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Overview: Systemic Hypertension

The SPYRAL HTN-OFF MED study used a controlled ablation strategy to perform renal sympathetic denervation; clinically meaningful blood pressure reductions occurred in the intervention group compared to the control group.

Although not yet accepted in general clinical practice, renal sympathetic nerve ablation may emerge as an alternative or adjunctive modality in the treatment of hypertension and may become useful in managing resistant hypertension and drug intolerance.

The HYGIA trial compared the effect of nighttime dosing of at least one antihypertensive medication with morning dosing of all antihypertensive medications in 19,000 participants with median follow up 6.3 years and demonstrated improved ambulatory blood pressure and a significant decline in major cardiovascular events in the nighttime dosing group.

Participants in the HYGIA were monitored via ambulatory blood pressure measurement, and the incidence of nocturnal hypotension was very low. However, profound nocturnal hypotension might not be detected in the absence of ambulatory blood pressure monitoring, and ischemic optic neuropathy or other low perfusion complications would be a concern.

Canagliflozin generally lowers blood pressure by 3–4 mm Hg in addition to better glycemic control through inhibition of the SGLT2 glucose transporter in patients with diabetes.

This drug was associated with improved renal outcomes and reduced cardiovascular risk in the CREDENCE trial of patients with diabetic nephropathy and can be considered when additional blood pressure control is needed in patients with type 2 diabetes.

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