PhD defence L. (Lida) Feyz

The autonomic nervous system consists of different pathways of neurons to control organ systems. It is divided into the sympathetic and parasympathetic nervous system. The sympathetic nervous system (SNS) regulates several hemodynamic variables, such as blood pressure, heart rate, cardiac output and vascular resistance. A strong relationship between sympathetic overactivity and essential hypertension has been described. The renal sympathetic nerves seem to have an important role in the initiation and maintenance of the sympathetic overactivity. Effective pharmacological treatment for hypertension was introduced in the early ’60. However despite optimal medical treatment using combinations of all available agents, blood pressure control often remains poor and the risk for cardiovascular disease remains high. Percutaneous renal sympathetic denervation (RDN) has been reported to lower blood pressure

by reducing renal sympathetic nerve activity. The initial efficacy results in non randomised trials were promising and the therapy seemed safe. However, the first sham-controlled study showed no superiority of RDN in lowering blood pressure as compared to sham. This study explored some key factors that may have contributed to the puzzling results, namely a more pronounced response to a sham procedure. Data on changes in antihypertensive drugs, outcomes in selected subgroup populations and detailed procedural data were studied in order to detect potential confounders that may have impacted the efficacy endpoint. The recently conducted trials showed the importance of standardised care in blood pressure management and proved the blood pressure lowering of RDN in a strict selective study population. However, in order to understand the place of RDN in the management of hypertension and in other sympathomimetic driven cardiovascular disease, this thesis tried to outline several challenges at the patient level to clinical outcomes.

Due to corona, the PhD defences do not take place publicly in the usual way in the Senate Hall or in the Professor Andries Querido Room. The candidates will defend their dissertation either in a small group or online.