Hypertension:
Evaluation for Renal Nerve Ablation
Anatomy
Access
Guiding catheter
Device

13. Anatomy of Renal Sympathetic Nerves

14. Impact of Number of Ablations on Change in Office SBP: Symplicity HTN-3 Matched Cohort Analysis
166
155
134
100 63 46 27 19 10
N=163
152
131 98 61 45 26 18 9
P value for trend= 0.01
Baseline SBP
95% CI P*
-1.7(-7.1, 3.7)
0.54
-3.1 (-8.6, 2.4)
0.27
-5.4 (-11.3, 0.5)
0.07
-7.1 (-13.9,-0.3)
0.04
-8.4 (-17.4, 0.7)
-11.5 (-21.8,-1.2)
0.03
-14.1 (-28.8, 0.7)
0.06
-12.0 (-30.0, 5.9)
0.18
-12.4 (-44.6, 19.8)
0.43
Propensity scores using baseline characteristics as covariates were used to match sham control and denervation patients
*P value change in SBP for RDN compared with sham
Data presented are mean (SD)
David E. Kandzari et al. EuroPCR 2014

15. The Zurich RNA Registry
Personal Experience:
The Zurich RNA Registry

18. Thank You! CRT 2017, Washington, DC, USA
How do I Treat Today‘s Patient with Resistant Hypertension in My Practice?
Difficult to treat hypertensives
Exclusion of secondary hypertension
Exclusion of systolic hypertension
Appropriate antihypertensive regimen
Ballon-based Ablation
Proper Follow-up
Thank You!