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Thesis topic proposal
 
Péter Légrády
Therapeutic approaches of resistant hypertension

THESIS TOPIC PROPOSAL

Institute: University of Szeged
theoretical medicine
Graduate School of Multidisciplinar Medical Scienses

Thesis supervisor: Péter Légrády
Location of studies: 1st Depatment of Internal Medicine, Faculty of Medicine, University of Szeged, H-6720 Szeged, Korányi fasor 8-10.Hungary
Abbreviation of location of studies: ÁOK


Description of the research topic:

Hypertension is defined as therapeutically resistant (RHT) when an appropriate lifestyle
modification with a triple antihypertensive drug combination (a diuretic and two other
antihypertensive drugs belonging to different classes but not necessarily including a
mineralocorticoid receptor antagonist) at adequate doses fail to lower systolis and diastolic
blood pressure (BP) values to <140 and 90 mmHg. The increased sympathetic nerve activity
has a key role in generating and sustaining primary, true RHT.
The kidney is also involved in the autonomic regulation of BP. On the one hand it partially
generates, and on the other hand it receives impulses that force the development of, and
sustain, sympathetic overactivity. Renal nerves arise from T10-L2 spinal segments, arborize
around the renal artery and primarily lie within the adventitia. Sympathetic stimuli increase
renin release from juxtaglomerular apparatus causing renal vasoconstriction, decrease of renal
blood flow and decline in kidney function. Afferent impulses originating from the kidney
provoked by damage and/or dysfunction of kidney modify the central sympathetic outflow
and so they may play role in developing and maintaining HT.
A neurovascular pulsatile compression (NVPC) of the RVLM also can be behind arterial
HT. The posteroinferior cerebellar artery and/or the vertebral artery can compress the rootentry
zone of cranial nerves IX and X and/or the sympathicoexcitatory neurones localised in
the retro-olivary sulcus near to the root-entry zone on the left side.
In addition to combined drug therapies there are many novel technologies for nonpharmacological,
non-lifestyle based therapy for HT. They have in common the attempt to
reduce the sympathetic overactivity instrumentally invasively. The development of
endovascular catheter technology in our days permits selective RDN in the adventitia of the
renal arteries. The radiofrequency energy is a heat energy that is delivered directly to the
nerves in the adventitia and destroys them while preserving other structures of the arterial
wall. It may be that renal nerves much more sensitive to heat energy and vibration than other
tissues close to them.
In a case of NVPC a successful neurosurgical neurovascular decompression of the brain
stem on the left side can guarantee a BP reduction with less or same need for antihypertensive
medication.
Aims: To filter out RHT patients from our hypertensive population. To choose the patients
among them with true primary resistance, and find the most proper candidates from them for
any invasive antihypertensive procedure. After a procedure follow-up these patients. To create
a registry of these patients.

Required language skills: English
Recommended language skills: English
Further requirements: 
TDK munka

Number of students who can be accepted: 1

Deadline for application: 2017-03-15

 
All rights reserved © 2007, Hungarian Doctoral Council. Doctoral Council registration number at commissioner for data protection: 02003/0001. Program version: 1.2318 ( 2016. XI. 26. )