1615_Al_Dhaybi.pdf

1、Saturday September 13th,2025Omar Al Dhaybi,MD,MS,FASNDirector,AHA Comprehensive HTN CenterMount Sinai Fuster HeartIcahn School of Medicine at Mount Sinai Consultant for Medtronic AstraZeneca BaxHTN advisory Board 2 RULE OUT WHITE COAT HYPERTENSION BEFORE CONSIDERATION FOR RDN 24 hours ambulatory blo

2、od pressure monitoring or home blood pressure logs x 2 weeks at least PATIENTS WITH SECONDARY HYPERTENSION SHOULD NOT BE REFERRED FOR RENAL DENERVATION:TREAT UNDERLYING DISEASE FIRST 3 CBC Renal function panel with Cystatin C(GFR=45 ml/min/1.73m2)Spot urine protein/creatinine or albumin/creatinine S

3、erum aldosterone/plasma renin activity(AM level)Plasma metanephrines TSH with reflex to T4 Renal Doppler Ultrasound 4-Adapted from Gupta P,et al.Hypertension.2017;70:1042-1048.Going from 2 to 3 medications doubled non-adherence Patients on 5 medications are nearly 50%non-adherent Majority of patient

4、s prescribed 6+medications were nonadherent Combined UK&Czech populations(N=1,348)Adherence determined by urine&blood biochemical analysis 020406080123456+%of nonadherent individuals*Number of prescribed antihypertensive medications5SBP reduction 5 10 mm Hg Other considerations Office SBP reduction

5、of 10 mm Hg or more Profound response:office SBP reduction of 16.5-20 mm Hg or more 24h mean SBP reduction 5 mm Hg Medication changes Win ratio analysis:primary criterion of at least 5 mmHg reduction in 24-h SBP secondary criterion of at least 10 mmHg reduction in office SBP decrease of antihyperten

6、sive medication potential additional parameters such as arterial mechanical properties or retinal capillary perfusion could also be considered as part of a hierarchical construct6Schmieder RE,Hettrick DA,Bohm M et al.Hypertension Research(2025)48:3273357Schmieder RE,Hettrick DA,Bohm M et al.Hyperten