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Azizi M, Sharp ASP, Fisher NDL, Weber MA, Lobo MD, Daemen J, Lurz P, Mahfoud F, Schmieder RE, Basile J, Bloch MJ, Saxena M, Wang Y, Sanghvi K, Jenkins JS, Devireddy C, Rader F, Gosse P, Claude L, Augustin DA, McClure CK, Kirtane AJ. Patient-Level Pooled Analysis of Endovascular Ultrasound Renal Denervation or a Sham Procedure 6 Months After Medication Escalation: The RADIANCE Clinical Trial Program. Circulation 2024; 149:747-759. [PMID: 37883784 DOI: 10.1161/circulationaha.123.066941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The randomized, sham-controlled RADIANCE-HTN (A Study of the Recor Medical Paradise System in Clinical Hypertension) SOLO, RADIANCE-HTN TRIO, and RADIANCE II (A Study of the Recor Medical Paradise System in Stage II Hypertension) trials independently met their primary end point of a greater reduction in daytime ambulatory systolic blood pressure (SBP) 2 months after ultrasound renal denervation (uRDN) in patients with hypertension. To characterize the longer-term effectiveness and safety of uRDN versus sham at 6 months, after the blinded addition of antihypertensive treatments (AHTs), we pooled individual patient data across these 3 similarly designed trials. METHODS Patients with mild to moderate hypertension who were not on AHT or with hypertension resistant to a standardized combination triple AHT were randomized to uRDN (n=293) versus sham (n=213); they were to remain off of added AHT throughout 2 months of follow-up unless specified blood pressure (BP) criteria were exceeded. In each trial, if monthly home BP was ≥135/85 mm Hg from 2 to 5 months, standardized AHT was sequentially added to target home BP <135/85 mm Hg under blinding to initial treatment assignment. Six-month outcomes included baseline- and AHT-adjusted change in daytime ambulatory, home, and office SBP; change in AHT; and safety. Linear mixed regression models using all BP measurements and change in AHT from baseline through 6 months were used. RESULTS Patients (70% men) were 54.1±9.3 years of age with a baseline daytime ambulatory/home/office SBP of 150.5±9.8/151.0±12.4/155.5±14.4 mm Hg, respectively. From 2 to 6 months, BP decreased in both groups with AHT titration, but fewer uRDN patients were prescribed AHT (P=0.004), and fewer additional AHT were prescribed to uRDN patients versus sham patients (P=0.001). Whereas the unadjusted between-group difference in daytime ambulatory SBP was similar at 6 months, the baseline and medication-adjusted between-group difference at 6 months was -3.0 mm Hg (95% CI, -5.7, -0.2; P=0.033), in favor of uRDN+AHT. For home and office SBP, the adjusted between-group differences in favor of uRDN+AHT over 6 months were -5.4 mm Hg (-6.8, -4.0; P<0.001) and -5.2 mm Hg (-7.1, -3.3; P<0.001), respectively. There was no heterogeneity between trials. Safety outcomes were few and did not differ between groups. CONCLUSIONS This individual patient-data analysis of 506 patients included in the RADIANCE trials demonstrates the maintenance of BP-lowering efficacy of uRDN versus sham at 6 months, with fewer added AHTs. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02649426 and NCT03614260.
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Affiliation(s)
- Michel Azizi
- Université Paris Cité, France (M.A.)
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France (M.A.)
- INSERM, Paris, France (M.A.)
| | - Andrew S P Sharp
- University Hospital of Wales and Cardiff University, Cardiff, UK (A.S.P.S.)
| | | | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York (M.A.W., M.S.)
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, UK (M.D.L.)
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center Rotterdam, the Netherlands (J.D.)
| | - Philipp Lurz
- Zentrum für Kardiologie, Universitätsmedizin Mainz, Germany (P.L.)
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany (F.M.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (F.M.)
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany (R.E.S.)
| | - Jan Basile
- Division of Cardiovascular Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston (J.B.)
| | - Michael J Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno (M.J.B.)
| | - Manish Saxena
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York (M.A.W., M.S.)
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (Y.W.)
| | | | | | - Chandan Devireddy
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.D.)
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, CA (F.R.)
| | | | - Lisa Claude
- Recor Medical, Inc., Palo Alto, CA (L.C., D.A.A.)
| | | | | | - Ajay J Kirtane
- Columbia University Irving Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K.)
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Sharp ASP, Cao KN, Esler MD, Kandzari DE, Lobo MD, Schmieder RE, Pietzsch JB. Cost-effectiveness of catheter-based radiofrequency renal denervation for the treatment of uncontrolled hypertension: an analysis for the UK based on recent clinical evidence. Eur Heart J Qual Care Clin Outcomes 2024:qcae001. [PMID: 38196127 DOI: 10.1093/ehjqcco/qcae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
AIMS Catheter-based radiofrequency renal denervation (RF RDN) has recently been approved for clinical use in the European Society of Hypertension guidelines and by the US FDA. This study evaluated the lifetime cost-effectiveness of RF RDN using contemporary evidence. METHODS AND RESULTS A decision-analytic model based on multivariate risk equations projected clinical events, quality-adjusted life years (QALYs) and costs. The model consisted of seven health states: hypertension alone, myocardial infarction (MI), other symptomatic coronary artery disease, stroke, heart failure (HF), end-stage renal disease, and death. Risk reduction associated with changes in office systolic blood pressure (oSBP) was estimated based on a published meta-regression of hypertension trials. The base case effect size of -4.9 mmHg oSBP (observed vs. sham control) was taken from the SPYRAL HTN-ON MED trial of 337 patients. Costs were based on NHS England data. The incremental cost-effectiveness ratio (ICER) was evaluated against the NICE cost-effectiveness threshold of £20 000-30 000 per QALY gained. Extensive scenario and sensitivity analyses were conducted, including the ON-MED subgroup on three medications and pooled effect sizes. RF RDN resulted in a relative risk reduction in clinical events over 10 years (0.80 for stroke, 0.88 for MI, 0.72 for HF), with an increase in health benefit over a patient's lifetime, adding 0.35 QALYs at a cost of £4 763, giving an ICER of £13 482 per QALY gained. Findings were robust across tested scenarios. CONCLUSION Catheter-based radiofrequency RDN can be a cost-effective strategy for uncontrolled hypertension in the UK, with an ICER substantially below the NICE cost-effectiveness threshold. Funding: Medtronic Inc.
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Affiliation(s)
- Andrew S P Sharp
- University Hospital of Wales and Cardiff University, Cardiff, UK
| | | | - Murray D Esler
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Lobo MD, Rull G, Saxena M, Kapil V. Selecting patients for interventional procedures to treat hypertension. Blood Press 2023; 32:2248276. [PMID: 37665430 DOI: 10.1080/08037051.2023.2248276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/05/2023]
Abstract
Purpose: Interventional approaches to treat hypertension are an emerging option that may be suitable for patients whose BP control cannot be achieved with lifestyle and/or pharmacotherapy and possibly for those who do not wish to take drug therapy.Materials and Methods: Interventional strategies include renal denervation with radiofrequency, ultrasound and alcohol-mediated platforms as well as baroreflex activation therapy and cardiac neuromodulation therapy. Presently renal denervation is the most advanced of the therapeutic options and is currently being commercialised in the EU.Results: It is apparent that RDN is effective in both unmedicated patients and patients with more severe hypertension including those with resistant hypertension.Conclusion: However, at present there is no evidence for the use of RDN in patients with secondary forms of hypertension and thus evaluation to rule these out is necessary before proceeding with a procedure. Furthermore, there are numerous pitfalls in the diagnosis and management of secondary hypertension which need to be taken into consideration. Finally, prior to performing an intervention it is appropriate to document presence/absence of hypertension-mediated organ damage.
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Affiliation(s)
- Melvin D Lobo
- William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Gurvinder Rull
- William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Manish Saxena
- William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Vikas Kapil
- William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, London, UK
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Mahfoud F, Azizi M, Daemen J, Sharp ASP, Patak A, Iglesias JF, Kirtane A, Fisher NDL, Scicli A, Lobo MD. Real-world experience with ultrasound renal denervation utilizing home blood pressure monitoring: the Global Paradise System registry study design. Clin Res Cardiol 2023:10.1007/s00392-023-02325-x. [PMID: 37943324 DOI: 10.1007/s00392-023-02325-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Hypertension is a major public health issue due to its association with cardiovascular disease risk. Despite the availability of effective antihypertensive drugs, rates of blood pressure (BP) control remain suboptimal. Renal denervation (RDN) has emerged as an effective non-pharmacological, device-based treatment option for patients with hypertension. The multicenter, single-arm, observational Global Paradise™ System (GPS) registry has been designed to examine the long-term safety and effectiveness of ultrasound RDN (uRDN) with the Paradise System in a large population of patients with hypertension. METHODS The study aims to enroll up to 3000 patients undergoing uRDN in routine clinical practice. Patients will be recruited over a 4-year period and followed for 5 years (at 3, 6, and 12 months after the uRDN procedure and annually thereafter). Standardized home BP measurements will be taken every 3 months with automatic upload to the cloud. Office and ambulatory BP and adverse events will be collected as per routine clinical practice. Quality-of-Life questionnaires will be used to capture patient-reported outcomes. CONCLUSIONS This observational registry will provide real-world information on the safety and effectiveness of uRDN in a large population of patients treated during routine clinical practice, and also allow for a better understanding of responses in prespecified subgroups. The focus on home BP in this registry is expected to improve completeness of long-term follow-up and provide unique insights into BP over time. Global Paradise System registry study design. ABP, ambulatory blood pressure; BP, blood pressure; FU, follow-up; M, month; OBP, office blood pressure.
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Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany.
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Michel Azizi
- Université Paris Cité, 75006, Paris, France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, 75015, Paris, France
- INSERM, CIC1418, 75015, Paris, France
| | - Joost Daemen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff and Cardiff University, Cardiff, UK
| | - Atul Patak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco and University of Toulouse, Toulouse, France
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Ajay Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| | - Naomi D L Fisher
- Division of Endocrinology, Diabetes and Hypertension, The Brigham and Women's Hospital, Boston, MA, USA
| | | | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
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Kirtane AJ, Sharp ASP, Mahfoud F, Fisher NDL, Schmieder RE, Daemen J, Lobo MD, Lurz P, Basile J, Bloch MJ, Weber MA, Saxena M, Wang Y, Sanghvi K, Jenkins JS, Devireddy C, Rader F, Gosse P, Sapoval M, Barman NC, Claude L, Augustin D, Thackeray L, Mullin CM, Azizi M. Patient-Level Pooled Analysis of Ultrasound Renal Denervation in the Sham-Controlled RADIANCE II, RADIANCE-HTN SOLO, and RADIANCE-HTN TRIO Trials. JAMA Cardiol 2023; 8:464-473. [PMID: 36853627 PMCID: PMC9975919 DOI: 10.1001/jamacardio.2023.0338] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
Importance Ultrasound renal denervation (uRDN) was shown to lower blood pressure (BP) in patients with uncontrolled hypertension (HTN). Establishing the magnitude and consistency of the uRDN effect across the HTN spectrum is clinically important. Objective To characterize the effectiveness and safety of uRDN vs a sham procedure from individual patient-level pooled data across uRDN trials including either patients with mild to moderate HTN on a background of no medications or with HTN resistant to standardized triple-combination therapy. Data Sources A Study of the ReCor Medical Paradise System in Clinical Hypertension (RADIANCE-HTN SOLO and TRIO) and A Study of the ReCor Medical Paradise System in Stage II Hypertension (RADIANCE II) trials. Study Selection Trials with similar designs, standardized operational implementation (medication standardization and blinding of both patients and physicians to treatment assignment), and follow-up. Data Extraction and Synthesis Pooled analysis using individual patient-level data using linear regression models to compare uRDN with sham across the trials. Main Outcomes and Measures The primary outcome was baseline-adjusted change in 2-month daytime ambulatory systolic BP (dASBP) between groups. Results A total of 506 patients were randomized in the 3 studies (uRDN, 293; sham, 213; mean [SD] age, 54.1 [9.3]; 354 male [70.0%]). After a 1-month medication stabilization period, dASBP was similar between the groups (mean [SD], uRDN, 150.3 [9.2] mm Hg; sham, 150.8 [10.5] mm Hg). At 2 months, dASBP decreased by 8.5 mm Hg to mean (SD) 141.8 (13.8) mm Hg among patients treated with uRDN and by 2.9 mm Hg to 147.9 (14.6) mm Hg among patients treated with a sham procedure (mean difference, -5.9; 95% CI, -8.1 to -3.8 mm Hg; P < .001 in favor of uRDN). BP decreases from baseline with uRDN vs sham were consistent across trials and across BP parameters (office SBP: -10.4 mm Hg vs -3.4 mm Hg; mean difference, -6.4 mm Hg; 95% CI, -9.1 to -3.6 mm Hg; home SBP: -8.4 mm Hg vs -1.4 mm Hg; mean difference, -6.8 mm Hg; 95% CI, -8.7 to -4.9 mm Hg, respectively). The BP reductions with uRDN vs sham were consistent across prespecified subgroups. Independent predictors of a larger BP response to uRDN were higher baseline BP and heart rate and the presence of orthostatic hypertension. No differences in early safety end points were observed between groups. Conclusions and Relevance Results of this patient-level pooled analysis suggest that BP reductions with uRDN were consistent across HTN severity in sham-controlled trials designed with a 2-month primary end point to standardize medications across randomized groups. Trial Registration ClinicalTrials.gov Identifier: NCT02649426 and NCT03614260.
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Affiliation(s)
- Ajay J. Kirtane
- Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York
- Associate Editor, JAMA Cardiology
| | - Andrew S. P. Sharp
- University Hospital of Wales and Cardiff University, Cardiff, United Kingdom
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge
| | | | - Roland E. Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Joost Daemen
- Department of Cardiology, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jan Basile
- Division of Cardiovascular Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston
| | - Michael J. Bloch
- Vascular Care, Renown Institute of Heart and Vascular Health, Department of Medicine, University of Nevada School of Medicine, Reno
| | - Michael A. Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | | | - Chandan Devireddy
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Marc Sapoval
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France
- INSERM, CIC1418, Paris, France
| | | | | | | | | | | | - Michel Azizi
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France
- INSERM, CIC1418, Paris, France
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Azizi M, Saxena M, Wang Y, Jenkins JS, Devireddy C, Rader F, Fisher NDL, Schmieder RE, Mahfoud F, Lindsey J, Sanghvi K, Todoran TM, Pacella J, Flack J, Daemen J, Sharp ASP, Lurz P, Bloch MJ, Weber MA, Lobo MD, Basile J, Claude L, Reeve-Stoffer H, McClure CK, Kirtane AJ. Endovascular Ultrasound Renal Denervation to Treat Hypertension: The RADIANCE II Randomized Clinical Trial. JAMA 2023; 329:651-661. [PMID: 36853250 PMCID: PMC9975904 DOI: 10.1001/jama.2023.0713] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/18/2023] [Indexed: 03/01/2023]
Abstract
Importance Two initial sham-controlled trials demonstrated that ultrasound renal denervation decreases blood pressure (BP) in patients with mild to moderate hypertension and hypertension that is resistant to treatment. Objective To study the efficacy and safety of ultrasound renal denervation without the confounding influence of antihypertensive medications in patients with hypertension. Design, Setting, and Participants Sham-controlled, randomized clinical trial with patients and outcome assessors blinded to treatment assignment that was conducted between January 14, 2019, and March 25, 2022, at 37 centers in the US and 24 centers in Europe, with randomization stratified by center. Patients aged 18 years to 75 years with hypertension (seated office systolic BP [SBP] ≥140 mm Hg and diastolic BP [DBP] ≥90 mm Hg despite taking up to 2 antihypertensive medications) were eligible if they had an ambulatory SBP/DBP of 135/85 mm Hg or greater and an SBP/DBP less than 170/105 mm Hg after a 4-week washout of their medications. Patients with an estimated glomerular filtration rate of 40 mL/min/1.73 m2 or greater and with suitable renal artery anatomy were randomized 2:1 to undergo ultrasound renal denervation or a sham procedure. Patients were to abstain from antihypertensive medications until the 2-month follow-up unless prespecified BP criteria were exceeded and were associated with clinical symptoms. Interventions Ultrasound renal denervation vs a sham procedure. Main Outcomes and Measures The primary efficacy outcome was the mean change in daytime ambulatory SBP at 2 months. The primary safety composite outcome of major adverse events included death, kidney failure, and major embolic, vascular, cardiovascular, cerebrovascular, and hypertensive events at 30 days and renal artery stenosis greater than 70% detected at 6 months. The secondary outcomes included mean change in 24-hour ambulatory SBP, home SBP, office SBP, and all DBP parameters at 2 months. Results Among 1038 eligible patients, 150 were randomized to ultrasound renal denervation and 74 to a sham procedure (mean age, 55 years [SD, 9.3 years]; 28.6% female; and 16.1% self-identified as Black or African American). The reduction in daytime ambulatory SBP was greater with ultrasound renal denervation (mean, -7.9 mm Hg [SD, 11.6 mm Hg]) vs the sham procedure (mean, -1.8 mm Hg [SD, 9.5 mm Hg]) (baseline-adjusted between-group difference, -6.3 mm Hg [95% CI, -9.3 to -3.2 mm Hg], P < .001), with a consistent effect of ultrasound renal denervation throughout the 24-hour circadian cycle. Among 7 secondary BP outcomes, 6 were significantly improved with ultrasound renal denervation vs the sham procedure. No major adverse events were reported in either group. Conclusions and Relevance In patients with hypertension, ultrasound renal denervation reduced daytime ambulatory SBP at 2 months in the absence of antihypertensive medications vs a sham procedure without postprocedural major adverse events. Trial Registration ClinicalTrials.gov Identifier: NCT03614260.
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Affiliation(s)
- Michel Azizi
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France
- INSERM, CIC1418, Paris, France
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, England
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | - Chandan Devireddy
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Roland E. Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge
| | - Jason Lindsey
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | | | - Thomas M. Todoran
- Division of Cardiovascular Medicine, Medical University of South Carolina, Charleston
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - John Pacella
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John Flack
- Springfield Memorial Hospital, Southern Illinois University School of Medicine, Springfield
| | - Joost Daemen
- Erasmus MC, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Andrew S. P. Sharp
- University Hospital of Wales, Cardiff, England
- University of Exeter, Exeter, England
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Michael J. Bloch
- Vascular Care, Renown Institute of Heart and Vascular Health, Department of Medicine, University of Nevada School of Medicine, Reno
| | - Michael A. Weber
- Downstate Medical Center, Division of Cardiovascular Medicine, State University of New York, New York
| | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, England
| | - Jan Basile
- Division of Cardiovascular Medicine, Medical University of South Carolina, Charleston
| | | | | | | | - Ajay J. Kirtane
- Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
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Sharp AS, Cao KN, Lobo MD, Schmieder RE, Esler MD, Kandzari DE, Pietzsch JB. CRT-600.06 Cost-Effectiveness of Catheter-Based Radiofrequency Renal Denervation for the Treatment of Uncontrolled Hypertension: An Analysis for the UK Based on Recent Clinical Evidence. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Azizi M, Mahfoud F, Weber MA, Sharp ASP, Schmieder RE, Lurz P, Lobo MD, Fisher NDL, Daemen J, Bloch MJ, Basile J, Sanghvi K, Saxena M, Gosse P, Jenkins JS, Levy T, Persu A, Kably B, Claude L, Reeve-Stoffer H, McClure C, Kirtane AJ, Mullin C, Thackeray L, Chertow G, Kahan T, Dauerman H, Ullery S, Abbott JD, Loening A, Zagoria R, Costello J, Krathan C, Lewis L, McElvarr A, Reilly J, Cash M, Williams S, Jarvis M, Fong P, Laffer C, Gainer J, Robbins M, Crook S, Maddel S, Hsi D, Martin S, Portnay E, Ducey M, Rose S, DelMastro E, Bangalore S, Williams S, Cabos S, Rodriguez Alvarez C, Todoran T, Powers E, Hodskins E, Paladugu V, Tecklenburg A, Devireddy C, Lea J, Wells B, Fiebach A, Merlin C, Rader F, Dohad S, Kim HM, Rashid M, Abraham J, Owan T, Abraham A, Lavasani I, Neilson H, Calhoun D, McElderry T, Maddox W, Oparil S, Kinder S, Radhakrishnan J, Batres C, Edwards S, Garasic J, Drachman D, Zusman R, Rosenfield K, Do D, Khuddus M, Zentko S, O'Meara J, Barb I, Foster A, Boyette A, Wang Y, Jay D, Skeik N, Schwartz R, Peterson R, Goldman JA, Goldman J, Ledley G, Katof N, Potluri S, Biedermann S, Ward J, White M, Mauri L, Sobieszczky P, Smith A, Aseltine L, Stouffer R, Hinderliter A, Pauley E, Wade T, Zidar D, Shishehbor M, Effron B, Costa M, Semenec T, Roongsritong C, Nelson P, Neumann B, Cohen D, Giri J, Neubauer R, Vo T, Chugh AR, Huang PH, Jose P, Flack J, Fishman R, Jones M, Adams T, Bajzer C, Mathur A, Jain A, Balawon A, Zongo O, Bent C, Beckett D, Lakeman N, Kennard S, D’Souza RJ, Statton S, Wilkes L, Anning C, Sayer J, Iyer SG, Robinson N, Sevillano A, Ocampo M, Gerber R, Faris M, Marshall AJ, Sinclair J, Pepper H, Davies J, Chapman N, Burak P, Carvelli P, Jadhav S, Quinn J, Rump LC, Stegbauer J, Schimmöller L, Potthoff S, Schmid C, Roeder S, Weil J, Hafer L, Agdirlioglu T, Köllner T, Böhm M, Ewen S, Kulenthiran S, Wachter A, Koch C, Fengler K, Rommel KP, Trautmann K, Petzold M, Ott C, Schmid A, Uder M, Heinritz U, Fröhlich-Endres K, Genth-Zotz S, Kämpfner D, Grawe A, Höhne J, Kaesberger B, von zur Mühlen C, Wolf D, Welzel M, Heinrichs G, Trabitzsch B, Cremer A, Trillaud H, Papadopoulos P, Maire F, Gaudissard J, Sapoval M, Livrozet M, Lorthioir A, Amar L, Paquet V, Pathak A, Honton B, Cottin M, Petit F, Lantelme P, Berge C, Courand PY, Langevin F, Delsart P, Longere B, Ledieu G, Pontana F, Sommeville C, Bertrand F, Feyz L, Zeijen V, Ruiter A, Huysken E, Blankestijn P, Voskuil M, Rittersma Z, Dolmans H, Kroon A, van Zwam W, Vranken J, de Haan. C, Renkin J, Maes F, Beauloye C, Lengelé JP, Huyberechts D, Bouvie A, Witkowski A, Januszewicz A, Kądziela J, Prejbisj A, Hering D, Ciecwierz D, Jaguszewski MJ, Owczuk R. Effects of Renal Denervation vs Sham in Resistant Hypertension After Medication Escalation: Prespecified Analysis at 6 Months of the RADIANCE-HTN TRIO Randomized Clinical Trial. JAMA Cardiol 2022; 7:1244-1252. [PMID: 36350593 PMCID: PMC9647563 DOI: 10.1001/jamacardio.2022.3904] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Importance Although early trials of endovascular renal denervation (RDN) for patients with resistant hypertension (RHTN) reported inconsistent results, ultrasound RDN (uRDN) was found to decrease blood pressure (BP) vs sham at 2 months in patients with RHTN taking stable background medications in the Study of the ReCor Medical Paradise System in Clinical Hypertension (RADIANCE-HTN TRIO) trial. Objectives To report the prespecified analysis of the persistence of the BP effects and safety of uRDN vs sham at 6 months in conjunction with escalating antihypertensive medications. Design, Setting, and Participants This randomized, sham-controlled, clinical trial with outcome assessors and patients blinded to treatment assignment, enrolled patients from March 11, 2016, to March 13, 2020. This was an international, multicenter study conducted in the US and Europe. Participants with daytime ambulatory BP of 135/85 mm Hg or higher after 4 weeks of single-pill triple-combination treatment (angiotensin-receptor blocker, calcium channel blocker, and thiazide diuretic) with estimated glomerular filtration rate (eGFR) of 40 mL/min/1.73 m2 or greater were randomly assigned to uRDN or sham with medications unchanged through 2 months. From 2 to 5 months, if monthly home BP was 135/85 mm Hg or higher, standardized stepped-care antihypertensive treatment starting with aldosterone antagonists was initiated under blinding to treatment assignment. Interventions uRDN vs sham procedure in conjunction with added medications to target BP control. Main Outcomes and Measures Six-month change in medications, change in daytime ambulatory systolic BP, change in home systolic BP adjusted for baseline BP and medications, and safety. Results A total of 65 of 69 participants in the uRDN group and 64 of 67 participants in the sham group (mean [SD] age, 52.4 [8.3] years; 104 male [80.6%]) with a mean (SD) eGFR of 81.5 (22.8) mL/min/1.73 m2 had 6-month daytime ambulatory BP measurements. Fewer medications were added in the uRDN group (mean [SD], 0.7 [1.0] medications) vs sham (mean [SD], 1.1 [1.1] medications; P = .045) and fewer patients in the uRDN group received aldosterone antagonists at 6 months (26 of 65 [40.0%] vs 39 of 64 [60.9%]; P = .02). Despite less intensive standardized stepped-care antihypertensive treatment, mean (SD) daytime ambulatory BP at 6 months was 138.3 (15.1) mm Hg with uRDN vs 139.0 (14.3) mm Hg with sham (additional decreases of -2.4 [16.6] vs -7.0 [16.7] mm Hg from month 2, respectively), whereas home SBP was lowered to a greater extent with uRDN by 4.3 mm Hg (95% CI, 0.5-8.1 mm Hg; P = .03) in a mixed model adjusting for baseline and number of medications. Adverse events were infrequent and similar between groups. Conclusions and Relevance In this study, in patients with RHTN initially randomly assigned to uRDN or a sham procedure and who had persistent elevation of BP at 2 months after the procedure, standardized stepped-care antihypertensive treatment escalation resulted in similar BP reduction in both groups at 6 months, with fewer additional medications required in the uRDN group. Trial Registration ClinicalTrials.gov Identifier: NCT02649426.
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Affiliation(s)
- Michel Azizi
- Université Paris Cité, F-75006 Paris, France,Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, F-75015 Paris, France,INSERM, CIC1418, F-75015 Paris, France
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge
| | - Michael A. Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York
| | - Andrew S. P. Sharp
- University Hospital of Wales, Cardiff and University of Exeter, Exeter, United Kingdom
| | - Roland E. Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | - Joost Daemen
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, Rotterdam, the Netherlands
| | - Michael J. Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno
| | - Jan Basile
- Division of Cardiovascular Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston
| | | | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | | | - Terry Levy
- Royal Bournemouth Hospital, Dorset, United Kingdom
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Benjamin Kably
- Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Department of Pharmacology, Paris, France
| | | | | | | | - Ajay J. Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Danny Do
- for the RADIANCE-HTN Investigators
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jay Giri
- for the RADIANCE-HTN Investigators
| | | | - Thu Vo
- for the RADIANCE-HTN Investigators
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9
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Sola J, Perruchod D, Cortes M, Pandit J, Lobo MD, Wuerzner G, Fisher ND, Shah J. Abstract P304: Persistent Use Of Aktiia 24/7 Blood Pressure Monitor Is Associated With Lower Blood Pressure In Hypertensive Patients. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.p304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Cuffless blood pressure (BP) monitors are a promising innovation for hypertension diagnosis and monitoring. Aktiia (Aktiia 24/7 BP Monitor, Aktiia, Switzerland) is a CE-marked, commercially available BP monitor that passively and continually collects BP waveforms via optical sensors at the wrist. After initial cuff calibration, the app displays BP estimates on a smartphone. No data exist on the impact of persistently showing a person their BP data with this device.
Hypothesis:
If people with hypertension persistently use Aktiia and are exposed to their BP data, there will be a change in behavior resulting in measurably lower BP.
Methods:
We analyzed the systolic BP (SBP) trends of 838 real-world users (Age 57±11, 14% female) who consistently used Aktiia for 6 months (375±287 app interactions, 3646±1417 cuffless readings per user, and 9±7 cuff readings per user). Users were grouped by the mean monthly SBP (<140 and >140 mmHg) calculated over 6 months. Then, cuff SBP averages were calculated monthly and compared to the SBP average of the first month. A t-test analysis was used to detect the difference in SBP between the first and successive months.
Results:
Hypertensive users (SBP > 140 mmHg) saw a reduction in SBP of -3.2 mmHg (CI: -0.70, -5.59, p<0.02), beginning at 3 months and sustained through 6 months. For users with SBP < 140 mm Hg, the mean SBP remained unchanged (Fig. 1).
Conclusion:
Persistent BP monitoring with Aktiia’s cuffless device is associated with a significant, sustained reduction in SBP for hypertensive patients at 6 months. Possible explanations include the Hawthorne effect or intensified treatment.
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Affiliation(s)
| | | | | | | | - Melvin D Lobo
- Barts Blood Pressure Cntr of Excellence, London, United Kingdom
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10
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Sola J, Cortes M, Perruchoud D, De Marco B, Lobo MD, Pellaton C, Wuerzner G, Fisher NDL, Shah J. Guidance for the Interpretation of Continual Cuffless Blood Pressure Data for the Diagnosis and Management of Hypertension. Front Med Technol 2022; 4:899143. [PMID: 35655524 PMCID: PMC9152366 DOI: 10.3389/fmedt.2022.899143] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Hypertension remains the leading risk factor for death worldwide. Despite its prevalence, success of blood pressure (BP) management efforts remains elusive, and part of the difficulty lies in the tool still used to diagnose, measure, and treat hypertension: the sphygmomanometer introduced by Samuel Siegfried Karl von Basch in 1867. In recent years, there has been an explosion of devices attempting to provide estimates of BP without a cuff, overcoming many limitations of cuff-based BP monitors. Unfortunately, the differences in underlying technologies between traditional BP cuffs and newer cuffless devices, as well as hesitancy of changing a well-implemented standard, still generate understandable skepticism about and reluctance to adopt cuffless BP monitors in clinical practice. This guidance document aims to navigate the scientific and medical communities through the types of cuffless devices and present examples of robust BP data collection which are better representations of a person's true BP. It highlights the differences between data collected by cuffless and traditional cuff-based devices and provides an initial framework of interpretation of the new cuffless datasets using, as an example, a CE-marked continual cuffless BP device (Aktiia BP Monitor, Aktiia, Switzerland). Demonstration of novel BP metrics, which have the potential to change the paradigm of hypertension diagnosis and treatment, are now possible for the first time with cuffless BP monitors that provide continual readings over long periods. Widespread adoption of continual cuffless BP monitors in healthcare will require a collaborative and thoughtful process, acknowledging that the transition from a legacy to a novel medical technology will be slow. Finally, this guidance concludes with a call to action to international scientific and expert associations to include cuffless BP monitors in original scientific research and in future versions of guidelines and standards.
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Affiliation(s)
| | | | | | | | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Cyril Pellaton
- Division of Cardiology, Réseau Hospitalier Neuchâtelois (RHNe), Neuchâtel, Switzerland
| | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Naomi D. L. Fisher
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women‘s Hospital, Boston, MA, United States
| | - Jay Shah
- Aktiia SA, Neuchâtel, Switzerland
- Division of Cardiology, Mayo Clinic Arizona, Phoenix, AZ, United States
- *Correspondence: Jay Shah
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11
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Kandzari DE, Mahfoud F, Weber MA, Townsend R, Parati G, Fisher NDL, Lobo MD, Bloch M, Böhm M, Sharp ASP, Schmieder RE, Azizi M, Schlaich MP, Papademetriou V, Kirtane AJ, Daemen J, Pathak A, Ukena C, Lurz P, Grassi G, Myers M, Finn AV, Morice MC, Mehran R, Jüni P, Stone GW, Krucoff MW, Whelton PK, Tsioufis K, Cutlip DE, Spitzer E. Clinical Trial Design Principles and Outcomes Definitions for Device-Based Therapies for Hypertension: A Consensus Document From the Hypertension Academic Research Consortium. Circulation 2022; 145:847-863. [PMID: 35286164 PMCID: PMC8912966 DOI: 10.1161/circulationaha.121.057687] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The clinical implications of hypertension in addition to a high prevalence of both uncontrolled blood pressure and medication nonadherence promote interest in developing device-based approaches to hypertension treatment. The expansion of device-based therapies and ongoing clinical trials underscores the need for consistency in trial design, conduct, and definitions of clinical study elements to permit trial comparability and data poolability. Standardizing methods of blood pressure assessment, effectiveness measures beyond blood pressure alone, and safety outcomes are paramount. The Hypertension Academic Research Consortium (HARC) document represents an integration of evolving evidence and consensus opinion among leading experts in cardiovascular medicine and hypertension research with regulatory perspectives on clinical trial design and methodology. The HARC document integrates the collective information among device-based therapies for hypertension to better address existing challenges and identify unmet needs for technologies proposed to treat the world’s leading cause of death and disability. Consistent with the Academic Research Consortium charter, this document proposes pragmatic consensus clinical design principles and outcomes definitions for studies aimed at evaluating device-based hypertension therapies.
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Affiliation(s)
| | - Felix Mahfoud
- Piedmont Heart Institute, Atlanta, GA (D.E.K.).,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (F.M.)
| | - Michael A Weber
- State University of New York, Downstate Medical College, New York (M.A.W.)
| | - Raymond Townsend
- University of Pennsylvania, Perelman School of Medicine, Philadelphia (R.T.)
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.).,Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere scientifico (IRCCS), Ospedale San Luca, Milan, Italy (G.P.)
| | | | - Melvin D Lobo
- Barts National Institute for Health Research Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.D.L.)
| | - Michael Bloch
- University of Nevada/Reno School of Medicine (M. Bloch).,Renown Institute for Heart and Vascular Health, Reno, NV (M. Bloch)
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany (F.M., M. Böhm, C.U.)
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff and University of Exeter, United Kingdom (A.S.P.S.)
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University Erlangen/Nürnberg, Germany (R.E.S.)
| | - Michel Azizi
- University of Paris, Institut national de la santé et de la recherche médicale (INSERM), Centre d'investigation clinique 418, Assistance Publique-Hôpitaux de Paris Hypertension Department and Département médico-universitaire Cardiologie Rein Transplantation Neurovasculaire, Georges Pompidou European Hospital, France (M.A.)
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit and Research Foundation, University of Western Australia (M.P.S.)
| | - Vasilios Papademetriou
- Department of Veterans Affairs and Georgetown University Medical Centers, Washington, DC (V.P.)
| | - Ajay J Kirtane
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York' NY (A.J.K.).,Cardiovascular Research Foundation, New York (A.J.K., R.M., G.W.S.)
| | - Joost Daemen
- Thoraxcenter, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands (J.D., E.S.)
| | - Atul Pathak
- Department of Cardiovasculaire Medicine, European Society of Hypertension Excellence Center, Princess Grace Hospital, Monaco (A.P.).,Centre for Anthropobiology and Genomics of Toulouse, Toulouse, France (A.P.)
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany (F.M., M. Böhm, C.U.)
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Germany (P.L.)
| | - Guido Grassi
- Clinica Medica University Milano-Bicocca, Milan, Italy (G.G.)
| | - Martin Myers
- Division of Cardiology, Sunnybrook Health Sciences Centre (M.M.), University of Toronto, Canada
| | | | | | - Roxana Mehran
- Cardiovascular Research Foundation, New York (A.J.K., R.M., G.W.S.).,Mount Sinai Hospital, New York (R.M., G.W.S.)
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation (P.J.), University of Toronto, Canada
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York (A.J.K., R.M., G.W.S.)
| | | | - Paul K Whelton
- Departments of Epidemiology and Medicine, Tulane University Health Sciences Center, New Orleans, LA (P.K.W.)
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Hippocratio Hospital, Greece (K.T.)
| | - Donald E Cutlip
- Baim Institute for Clinical Research, Boston, MA (D.E.C.).,Beth Israel Deaconess Medical Center, Boston, MA (D.E.C.)
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12
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Fisher NDL, Kirtane AJ, Daemen J, Rader F, Lobo MD, Saxena M, Abraham J, Schmieder RE, Sharp ASP, Gosse P, Claude L, Song Y, Azizi M. Plasma renin and aldosterone concentrations related to endovascular ultrasound renal denervation in the RADIANCE-HTN SOLO trial. J Hypertens 2022; 40:221-228. [PMID: 34433763 DOI: 10.1097/hjh.0000000000002994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The RADIANCE-HTN SOLO trial demonstrated a greater reduction in daytime ambulatory SBP at 2 months by endovascular ultrasound renal denervation than sham procedure. We hypothesized that plasma renin and aldosterone concentrations would be associated with the SBP response to renal denervation. METHODS Hypertensive patients were randomized to renal denervation (n = 74) or sham (n = 72) after a 4-week washout of antihypertensive medications. In a 53-patient subset, 2-month and 6-month plasma renin and aldosterone concentration were measured. Dietary sodium was not controlled. RESULTS Mean age of the 29 treatment and 24 sham patients was 54 years; 62% were men; 17% black. Daytime ambulatory SBP fell in the denervation but not the sham group at 2 months (-7.8 ± 10.7 vs. -0.1 ± 10.1 mmHg; P = 0.048). Baseline plasma renin and aldosterone concentrations were in the low-normal range, did not change significantly at 2 months in either group and did not predict response to renal denervation. At 6 months, after the addition of antihypertensive medications, there was a significant rise in renin in the sham but not the denervation group. CONCLUSION Although renal denervation but not sham resulted in a decrease in daytime ambulatory SBP at 2 months, renin and aldosterone concentrations did neither predict the BP response to renal denervation; nor did they fall after denervation. A rise in renin at 6 months in the sham group likely represents confounding from antihypertensive medications. Whether the BP-lowering effect of renal denervation depends on reducing local intrarenal renin release requires further study.
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Affiliation(s)
- Naomi D L Fisher
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Joost Daemen
- Erasmus MC, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff and University of Exeter, Exeter, UK
| | | | | | - Yang Song
- Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Michel Azizi
- Université de Paris
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE
- INSERM, CIC1418, Paris, France
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13
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Mahfoud F, Weber M, Schmieder RE, Lobo MD, Blankestijn PJ, Persu A, Fischell TA, Parise H, Pathak A, Kandzari DE. Catheter-based alcohol-mediated renal denervation for the treatment of uncontrolled hypertension: design of two sham-controlled, randomized, blinded trials in the absence (TARGET BP OFF-MED) and presence (TARGET BP I) of antihypertensive medications. Am Heart J 2021; 239:90-99. [PMID: 34052211 DOI: 10.1016/j.ahj.2021.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Arterial hypertension is a common and life-threatening condition and poses a large global health burden. Device-based treatments have been developed as adjunctive or alternative therapy, to be used with or without antihypertensive medication for treating uncontrolled hypertension. The safety and feasibility of chemical renal denervation (RDN) using the Peregrine Catheter and alcohol were demonstrated in a first-in-man and open-label clinical trials, prompting the initiation of the ongoing TARGET BP OFF-MED and TARGET BP I trials. DESIGN The TARGET BP trials are randomized, blinded, sham-controlled trials designed to assess the safety and efficacy of alcohol-mediated RDN for the treatment of uncontrolled hypertension in the absence of antihypertensive medications (TARGET BP OFF-MED) or in addition to prescribed antihypertensive medications (TARGET BP I). Subjects with confirmed uncontrolled hypertension and suitable renal artery anatomy are randomized (1:1) to receive either RDN using the Peregrine Kit with alcohol (0.6 mL per renal artery) infused through the Peregrine Catheter or diagnostic renal angiography only (sham procedure). TARGET BP OFF-MED completed enrollment and randomized 96 subjects. TARGET BP I will randomize approximately 300 subjects and will transition to an open-label safety cohort of approximately 300 subjects receiving RDN once the primary efficacy endpoint of the Randomized Controlled Trial (RCT) cohort has been met. Primary endpoints are change in mean 24-hour ambulatory systolic blood pressure from baseline to 8 weeks (TARGET BP OFF-MED) and 3 months (TARGET BP I) post-procedure. CONCLUSION The TARGET BP trials are the first large-scale, international, randomized trials aimed to investigate the safety and BP lowering efficacy of a novel RDN method, with perivascular alcohol delivery using the Peregrine Kit.
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Affiliation(s)
- Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany.
| | | | - Roland E Schmieder
- Universitätsklinik Erlangen, Friedrich Alexander University Erlangen/Nürnberg, Germany
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Peter J Blankestijn
- Department of Nephrology, University Medical Center, Utrecht, The Netherlands
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | | | | | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco
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14
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Azizi M, Daemen J, Lobo MD, Mahfoud F, Sharp ASP, Schmieder RE, Wang Y, Saxena M, Lurz P, Sayer J, Bloch MJ, Basile J, Weber MA, Rump LC, Levy T, Sapoval M, Sanghvi K, Rader F, Fisher NDL, Gosse P, Abraham J, Claude L, Barman NC, McClure CK, Liu Y, Kirtane AJ. 12-Month Results From the Unblinded Phase of the RADIANCE-HTN SOLO Trial of Ultrasound Renal Denervation. JACC Cardiovasc Interv 2021; 13:2922-2933. [PMID: 33357531 DOI: 10.1016/j.jcin.2020.09.054] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study reports the 12-month results of the RADIANCE-HTN (A Study of the ReCor Medical Paradise System in Clinical Hypertension) SOLO trial following unblinding of patients at 6 months. BACKGROUND The blood pressure (BP)-lowering efficacy and safety of endovascular ultrasound renal denervation (RDN) in the absence (2 months) and presence (6 months) of antihypertensive medications were previously reported. METHODS Patients with daytime ambulatory BP ≥135/85 mm Hg after 4 weeks off medication were randomized to RDN (n = 74) or sham (n = 72) and maintained off medication for 2 months. A standardized medication escalation protocol was instituted between 2 and 5 months (blinded phase). Between 6 and 12 months (unblinded phase), patients received antihypertensive medications at physicians' discretion. Outcomes at 12 months included medication burden, change in daytime ambulatory systolic BP (dASBP) and office or home systolic BP (SBP), visit-to-visit variability in SBP, and safety. RESULTS Sixty-five of 74 RDN patients and 67 of 72 sham patients had 12-month dASBP measurements. The proportion of patients on ≥2 medications (27.7% vs. 44.8%; p = 0.041), the number of medications (0 vs. 1.4; p = 0.015), and defined daily dose (1.4 vs. 2.2; p = 0.007) were less with RDN versus sham. The decrease in dASBP from baseline in the RDN group (-16.5 ± 12.9 mm Hg) remained stable at 12 months. The RDN versus sham adjusted difference at 12 months was -2.3 mm Hg (95% confidence interval [CI]: -5.9 to 1.3 mm Hg; p = 0.201) for dASBP, -6.3 mm Hg (95% CI: -11.1 to -1.5 mm Hg; p = 0.010) for office SBP, and -3.4 mm Hg (95% CI: -6.9 to 0.1 mm Hg; p = 0.062) for home SBP. Visit-to-visit variability in SBP was smaller in the RDN group. No renal artery injury was detected on computed tomographic or magnetic resonance angiography. CONCLUSIONS Despite unblinding, the BP-lowering effect of RDN was maintained at 12 months with fewer prescribed medications compared with sham.
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Affiliation(s)
- Michel Azizi
- Université de Paris, Paris, France; AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France; INSERM, CIC1418, Paris, France.
| | - Joost Daemen
- Erasmus Medical Center, University Medical Center Rotterdam, Department of Cardiology, Rotterdam, the Netherlands
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff and University of Exeter, Exeter, United Kingdom
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jeremy Sayer
- The Essex Cardiothoracic Centre, Essex, United Kingdom
| | - Michael J Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno, Nevada, USA
| | - Jan Basile
- Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York, New York, USA
| | - Lars C Rump
- University Clinic Dusseldorf, Dusseldorf, Germany
| | - Terry Levy
- Royal Bournemouth Hospital, Dorset, United Kingdom
| | - Marc Sapoval
- Université de Paris, Paris, France; AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France; INSERM, CIC1418, Paris, France
| | - Kintur Sanghvi
- Deborah Heart & Lung Center, Brown Mills, New Jersey, USA
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | | | | | | | | | | | | | - Yuyin Liu
- The Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Ajay J Kirtane
- Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
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15
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Lovegrove E, Rull G, Shah M, Julu PO, Wolff C, Gallagher DA, Lobo MD. Dysautonomia Causing Severe Orthostatic Hypotension: An Important, Early Finding in Neurodegenerative Disorders. JACC Case Rep 2021; 3:1156-1160. [PMID: 34471903 PMCID: PMC8314124 DOI: 10.1016/j.jaccas.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
Orthostatic hypotension is common and dangerous; it has neurogenic and nonneurogenic causes. We present the case of a 40-year-old man with severe neurogenic hypotension, caused by young-onset multiple system atrophy. In patients presenting with neurogenic orthostatic hypotension, underlying neurodegenerative diseases should always be considered. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Elizabeth Lovegrove
- William Harvey Research Institute and Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Gurvinder Rull
- William Harvey Research Institute and Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Mussadiq Shah
- William Harvey Research Institute and Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Peter O Julu
- William Harvey Research Institute and Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Christopher Wolff
- William Harvey Research Institute and Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - David A Gallagher
- Department of Neurology, Barts Health National Health Service Trust, London, United Kingdom
| | - Melvin D Lobo
- William Harvey Research Institute and Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
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16
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Azizi M, Sanghvi K, Saxena M, Gosse P, Reilly JP, Levy T, Rump LC, Persu A, Basile J, Bloch MJ, Daemen J, Lobo MD, Mahfoud F, Schmieder RE, Sharp ASP, Weber MA, Sapoval M, Fong P, Pathak A, Lantelme P, Hsi D, Bangalore S, Witkowski A, Weil J, Kably B, Barman NC, Reeve-Stoffer H, Coleman L, McClure CK, Kirtane AJ. Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, sham-controlled trial. Lancet 2021; 397:2476-2486. [PMID: 34010611 DOI: 10.1016/s0140-6736(21)00788-1] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Endovascular renal denervation reduces blood pressure in patients with mild-to-moderate hypertension, but its efficacy in patients with true resistant hypertension has not been shown. We aimed to assess the efficacy and safety of endovascular ultrasound renal denervation in patients with hypertension resistant to three or more antihypertensive medications. METHODS In a randomised, international, multicentre, single-blind, sham-controlled trial done at 28 tertiary centres in the USA and 25 in Europe, we included patients aged 18-75 years with office blood pressure of at least 140/90 mm Hg despite three or more antihypertensive medications including a diuretic. Eligible patients were switched to a once daily, fixed-dose, single-pill combination of a calcium channel blocker, an angiotensin receptor blocker, and a thiazide diuretic. After 4 weeks of standardised therapy, patients with daytime ambulatory blood pressure of at least 135/85 mm Hg were randomly assigned (1:1) by computer (stratified by centres) to ultrasound renal denervation or a sham procedure. Patients and outcome assessors were masked to randomisation. Addition of antihypertensive medications was allowed if specified blood pressure thresholds were exceeded. The primary endpoint was the change in daytime ambulatory systolic blood pressure at 2 months in the intention-to-treat population. Safety was also assessed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT02649426. FINDINGS Between March 11, 2016, and March 13, 2020, 989 participants were enrolled and 136 were randomly assigned to renal denervation (n=69) or a sham procedure (n=67). Full adherence to the combination medications at 2 months among patients with urine samples was similar in both groups (42 [82%] of 51 in the renal denervation group vs 47 [82%] of 57 in the sham procedure group; p=0·99). Renal denervation reduced daytime ambulatory systolic blood pressure more than the sham procedure (-8·0 mm Hg [IQR -16·4 to 0·0] vs -3·0 mm Hg [-10·3 to 1·8]; median between-group difference -4·5 mm Hg [95% CI -8·5 to -0·3]; adjusted p=0·022); the median between-group difference was -5·8 mm Hg (95% CI -9·7 to -1·6; adjusted p=0·0051) among patients with complete ambulatory blood pressure data. There were no differences in safety outcomes between the two groups. INTERPRETATION Compared with a sham procedure, ultrasound renal denervation reduced blood pressure at 2 months in patients with hypertension resistant to a standardised triple combination pill. If the blood pressure lowering effect and safety of renal denervation are maintained in the long term, renal denervation might be an alternative to the addition of further antihypertensive medications in patients with resistant hypertension. FUNDING ReCor Medical.
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Affiliation(s)
- Michel Azizi
- Université de Paris, Paris, France; Hypertension Department and DMU CARTE, AP-HP Hôpital Européen Georges-Pompidou, Paris, France; INSERM, CIC1418, Paris, France.
| | | | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - John P Reilly
- Ochsner Heart and Vascular Institute, New Orleans, LA, USA
| | - Terry Levy
- Royal Bournemouth Hospital, Bournemouth, UK
| | - Lars C Rump
- University Clinic Dusseldorf, Dusseldorf, Germany
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Jan Basile
- Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Michael J Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno, NV, USA
| | - Joost Daemen
- Erasmus MC, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Andrew S P Sharp
- Cardiology Department, University Hospital of Wales, Cardiff, UK; NIHR Clinical Research Facility, University of Exeter, Exeter, UK
| | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | - Marc Sapoval
- Université de Paris, Paris, France; Hypertension Department and DMU CARTE, AP-HP Hôpital Européen Georges-Pompidou, Paris, France
| | - Pete Fong
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco; UMR UT3 CNRS 5288, University of Toulouse, Toulouse, France
| | | | - David Hsi
- Stamford Hospital, Stamford, CT, USA
| | | | | | | | - Benjamin Kably
- Université de Paris, Paris, France; AP-HP Hôpital Européen Georges-Pompidou, Pharmacology Unit and DMU CARTE, Paris, France
| | | | | | | | | | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
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17
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Saxena M, Schmieder RE, Kirtane AJ, Mahfoud F, Daemen J, Basile J, Lurz P, Gosse P, Sanghvi K, Fisher NDL, Rump LC, Pathak A, Blankestijn PJ, Mathur A, Wang Y, Weber MA, Sharp ASP, Bloch MJ, Barman NC, Claude L, Song Y, Azizi M, Lobo MD. Predictors of blood pressure response to ultrasound renal denervation in the RADIANCE-HTN SOLO study. J Hum Hypertens 2021; 36:629-639. [PMID: 34031548 PMCID: PMC9287166 DOI: 10.1038/s41371-021-00547-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/09/2021] [Accepted: 04/23/2021] [Indexed: 02/03/2023]
Abstract
The blood pressure (BP) lowering response to renal denervation (RDN) remains variable with about one-third of patients not responding to ultrasound or radiofrequency RDN. Identification of predictors of the BP response to RDN is needed to optimize patient selection for this therapy. This is a post-hoc analysis of the RADIANCE-HTN SOLO study. BP response to RDN was measured by the change in daytime ambulatory systolic blood pressure (dASBP) at 2 months post procedure. Univariate regression was used initially to assess potential predictors of outcome followed by multivariate regression analysis. In the univariate analysis, predictors of response to RDN were higher baseline daytime ambulatory diastolic blood pressure (dADBP), the use of antihypertensive medications at screening, and presence of orthostatic hypertension (OHTN) whilst the presence of untreated accessory arteries was a negative predictor of response. Multivariate analysis determined that dADBP and use of antihypertensive medications were predictors of response to RDN with a trend for OHTN to predict response. Obese females also appeared to be better responders to RDN in an interaction model. RDN is more effective in patients with elevated baseline dADBP and those with OHTN, suggesting increased peripheral vascular resistance secondary to heightened sympathetic tone. These assessments are easy to perform in clinical setting and may help in phenotyping patients who will respond better to RDN.
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Affiliation(s)
- Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK.
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| | - Felix Mahfoud
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany
| | - Joost Daemen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, NL, The Netherlands
| | - Jan Basile
- Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | | | - Lars C Rump
- University Clinic Dusseldorf, Dusseldorf, Germany
| | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco, Monaco
| | | | - Anthony Mathur
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff, UK.,University of Exeter, Exeter, UK
| | - Michael J Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno, NV, USA
| | | | | | - Yang Song
- Baim Institute for Clinical Research, Boston, MA, USA
| | - Michel Azizi
- Université de Paris, Paris, France.,Hypertension Department and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.,INSERM, CIC1418, Paris, France
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
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18
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Mahfoud F, Azizi M, Ewen S, Pathak A, Ukena C, Blankestijn PJ, Böhm M, Burnier M, Chatellier G, Durand Zaleski I, Grassi G, Joner M, Kandzari DE, Kirtane A, Kjeldsen SE, Lobo MD, Lüscher TF, McEvoy JW, Parati G, Rossignol P, Ruilope L, Schlaich MP, Shahzad A, Sharif F, Sharp ASP, Sievert H, Volpe M, Weber MA, Schmieder RE, Tsioufis C, Wijns W. Proceedings from the 3rd European Clinical Consensus Conference for clinical trials in device-based hypertension therapies. Eur Heart J 2021; 41:1588-1599. [PMID: 32211888 PMCID: PMC7174031 DOI: 10.1093/eurheartj/ehaa121] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/19/2019] [Accepted: 02/10/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michel Azizi
- Université de Paris, INSERM CIC1418, F-75015 Paris, France.,APHP, Hôpital Européen Georges Pompidou, Hypertension Unit, F-75015 Paris, France.,F-CRIN INI-CRCT Network, Nancy, France
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Atul Pathak
- F-CRIN INI-CRCT Network, Nancy, France.,Department of Cardivascular Medicine, INSERM 1048, Princess Grace Hospital (CHPG), Avenue Pasteur, 98000 Monaco, Monaco
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | | | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | | | - Gilles Chatellier
- Université de Paris, INSERM CIC1418, F-75015 Paris, France.,APHP, Hôpital Européen Georges Pompidou, Clinical Trial Unit, F-75015 Paris, France
| | | | - Guido Grassi
- Clinica Medica, University of Milano Bicocca, Milan, Italy
| | - Michael Joner
- Deutsches Herzzentrum München, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich, Munich, Germany
| | | | - Ajay Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| | | | - Melvin D Lobo
- William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, Zürich, Switzerland.,Royal Brompton and Harefield Hospital Trust, Imperial College London, London, UK
| | | | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca-Istituto Auxologico Italiano, IRCCS, Milano, Italy
| | - Patrick Rossignol
- F-CRIN INI-CRCT Network, Nancy, France.,Université de Lorraine, Inserm, Centre d'Investigations cliniques-plurithématique 1433, Inserm U1116, Nancy, France.,CHRU Nancy, Nancy, France
| | - Luis Ruilope
- Institute of Research i+12 and CIBER CV, Hospital 12 de Octubre and Faculty of Sport Medicine, European University, Madrid, Spain
| | - Markus P Schlaich
- Dobney Hypertension Centre, The University of Western Australia-Royal Perth Hospital Campus, Perth, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Atif Shahzad
- National University of Ireland Galway, Galway, Ireland.,Galway University Hospital, Galway, Ireland
| | - Faisal Sharif
- National University of Ireland Galway, Galway, Ireland.,Galway University Hospital, Galway, Ireland
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff, UK.,University of Exeter, Exeter, UK
| | - Horst Sievert
- CardioVascular Center Frankfurt CVC, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, UK.,University California San Francisco UCSF, San Francisco, USA.,Yunnan Hospital Fuwai, Kunming, China
| | - Massimo Volpe
- Sapienza University of Rome-Sant'Andrea Hospital Rome and IRCCS Neuromed, Pozzilli, Italy
| | | | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital, Erlangen, Germany
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - William Wijns
- The Lambe Institute for Translational Medicine, National University of Ireland Galway, Galway, Ireland
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19
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Abstract
In the past decade, efforts to improve blood pressure control have looked beyond conventional approaches of lifestyle modification and drug therapy to embrace interventional therapies. Based upon animal and human studies clearly demonstrating a key role for the sympathetic nervous system in the etiology of hypertension, the newer technologies that have emerged are predominantly aimed at neuromodulation of peripheral nervous system targets. These include renal denervation, baroreflex activation therapy, endovascular baroreflex amplification therapy, carotid body ablation, and pacemaker-mediated programmable hypertension control. Of these, renal denervation is the most mature, and with a recent series of proof-of-concept trials demonstrating the safety and efficacy of radiofrequency and more recently ultrasound-based renal denervation, this technology is poised to become available as a viable treatment option for hypertension in the foreseeable future. With regard to baroreflex activation therapy, endovascular baroreflex amplification, carotid body ablation, and programmable hypertension control, these are developing technologies for which more human data are required. Importantly, central nervous system control of the circulation remains a poorly understood yet vital component of the hypertension pathway and mandates further investigation. Technology to improve blood pressure control through deep brain stimulation of key cardiovascular control territories is, therefore, of interest. Furthermore, alternative nonsympathomodulatory intervention targeting the hemodynamics of the circulation may also be worth exploring for patients in whom sympathetic drive is less relevant to hypertension perpetuation. Herein, we review the aforementioned technologies with an emphasis on the preclinical data that underpin their rationale and the human evidence that supports their use.
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Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany (F.M.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology (MIT), Cambridge, MA (F.M.)
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, The University of Western Australia, Australia (M.S.)
- Departments of Cardiology (M.S.), Royal Perth Hospital, Australia
- Nephrology (M.S.), Royal Perth Hospital, Australia
- Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (M.S.)
| | - Melvin D Lobo
- William Harvey Research Institute and Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.D.L.)
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (M.D.L.)
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20
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Gosse P, Cremer A, Kirtane AJ, Lobo MD, Saxena M, Daemen J, Wang Y, Stegbauer J, Weber MA, Abraham J, Kario K, Bangalore S, Claude L, Liu Y, Azizi M. Ambulatory Blood Pressure Monitoring to Predict Response to Renal Denervation: A Post Hoc Analysis of the RADIANCE-HTN SOLO Study. Hypertension 2020; 77:529-536. [PMID: 33356403 DOI: 10.1161/hypertensionaha.120.16292] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal denervation (RDN) is effective in lowering blood pressure (BP) in patients with hypertension. The issue remains how to best identify potential responders. Ambulatory BP monitoring may be useful. Baseline nighttime systolic BP (SBP) ≥136 mm Hg and its variability (SD) ≥12 mm Hg in DENER-HTN trial or 24-hour heart rate ≥73.5 bpm in SPYRAL HTN-OFF MED Trial were shown to predict the BP response to RDN. We applied these criteria to the patients with hypertension in the sham-controlled RADIANCE-HTN SOLO trial to predict the BP response to ultrasound RDN at 2 months while patients were maintained off medications. BP responders were defined as: clinical with 24-hour SBP <130 mm Hg (RDN: 22/64 versus sham: 7/58); meaningful with 24-hour SBP reduction ≥10 mm Hg (RDN: 24/64, sham: 7/58); and extreme with 24-hour SBP reduction above mean+2 SD of the SBP decrease in the sham group, that is, ≥16.5 mm Hg (RDN: 10/64 versus sham: 2/58). The predictive criteria reported above were tested for sensitivity, specificity, and positive and negative predictive values. The predictive value varied according to the definition of response, with the clinical definition being strongly influenced by regression to the mean. Baseline nighttime SBP and its variability, especially when combined, offered good specificity (>90% irrespective of definition) but low sensitivity (from 9.1% to 30% depending on the definition) to predict responders; the heart rate criterion had insufficient predictive value. This analysis suggests the potential role of nighttime SBP and its variability to predict BP response to RDN in patients with hypertension. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02649426.
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Affiliation(s)
- Philippe Gosse
- From the Hôpital Saint-André-CHU, Bordeaux, France (P.G., A.C.)
| | - Antoine Cremer
- From the Hôpital Saint-André-CHU, Bordeaux, France (P.G., A.C.)
| | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation (A.J.K.)
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.D.L., M.S.)
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.D.L., M.S.)
| | - Joost Daemen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, NL, the Netherlands (J.D.)
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (Y.W.)
| | - Johannes Stegbauer
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany (J.S.)
| | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center (M.A.W.)
| | - Josephine Abraham
- Division of Nephrology and Hypertension, University of Utah, Salt lake city (J.A.)
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | | | | | - Yuyin Liu
- Baim Institute for Clinical Research, Boston, MA (Y.L.)
| | - Michel Azizi
- Université de Paris, F-75006 Paris, France (M.A.).,AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, F-75015 Paris, France (M.A.).,INSERM, CIC1418, F-75015 Paris, France (M.A.)
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21
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Bertog S, Sharma A, Mahfoud F, Pathak A, Schmieder RE, Sievert K, Papademetriou V, Weber MA, Haratani N, Lobo MD, Saxena M, Kandzari DE, Fischell TA, Sievert H. Alcohol-Mediated Renal Sympathetic Neurolysis for the Treatment of Hypertension: The Peregrine™ Infusion Catheter. Cardiovasc Revasc Med 2020; 24:77-86. [PMID: 32958438 DOI: 10.1016/j.carrev.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/15/2020] [Accepted: 09/01/2020] [Indexed: 01/12/2023]
Abstract
Renal sympathetic denervation using conventional non-irrigated radiofrequency catheters has potential technical shortcomings, including limited penetration depth and incomplete circumferential nerve damage, potentially impacting therapeutic efficacy. Against this background, second generation multi-electrode, radiofrequency and ultrasound renal denervation systems have been developed to provide more consistent circumferential nerve ablation. Irrigated catheters may allow deeper penetration while minimizing arterial injury. In this context, catheter-based chemical denervation, with selective infusion of alcohol, a potent neurolytic agent, into the perivascular space, may minimize endothelial, intimal and medial injury while providing circumferential neurolysis. Animal studies demonstrate pronounced renal norepinephrine level reductions and consistent renal nerve injury after perivascular alcohol infusion using the Peregrine Catheter. Early clinical studies demonstrated significant blood pressure reductions and a reasonable safety profile. Randomized sham-controlled trials (NCT03503773, NCT02910414) are underway to examine whether the aforementioned theoretical advantages of alcohol-medicated denervation with the Peregrine System™ Kit translate into clinical benefits.
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Affiliation(s)
- Stefan Bertog
- CardioVascular Center Frankfurt, Frankfurt, Germany; Minneapolis Veterans Affairs Medical Center, Minneapolis, USA
| | - Alok Sharma
- Minneapolis Veterans Affairs Medical Center, Minneapolis, USA
| | - Felix Mahfoud
- Saarland University Hospital, Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Homburg/Saar, Germany; Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco
| | - Roland E Schmieder
- University Hospital of the Friedrich Alexander University Erlangen-Nürnberg, Germany
| | - Kolja Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany; Johannes Gutenberg Universität, Mainz, Germany
| | | | | | | | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University, London, UK
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University, London, UK
| | | | | | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, UK.
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22
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Ray KK, Laufs U, Cosentino F, Lobo MD, Landmesser U. The year in cardiology: cardiovascular prevention. Eur Heart J 2020; 41:1157-1163. [DOI: 10.1093/eurheartj/ehz929] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/03/2019] [Accepted: 12/19/2019] [Indexed: 12/26/2022] Open
Abstract
Abstract
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Affiliation(s)
- Kausik K Ray
- Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, Imperial College London, Reynolds building, St Dunstan’s Road, London W68RP, UK
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Francesco Cosentino
- Unit of Cardiology, Department of Medicine, Karolinska Institute and Karolinska University Hospital, SE 171 76, Stockholm, Sweden
| | - Melvin D Lobo
- Department of Clinical Pharmacology, Barts NIHR Biomedical Research Centre, William Harvey Research Institute, QMUL Charterhouse Square, London EC1M 6BQ, UK
| | - Ulf Landmesser
- Department of Cardiology, Charite University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health (BIH); German Center of Cardiovascular Research (DZHK); Partner Site Berlin, Berlin, Germany
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23
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Affiliation(s)
- Carmela Maniero
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Ajay K Gupta
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, UK
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24
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Lobo MD, Sharp ASP, Kapil V, Davies J, de Belder MA, Cleveland T, Bent C, Chapman N, Dasgupta I, Levy T, Mathur A, Matson M, Saxena M, Cappuccio FP. Joint UK societies' 2019 consensus statement on renal denervation. Heart 2019; 105:1456-1463. [PMID: 31292190 PMCID: PMC6817707 DOI: 10.1136/heartjnl-2019-315098] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 02/06/2023] Open
Abstract
Improved and durable control of hypertension is a global priority for healthcare providers and policymakers. There are several lifestyle measures that are proven to result in improved blood pressure (BP) control. Moreover, there is incontrovertible evidence from large scale randomised controlled trials (RCTs) that antihypertensive drugs lower BP safely and effectively in the long-term resulting in substantial reduction in cardiovascular morbidity and mortality. Importantly, however, evidence is accumulating to suggest that patients neither sustain long-term healthy behaviours nor adhere to lifelong drug treatment regimens and thus alternative measures to control hypertension warrant further investigation. Endovascular renal denervation (RDN) appears to hold some promise as a non-pharmacological approach to lowering BP and achieves renal sympathectomy using either radiofrequency energy or ultrasound-based approaches. This treatment modality has been evaluated in clinical trials in humans since 2009 but initial studies were compromised by being non-randomised, without sham control and small in size. Subsequently, clinical trial design and rigour of execution has been greatly improved resulting in recent sham-controlled RCTs that demonstrate short-term reduction in ambulatory BP without any significant safety concerns in both medication-naïve and medication-treated hypertensive patients. Despite this, the joint UK societies still feel that further evaluation of this therapy is warranted and that RDN should not be offered to patients outside of the context of clinical trials. This document reviews the updated evidence since our last consensus statement from 2014 and provides a research agenda for future clinical studies.
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Affiliation(s)
- Melvin D Lobo
- William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK.,Department of Cardiovascular Medicine, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Andrew S P Sharp
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,Department of Cardiology, Exeter Hospital, University of Exeter, Exeter, UK
| | - Vikas Kapil
- William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK.,Department of Cardiovascular Medicine, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Justin Davies
- Department of Cardiology, Imperial College Healthcare Trust, London, UK
| | - Mark A de Belder
- Department of Cardiology, James Cook University Hospital, Middlesborough, UK.,The National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
| | - Trevor Cleveland
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHSFT, Northern General Hospital, Sheffield, UK
| | - Clare Bent
- Department of Interventional Radiology, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Neil Chapman
- Department of Cardiology, Imperial College Healthcare Trust, London, UK
| | - Indranil Dasgupta
- Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK
| | - Terry Levy
- Department of Interventional Radiology, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Anthony Mathur
- William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK.,Department of Cardiovascular Medicine, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | - Manish Saxena
- William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK.,Department of Cardiovascular Medicine, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Francesco P Cappuccio
- Warwick Medical School, University of Warwick, Coventry, UK.,University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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25
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Azizi M, Schmieder RE, Mahfoud F, Weber MA, Daemen J, Lobo MD, Sharp AS, Bloch MJ, Basile J, Wang Y, Saxena M, Lurz P, Rader F, Sayer J, Fisher ND, Fouassier D, Barman NC, Reeve-Stoffer H, McClure C, Kirtane AJ, Jay D, Skeik N, Schwartz R, Dohad S, Victor R, Sanghvi K, Costello J, Walsh C, Abraham J, Owan T, Abraham A, Mauri L, Sobieszczky P, Williams J, Roongsritong C, Todoran T, Powers E, Hodskins E, Fong P, Laffer C, Gainer J, Robbins M, Reilly J, Cash M, Goldman J, Aggarwal S, Ledley G, His D, Martin S, Portnay E, Calhoun D, McElderry T, Maddox W, Oparil S, Huang PH, Jose P, Khuddus M, Zentko S, O’Meara J, Barb I, Garasic J, Drachman D, Zusman R, Rosenfield K, Devireddy C, Lea J, Wells B, Stouffer R, Hinderliter A, Pauley E, Potluri S, Biedermann S, Bangalore S, Williams S, Zidar D, Shishehbor M, Effron B, Costa M, Radhakrishnan J, Mathur A, Jain A, Iyer SG, Robinson N, Edroos SA, Levy T, Patel A, Beckett D, Bent C, Davies J, Chapman N, Shin MS, Howard J, Joseph A, D’Souza R, Gerber R, Faris M, Marshall AJ, Elorz C, Höllriegel R, Fengler K, Rommel KP, Böhm M, Ewen S, Lucic J, Ott C, Schmid A, Uder M, Rump C, Stegbauer J, Kröpil P, Sapoval M, Cornu E, Lorthioir A, Gosse P, Cremer A, Trillaud H, Papadopoulos P, Pathak A, Honton B, Lantelme P, Berge C, Courand PY, Feyz L, Blankestijn P, Voskuil M, Rittersma Z, Kroon A, van Zwam W, Persu A, Renkin J. Six-Month Results of Treatment-Blinded Medication Titration for Hypertension Control After Randomization to Endovascular Ultrasound Renal Denervation or a Sham Procedure in the RADIANCE-HTN SOLO Trial. Circulation 2019; 139:2542-2553. [PMID: 30880441 DOI: 10.1161/circulationaha.119.040451] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The multicenter, international, randomized, blinded, sham-controlled RADIANCE-HTN SOLO trial (A Study of the ReCor Medical Paradise System in Clinical Hypertension) demonstrated a 6.3 mm Hg greater reduction in daytime ambulatory systolic blood pressure (BP) at 2 months by endovascular ultrasound renal denervation (RDN) compared with a sham procedure among patients not treated with antihypertensive medications. We report 6-month results after the addition of a recommended standardized stepped-care antihypertensive treatment to the randomized endovascular procedure under continued blinding to initial treatment. METHODS Patients with a daytime ambulatory BP ≥135/85 mm Hg and <170/105 mm Hg after a 4-week discontinuation of up to 2 antihypertensive medications, and a suitable renal artery anatomy, were randomized to RDN (n=74) or sham (n=72). Patients were to remain off antihypertensive medications throughout the first 2 months of follow-up unless safety BP criteria were exceeded. Between 2 and 5 months, if monthly measured home BP was ≥135/85 mm Hg, a standardized stepped-care antihypertensive treatment was recommended consisting of the sequential addition of amlodipine (5 mg/d), a standard dose of an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and hydrochlorothiazide (12.5 mg/d), followed by the sequential uptitration of hydrochlorothiazide (25 mg/d) and amlodipine (10 mg/d). Outcomes included the 6-month (1) change in daytime ambulatory systolic BP adjusted for medications and baseline systolic BP, (2) medication burden, and (3) safety. RESULTS A total of 69/74 RDN patients and 71/72 sham patients completed the 6-month ambulatory BP measurement. At 6 months, 65.2% of patients in the RDN group were treated with the standardized stepped-care antihypertensive treatment versus 84.5% in the sham group (P=0.008), and the average number of antihypertensive medications and defined daily dose were less in the RDN group than in the sham group (0.9±0.9 versus 1.3±0.9, P=0.010 and 1.4±1.5 versus 2.0±1.8, P=0.018; respectively). Despite less intensive standardized stepped-care antihypertensive treatment, RDN reduced daytime ambulatory systolic BP to a greater extent than sham (-18.1±12.2 versus -15.6±13.2 mm Hg, respectively; difference adjusted for baseline BP and number of medications: -4.3 mm Hg, 95% confidence interval, -7.9 to -0.6, P=0.024). There were no major adverse events in either group through 6 months. CONCLUSIONS The BP-lowering effect of endovascular ultrasound RDN was maintained at 6 months with less prescribed antihypertensive medications compared with a sham control. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT02649426.
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Affiliation(s)
- Michel Azizi
- Université Paris-Descartes, France (M.A., D.F.)
- AP-HP, Department of Hypertension, Hôpital Européen Georges-Pompidou, Paris, France (M.A., D.F.)
- INSERM, CIC1418, Paris, France (M.A., D.F.)
| | - Roland E. Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Germany (R.E.S.)
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany (F.M.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (F.M.)
| | - Michael A. Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York (M.A.W.)
| | - Joost Daemen
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, Rotterdam, The Netherlands (J.D.)
| | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.D.L., M.S.)
| | - Andrew S.P. Sharp
- Royal Devon and Exeter NHS Foundation Trust, United Kingdom (A.S.P.S.)
| | - Michael J. Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno, NV (M.J.B.)
| | - Jan Basile
- Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H Johnson VA Medical Center, Charleston (J.B.)
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis (Y.W.)
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.D.L., M.S.)
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Germany (P.L.)
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, CA (F.R.)
| | - Jeremy Sayer
- The Essex Cardiothoracic Centre, United Kingdom (J.S.)
| | | | - David Fouassier
- Université Paris-Descartes, France (M.A., D.F.)
- AP-HP, Department of Hypertension, Hôpital Européen Georges-Pompidou, Paris, France (M.A., D.F.)
- INSERM, CIC1418, Paris, France (M.A., D.F.)
| | | | | | | | - Ajay J. Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (A.J.K.)
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Schuster Bruce C, Rull G, Sotiris A, Lobo MD. Novel stratified medicines approach to manage uncontrolled hypertension due to multiple drug intolerances. BMJ Case Rep 2018; 11:11/1/e226045. [PMID: 30567232 DOI: 10.1136/bcr-2018-226045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 61-year-old man with a 30-year history of uncontrolled hypertension was unable to tolerate conventional antihypertensive medications from all classes. At the time of referral to our centre he had discontinued all antihypertensive drugs and felt well. However, his average home blood pressure (HBP) reading was 179/125 mm Hg and echocardiography demonstrated moderate concentric left ventricular hypertrophy. A novel stratified medicines algorithm was used to guide treatment entailing transdermal clonidine patch therapy instead of tablet formulations. Sixteen months later, his average HBP was 147/106 mm Hg with no side effects and the left ventricular hypertrophy had completely regressed. Our experience has taught us that multiple drug intolerance is a common, often overlooked, cause of non-adherence to antihypertensive medication. This case demonstrates the benefit of a novel approach to optimise blood pressure control and emphasises the important role of hypertension specialists in managing complex, high-risk patients unable to tolerate guideline-based therapy.
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Affiliation(s)
- Catherine Schuster Bruce
- Barts BP Centre of Excellence, William Harvey Research Institute, London, UK.,NIHR Barts Cardiovascular Biomedical Research Centre, London, UK
| | - Gurvinder Rull
- Barts BP Centre of Excellence, William Harvey Research Institute, London, UK.,NIHR Barts Cardiovascular Biomedical Research Centre, London, UK
| | - Antoniou Sotiris
- Barts BP Centre of Excellence, William Harvey Research Institute, London, UK.,NIHR Barts Cardiovascular Biomedical Research Centre, London, UK
| | - Melvin D Lobo
- Barts BP Centre of Excellence, William Harvey Research Institute, London, UK.,NIHR Barts Cardiovascular Biomedical Research Centre, London, UK
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Sharp ASP, Saxena M, Lobo MD. Renal artery sympathetic denervation: Back on track! Eur Heart J 2018; 39:4056-4057. [PMID: 30535018 DOI: 10.1093/eurheartj/ehy718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrew S P Sharp
- Department of Cardiology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Manish Saxena
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Melvin D Lobo
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, NHS Professor in Cardiovascular Medicine, Barts NIHR Biomedical Research Centre, William Harvey Research Institute, QMUL, Charterhouse Square, London EC1M 6BQ, UK, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, UK, Tel: 020 7882 3402; Fax: 020 7882 3408
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Saxena M, Shour T, Shah M, Wolff CB, Julu POO, Kapil V, Collier DJ, Ng FL, Gupta A, Balawon A, Pheby J, Zak A, Rull G, O'Brien B, Schmieder RE, Lobo MD. Attenuation of Splanchnic Autotransfusion Following Noninvasive Ultrasound Renal Denervation: A Novel Marker of Procedural Success. J Am Heart Assoc 2018; 7:JAHA.118.009151. [PMID: 29895590 PMCID: PMC6220552 DOI: 10.1161/jaha.118.009151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Renal denervation has no validated marker of procedural success. We hypothesized that successful renal denervation would reduce renal sympathetic nerve signaling demonstrated by attenuation of α-1-adrenoceptor-mediated autotransfusion during the Valsalva maneuver. METHODS AND RESULTS In this substudy of the Wave IV Study: Phase II Randomized Sham Controlled Study of Renal Denervation for Subjects With Uncontrolled Hypertension, we enrolled 23 subjects with resistant hypertension. They were randomized either to bilateral renal denervation using therapeutic levels of ultrasound energy (n=12) or sham application of diagnostic ultrasound (n=11). Within-group changes in autonomic parameters, office and ambulatory blood pressure were compared between baseline and 6 months in a double-blind manner. There was significant office blood pressure reduction in both treatment (16.1±27.3 mm Hg, P<0.05) and sham groups (27.9±15.0 mm Hg, P<0.01) because of which the study was discontinued prematurely. However, during the late phase II (Iii) of Valsalva maneuver, renal denervation resulted in substantial and significant reduction in mean arterial pressure (21.8±25.2 mm Hg, P<0.05) with no significant changes in the sham group. Moreover, there were significant reductions in heart rate in the actively treated group at rest (6.0±11.5 beats per minute, P<0.05) and during postural changes (supine 7.2±8.4 beats per minute, P<0.05, sit up 12.7±16.7 beats per minute, P<0.05), which were not observed in the sham group. CONCLUSIONS Blood pressure reduction per se is not necessarily a marker of successful renal nerve ablation. Reduction in splanchnic autotransfusion following renal denervation has not been previously demonstrated and denotes attenuation of (renal) sympathetic efferent activity and could serve as a marker of procedural success. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02029885.
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Affiliation(s)
- Manish Saxena
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom .,William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University London, London, United Kingdom
| | - Tariq Shour
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University London, London, United Kingdom
| | - Mussadiq Shah
- William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University London, London, United Kingdom
| | - Christopher B Wolff
- William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University London, London, United Kingdom
| | - Peter O O Julu
- William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University London, London, United Kingdom
| | - Vikas Kapil
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University London, London, United Kingdom
| | - David J Collier
- William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University London, London, United Kingdom
| | - Fu Liang Ng
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University London, London, United Kingdom
| | - Ajay Gupta
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University London, London, United Kingdom
| | - Armida Balawon
- William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University London, London, United Kingdom
| | - Jane Pheby
- William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University London, London, United Kingdom
| | - Anne Zak
- William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University London, London, United Kingdom
| | - Gurvinder Rull
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Benjamin O'Brien
- William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University London, London, United Kingdom
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital, University of Erlangen/Nuremberg, Erlangen, Germany
| | - Melvin D Lobo
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University London, London, United Kingdom
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Azizi M, Schmieder RE, Mahfoud F, Weber MA, Daemen J, Davies J, Basile J, Kirtane AJ, Wang Y, Lobo MD, Saxena M, Feyz L, Rader F, Lurz P, Sayer J, Sapoval M, Levy T, Sanghvi K, Abraham J, Sharp ASP, Fisher NDL, Bloch MJ, Reeve-Stoffer H, Coleman L, Mullin C, Mauri L. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial. Lancet 2018; 391:2335-2345. [PMID: 29803590 DOI: 10.1016/s0140-6736(18)31082-1] [Citation(s) in RCA: 433] [Impact Index Per Article: 72.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Early studies suggest that radiofrequency-based renal denervation reduces blood pressure in patients with moderate hypertension. We investigated whether an alternative technology using endovascular ultrasound renal denervation reduces ambulatory blood pressure in patients with hypertension in the absence of antihypertensive medications. METHODS RADIANCE-HTN SOLO was a multicentre, international, single-blind, randomised, sham-controlled trial done at 21 centres in the USA and 18 in Europe. Patients with combined systolic-diastolic hypertension aged 18-75 years were eligible if they had ambulatory blood pressure greater than or equal to 135/85 mm Hg and less than 170/105 mm Hg after a 4-week discontinuation of up to two antihypertensive medications and had suitable renal artery anatomy. Patients were randomised (1:1) to undergo renal denervation with the Paradise system (ReCor Medical, Palo Alto, CA, USA) or a sham procedure consisting of renal angiography only. The randomisation sequence was computer generated and stratified by centres with randomised blocks of four or six and permutation of treatments within each block. Patients and outcome assessors were blinded to randomisation. The primary effectiveness endpoint was the change in daytime ambulatory systolic blood pressure at 2 months in the intention-to-treat population. Patients were to remain off antihypertensive medications throughout the 2 months of follow-up unless specified blood pressure criteria were exceeded. Major adverse events included all-cause mortality, renal failure, an embolic event with end-organ damage, renal artery or other major vascular complications requiring intervention, or admission to hospital for hypertensive crisis within 30 days and new renal artery stenosis within 6 months. This study is registered with ClinicalTrials.gov, number NCT02649426. FINDINGS Between March 28, 2016, and Dec 28, 2017, 803 patients were screened for eligibility and 146 were randomised to undergo renal denervation (n=74) or a sham procedure (n=72). The reduction in daytime ambulatory systolic blood pressure was greater with renal denervation (-8·5 mm Hg, SD 9·3) than with the sham procedure (-2·2 mm Hg, SD 10·0; baseline-adjusted difference between groups: -6·3 mm Hg, 95% CI -9·4 to -3·1, p=0·0001). No major adverse events were reported in either group. INTERPRETATION Compared with a sham procedure, endovascular ultrasound renal denervation reduced ambulatory blood pressure at 2 months in patients with combined systolic-diastolic hypertension in the absence of medications. FUNDING ReCor Medical.
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Affiliation(s)
- Michel Azizi
- Université Paris-Descartes, Paris, France; Hypertension Department and DHU PARC, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France; INSERM CIC1418, Paris, France
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg, Germany; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | - Joost Daemen
- Erasmus MC Thoraxcenter, Rotterdam, NL, Netherlands
| | - Justin Davies
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jan Basile
- Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Ajay J Kirtane
- Columbia University Medical Center-New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Lida Feyz
- Erasmus MC Thoraxcenter, Rotterdam, NL, Netherlands
| | | | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Leipzig, Germany
| | | | - Marc Sapoval
- Université Paris-Descartes, Paris, France; Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France; INSERM U 970, Paris, France
| | - Terry Levy
- Royal Bournemouth Hospital, Bournemouth, UK
| | | | | | | | | | - Michael J Bloch
- Department of Medicine, University of Nevada School of Medicine, Reno, NV, USA; Vascular Care, Renown Institute of Heart and Vascular Health, Reno, NV, USA
| | | | | | | | - Laura Mauri
- The Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Mahfoud F, Schmieder RE, Azizi M, Pathak A, Sievert H, Tsioufis C, Zeller T, Bertog S, Blankestijn PJ, Böhm M, Burnier M, Chatellier G, Durand Zaleski I, Ewen S, Grassi G, Joner M, Kjeldsen SE, Lobo MD, Lotan C, Lüscher TF, Parati G, Rossignol P, Ruilope L, Sharif F, van Leeuwen E, Volpe M, Windecker S, Witkowski A, Wijns W. Proceedings from the 2nd European Clinical Consensus Conference for device-based therapies for hypertension: state of the art and considerations for the future. Eur Heart J 2017; 38:3272-3281. [PMID: 28475773 PMCID: PMC5837218 DOI: 10.1093/eurheartj/ehx215] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/13/2017] [Accepted: 04/06/2017] [Indexed: 01/31/2023] Open
Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Angiologie und Internistische Intensivmedizin, 66421 Homburg, Saar, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Michel Azizi
- Paris-Descartes University, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France
- INSERM, CIC1418, and FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), F-75015 Paris, France
| | - Atul Pathak
- Department of Cardiovascular Medicine, Hypertension, Risk Factors and Heart Failure Unit, Clinique Pasteur, Avenue de Lombez, Toulouse, France
- INSERM 1048, and FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Toulouse, France
| | - Horst Sievert
- CardioVascular Center (CVC), Seckbacher Landstraße, Frankfurt, Germany
- Anglia Ruskin University, Chelmsford, UK
| | - Costas Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | - Thomas Zeller
- Klinik Kardiologie und Angiologie II, Universitaets-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Stefan Bertog
- CardioVascular Center (CVC), Seckbacher Landstraße, Frankfurt, Germany
| | - Peter J Blankestijn
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael Böhm
- Klinik für Innere Medizin III, Saarland University Hospital, Angiologie und Internistische Intensivmedizin, 66421 Homburg, Saar, Germany
| | - Michel Burnier
- Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland
| | | | - Isabelle Durand Zaleski
- ECEVE, UMR 1123, AP HP URCEco Ile de France Hopital de l’Hotel Dieu, Paris, France
- Sante Publique Hopital Henri Mondor, Creteil, France
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Saarland University Hospital, Angiologie und Internistische Intensivmedizin, 66421 Homburg, Saar, Germany
| | - Guido Grassi
- Clinica Medica, Università Milano-Bicocca, Italy
- IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
| | - Michael Joner
- Deutsches Herzzentrum München, Klinik für Kardiologie, Germany
- Deutsches Zentrum für Herz-Kreislaufforschung e.V., Standort München, Germany
| | - Sverre E Kjeldsen
- ECEVE, UMR 1123, AP HP URCEco Ile de France Hopital de l’Hotel Dieu, Paris, France
- University of Oslo, Institute for Clinical Medicine, Oslo, Norway
| | - Melvin D Lobo
- William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Chaim Lotan
- Clinica Medica, Università Milano-Bicocca, Italy
| | | | | | - Patrick Rossignol
- INSERM, Centre d’Investigations Cliniques Plurithématique 1433 & U1116, Université de Lorraine, CHRU de Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Luis Ruilope
- Institute of Investigation imas12 and Hypertension Unit, Hospital 12 de Octubre; Department of Preventive Medicine and Public Health, Universidad Autonoma and Department of Postdoctoral Studies and Investigation, Universidad Europea de Madrid, Madrid, Spain
| | - Faisal Sharif
- CURAM, Cardiovascular Research Centre (CVRC) and BioInnovate Ireland, National University of Ireland Galway, Ireland
| | - Evert van Leeuwen
- Department IQ healthcare, section Ethics, Radboudumc, Nijmegen, The Netherlands
| | - Massimo Volpe
- Cardiology, Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome and IRCCS Neuromed, Pozzilli, Italy
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Adam Witkowski
- Department of Interventional Cardiology & Angiology, Institute of Cardiology, Warsaw, Poland
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland
- Saolta University Healthcare Group, Galway, Ireland
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31
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Lobo MD, Ott C, Sobotka PA, Saxena M, Stanton A, Cockcroft JR, Sulke N, Dolan E, van der Giet M, Hoyer J, Furniss SS, Foran JP, Witkowski A, Januszewicz A, Schoors D, Tsioufis K, Rensing BJ, Scott B, Ng GA, Schmieder RE. Central Iliac Arteriovenous Anastomosis for Uncontrolled Hypertension: One-Year Results From the ROX CONTROL HTN Trial. Hypertension 2017; 70:1099-1105. [PMID: 29061728 DOI: 10.1161/hypertensionaha.117.10142] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/19/2017] [Accepted: 09/12/2017] [Indexed: 01/12/2023]
Abstract
Creation of a central iliac arteriovenous anastomosis using a novel nitinol coupler device results in an immediate, significant reduction of blood pressure (BP). We present efficacy and safety findings at 12 months post-coupler insertion. This open-label, multicenter, prospective, randomized trial enrolled patients with a baseline office systolic BP ≥140 mm Hg and average daytime ambulatory BP ≥135/85 mm Hg. Subjects were randomly allocated to coupler implantation and continuing previous pharmacotherapy or to maintain previous treatment alone. At 12 months, 39 patients who had coupler therapy were included in the intention-to-treat analysis. Office-based systolic BP reduced by 25.1±23.3 mm Hg (baseline, 174±18 mm Hg; P<0.0001) post-coupler placement, and office diastolic BP reduced by 20.8±13.3 mm Hg (baseline, 100±13 mm Hg; P<0.0001). Mean 24-hour ambulatory BP reduced by 12.6±17.4/15.3±9.7 mm Hg (P<0.0001 for both). In a prespecified subset of patients who failed to respond adequately to prior renal denervation, coupler therapy led to highly significant reduction in office systolic/diastolic BP (30.7/24.1 mm Hg) and significant reduction in 24-hour ambulatory systolic/diastolic BP (12.4/14.4 mm Hg) at 12 months (n=9). After coupler therapy, 14 patients (33%) developed ipsilateral venous stenosis; all were treated successfully with venous stenting. These findings confirm the importance of arterial mechanics in the pathophysiology of hypertension and support the clinical use of a central iliac arteriovenous anastomosis. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01642498.
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Affiliation(s)
- Melvin D Lobo
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.).
| | - Christian Ott
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Paul A Sobotka
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Manish Saxena
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Alice Stanton
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - John R Cockcroft
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Neil Sulke
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Eamon Dolan
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Markus van der Giet
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Joachim Hoyer
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Stephen S Furniss
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - John P Foran
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Adam Witkowski
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Andrzej Januszewicz
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Danny Schoors
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Konstantinos Tsioufis
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Benno J Rensing
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Benjamin Scott
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - G André Ng
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
| | - Roland E Schmieder
- From the NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, London, United Kingdom (M.D.L., M.S.); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O.); Cardiovascular Medicine, Ohio State University, Columbus (P.A.S.); ROX Medical, Inc, San Clemente, CA (P.A.S.); Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin (A.S.); Department of Cardiology, Columbia Presbyterian Hospital, New York, NY (J.R.C.); Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom (N.S.); Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland (E.D.); Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Germany (M.v.d.G.); Department of Internal Medicine and Nephrology, Universitätsklinikum Marburg, Germany (J.H.); Department of Cardiology, East Sussex Healthcare NHS Trust, United Kingdom (S.S.F.); Cardiac Department, Royal Brompton Hospital, London, United Kingdom (J.P.F.); Cardiology Department, St Helier Hospital, Surrey, United Kingdom (J.P.F.); Department of Interventional Cardiology and Angiology (A.W.) and Department of Hypertension (A.J.), Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Universitair Ziekenhuis Brussel, Belgium (D.S.); Department of Cardiology, Hippokration General Hospital of Athens, Greece (K.T.); Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands (B.J.R.); Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium (B.S.); Department of Cardiovascular Sciences, NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Glenfield Hospital, United Kingdom (G.A.N.); and Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany (R.E.S.)
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Abstract
Hypertension continues to be a major contributor to global morbidity and mortality, fuelled by an abundance of patients with uncontrolled blood pressure despite the multitude of pharmacological options available. This may occur as a consequence of true resistant hypertension, through an inability to tolerate current pharmacological therapies, or non-adherence to antihypertensive medication. In recent years, there has been a rapid expansion of device-based therapies proposed as novel non-pharmacological approaches to treating resistant hypertension. In this review, we discuss seven novel devices—renal nerve denervation, baroreflex activation therapy, carotid body ablation, central iliac arteriovenous anastomosis, deep brain stimulation, median nerve stimulation, and vagal nerve stimulation. We highlight how the devices differ, the varying degrees of evidence available to date and upcoming trials. This review also considers the possible factors that may enable appropriate device selection for different hypertension phenotypes.
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Affiliation(s)
- Fu L Ng
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London, EC1A 7BE, UK.,Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, William Harvey Research Institute, Queen Mary University London, London, EC1M 6BQ, UK
| | - Manish Saxena
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London, EC1A 7BE, UK.,Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, William Harvey Research Institute, Queen Mary University London, London, EC1M 6BQ, UK
| | - Felix Mahfoud
- Department of Internal Medicine, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Atul Pathak
- Department of Cardiovascular Medicine, Hypertension and Heart Failure Unit, Health Innovation Lab (Hi-Lab) Clinique Pasteur, Toulouse, France
| | - Melvin D Lobo
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London, EC1A 7BE, UK. .,Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, William Harvey Research Institute, Queen Mary University London, London, EC1M 6BQ, UK.
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Abstract
Hypertension management poses a major challenge to clinicians globally once non-drug (lifestyle) measures have failed to control blood pressure (BP). Although drug treatment strategies to lower BP are well described, poor control rates of hypertension, even in the first world, suggest that more needs to be done to surmount the problem. A major issue is non-adherence to antihypertensive drugs, which is caused in part by drug intolerance due to side effects. More effective antihypertensive drugs are therefore required which have excellent tolerability and safety profiles in addition to being efficacious. For those patients who either do not tolerate or wish to take medication for hypertension or in whom BP control is not attained despite multiple antihypertensives, a novel class of interventional procedures to manage hypertension has emerged. While most of these target various aspects of the sympathetic nervous system regulation of BP, an additional procedure is now available, which addresses mechanical aspects of the circulation. Most of these new devices are supported by early and encouraging evidence for both safety and efficacy, although it is clear that more rigorous randomized controlled trial data will be essential before any of the technologies can be adopted as a standard of care.
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Affiliation(s)
- Melvin D. Lobo
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Paul A. Sobotka
- The Ohio State University, Columbus, OH, USA
- ROX Medical, San Clemente, CA, USA
| | - Atul Pathak
- Department of Cardiovascular Medicine, Hypertension and Heart Failure Unit, Health Innovation Lab (Hi-Lab) Clinique Pasteur, Toulouse, France
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Ott C, Lobo MD, Sobotka PA, Mahfoud F, Stanton A, Cockcroft J, Sulke N, Dolan E, van der Giet M, Hoyer J, Furniss SS, Foran JP, Witkowski A, Januszewicz A, Schoors D, Tsioufis K, Rensing BJ, Saxena M, Scott B, Ng GA, Achenbach S, Schmieder RE. Effect of Arteriovenous Anastomosis on Blood Pressure Reduction in Patients With Isolated Systolic Hypertension Compared With Combined Hypertension. J Am Heart Assoc 2016; 5:JAHA.116.004234. [PMID: 28003251 PMCID: PMC5210451 DOI: 10.1161/jaha.116.004234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Options for interventional therapy to lower blood pressure (BP) in patients with treatment‐resistant hypertension include renal denervation and the creation of an arteriovenous anastomosis using the ROX coupler. It has been shown that BP response after renal denervation is greater in patients with combined hypertension (CH) than in patients with isolated systolic hypertension (ISH). We analyzed the effect of ROX coupler implantation in patients with CH as compared with ISH. Methods and Results The randomized, controlled, prospective ROX Control Hypertension Study included patients with true treatment‐resistant hypertension (office systolic BP ≥140 mm Hg, average daytime ambulatory BP ≥135/85 mm Hg, and treatment with ≥3 antihypertensive drugs including a diuretic). In a post hoc analysis, we stratified patients with CH (n=31) and ISH (n=11). Baseline office systolic BP (177±18 mm Hg versus 169±17 mm Hg, P=0.163) and 24‐hour ambulatory systolic BP (159±16 mm Hg versus 154±11 mm Hg, P=0.463) did not differ between patients with CH and those with ISH. ROX coupler implementation resulted in a significant reduction in office systolic BP (CH: −29±21 mm Hg versus ISH: −22±31 mm Hg, P=0.445) and 24‐hour ambulatory systolic BP (CH: −14±20 mm Hg versus ISH: −13±15 mm Hg, P=0.672), without significant differences between the two groups. The responder rate (office systolic BP reduction ≥10 mm Hg) after 6 months was not different (CH: 81% versus ISH: 82%, P=0.932). Conclusions Our data suggest that creation of an arteriovenous anastomosis using the ROX coupler system leads to a similar reduction of office and 24‐hour ambulatory systolic BP in patients with combined and isolated systolic hypertension. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01642498.
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Affiliation(s)
- Christian Ott
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Melvin D Lobo
- William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom
| | | | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Alice Stanton
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
| | - John Cockcroft
- Cardiolgy Department, Wales Heart Research Institute, Cardiff, United Kingdom
| | - Neil Sulke
- Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom
| | - Eamon Dolan
- Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland
| | - Markus van der Giet
- Department of Endocrinology and Nephrology, Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Hoyer
- Department of Internal Medicine and Nephrology, Universitätsklinikum Gießen und Marburg GmbH, Marburg, Germany
| | - Stephen S Furniss
- Department of Cardiology, East Sussex Healthcare NHS Trust, East Sussex, United Kingdom
| | - John P Foran
- Cardiac Department, Royal Brompton Hospital, London, United Kingdom.,Cardiolgy Department, St. Helier Hospital, Surrey, United Kingdom
| | | | | | - Danny Schoors
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Benno J Rensing
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Manish Saxena
- William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom
| | - Benjamin Scott
- Department of Cardiology, ZNA - Cardio Middelheim, Antwerp, Belgium
| | - G André Ng
- Department of Cardiovascular Sciences, University of Leicester Glenfield Hospital/NIHR Leicester Cardiovascular Biomedical Research, Leicester, United Kingdom
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Narkiewicz K, Ratcliffe LEK, Hart EC, Briant LJB, Chrostowska M, Wolf J, Szyndler A, Hering D, Abdala AP, Manghat N, Burchell AE, Durant C, Lobo MD, Sobotka PA, Patel NK, Leiter JC, Engelman ZJ, Nightingale AK, Paton JFR. Unilateral Carotid Body Resection in Resistant Hypertension: A Safety and Feasibility Trial. ACTA ACUST UNITED AC 2016; 1:313-324. [PMID: 27766316 PMCID: PMC5063532 DOI: 10.1016/j.jacbts.2016.06.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 11/17/2022]
Abstract
Animal and human data indicate pathological afferent signaling emanating from the carotid body that drives sympathetically mediated elevations in blood pressure in conditions of hypertension. This first-in-man, proof-of-principle study tested the safety and feasibility of unilateral carotid body resection in 15 patients with drug-resistant hypertension. The procedure proved to be safe and feasible. Overall, no change in blood pressure was found. However, 8 patients showed significant reductions in ambulatory blood pressure coinciding with decreases in sympathetic activity. The carotid body may be a novel target for treating an identifiable subpopulation of humans with hypertension.
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Key Words
- ABP, ambulatory blood pressure
- ASBP, ambulatory systolic blood pressure
- BRS, baroreceptor reflex sensitivity
- CB, carotid body
- HRV, heart rate variability
- HVR, hypoxic ventilatory response
- MSNA, muscle sympathetic nerve activity
- OBP, office blood pressure
- OSBP, office systolic blood pressure
- afferent drive
- baroreceptor reflex
- hypertension
- hypoxia
- peripheral chemoreceptor
- sympathetic nervous system
- uCB, unilateral carotid body
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Affiliation(s)
- Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Laura E K Ratcliffe
- CardioNomics Research Group, Clinical Research & Imaging Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Emma C Hart
- CardioNomics Research Group, Clinical Research & Imaging Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, United Kingdom
| | - Linford J B Briant
- CardioNomics Research Group, Clinical Research & Imaging Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Marzena Chrostowska
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Wolf
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Anna Szyndler
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Ana P Abdala
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, United Kingdom
| | - Nathan Manghat
- CardioNomics Research Group, Clinical Research & Imaging Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Amy E Burchell
- CardioNomics Research Group, Clinical Research & Imaging Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Claire Durant
- CardioNomics Research Group, Clinical Research & Imaging Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Melvin D Lobo
- NIHR Barts Cardiovascular Biomedical Research Unit, William Harvey Research Institute, QMUL, Charterhouse Square, London, United Kingdom
| | - Paul A Sobotka
- Department of Internal Medicine, Division of Cardiovascular Diseases, The Ohio State University, Columbus, Ohio
| | - Nikunj K Patel
- Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - James C Leiter
- Department of Physiology and Neurobiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | | | - Angus K Nightingale
- CardioNomics Research Group, Clinical Research & Imaging Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Julian F R Paton
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, United Kingdom
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36
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Ewen S, Lobo MD, Pathak A, Schmieder RE, Tsioufis C, Wijns W, Mahfoud F. Will SPRINT change my practice? SPRINT: a randomised trial of intensive versus standard blood-pressure control. EUROINTERVENTION 2016; 12:809-12. [PMID: 27542797 DOI: 10.4244/eijv12i6a132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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Saxena M, Sobotka PA, Hamshere SM, Jain A, Mathur A, Knight C, Collier DJ, Lobo MD. Antihypertensive Effects of a Central Arteriovenous Anastomosis Are Mediated Through Profound Reduction in Systemic Vascular Resistance. Circ Cardiovasc Interv 2016; 9:e004012. [PMID: 27512091 DOI: 10.1161/circinterventions.116.004012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Manish Saxena
- From the Barts BP Centre of Excellence (M.S., D.J.C., M.D.L.) and Department of Cardiology (S.M.H., A.J., A.M., C.K.), Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom; William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, Queen Mary University London, United Kingdom (M.S., D.J.C., M.D.L.); Department of Internal Medicine, Division of Cardiovascular Diseases, The Ohio State University, Columbus (P.A.S.); and ROX Medical Inc, San Clemente, CA (P.A.S.).
| | - Paul A Sobotka
- From the Barts BP Centre of Excellence (M.S., D.J.C., M.D.L.) and Department of Cardiology (S.M.H., A.J., A.M., C.K.), Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom; William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, Queen Mary University London, United Kingdom (M.S., D.J.C., M.D.L.); Department of Internal Medicine, Division of Cardiovascular Diseases, The Ohio State University, Columbus (P.A.S.); and ROX Medical Inc, San Clemente, CA (P.A.S.)
| | - Stephen M Hamshere
- From the Barts BP Centre of Excellence (M.S., D.J.C., M.D.L.) and Department of Cardiology (S.M.H., A.J., A.M., C.K.), Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom; William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, Queen Mary University London, United Kingdom (M.S., D.J.C., M.D.L.); Department of Internal Medicine, Division of Cardiovascular Diseases, The Ohio State University, Columbus (P.A.S.); and ROX Medical Inc, San Clemente, CA (P.A.S.)
| | - Ajay Jain
- From the Barts BP Centre of Excellence (M.S., D.J.C., M.D.L.) and Department of Cardiology (S.M.H., A.J., A.M., C.K.), Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom; William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, Queen Mary University London, United Kingdom (M.S., D.J.C., M.D.L.); Department of Internal Medicine, Division of Cardiovascular Diseases, The Ohio State University, Columbus (P.A.S.); and ROX Medical Inc, San Clemente, CA (P.A.S.)
| | - Anthony Mathur
- From the Barts BP Centre of Excellence (M.S., D.J.C., M.D.L.) and Department of Cardiology (S.M.H., A.J., A.M., C.K.), Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom; William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, Queen Mary University London, United Kingdom (M.S., D.J.C., M.D.L.); Department of Internal Medicine, Division of Cardiovascular Diseases, The Ohio State University, Columbus (P.A.S.); and ROX Medical Inc, San Clemente, CA (P.A.S.)
| | - Charles Knight
- From the Barts BP Centre of Excellence (M.S., D.J.C., M.D.L.) and Department of Cardiology (S.M.H., A.J., A.M., C.K.), Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom; William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, Queen Mary University London, United Kingdom (M.S., D.J.C., M.D.L.); Department of Internal Medicine, Division of Cardiovascular Diseases, The Ohio State University, Columbus (P.A.S.); and ROX Medical Inc, San Clemente, CA (P.A.S.)
| | - David J Collier
- From the Barts BP Centre of Excellence (M.S., D.J.C., M.D.L.) and Department of Cardiology (S.M.H., A.J., A.M., C.K.), Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom; William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, Queen Mary University London, United Kingdom (M.S., D.J.C., M.D.L.); Department of Internal Medicine, Division of Cardiovascular Diseases, The Ohio State University, Columbus (P.A.S.); and ROX Medical Inc, San Clemente, CA (P.A.S.)
| | - Melvin D Lobo
- From the Barts BP Centre of Excellence (M.S., D.J.C., M.D.L.) and Department of Cardiology (S.M.H., A.J., A.M., C.K.), Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom; William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, Queen Mary University London, United Kingdom (M.S., D.J.C., M.D.L.); Department of Internal Medicine, Division of Cardiovascular Diseases, The Ohio State University, Columbus (P.A.S.); and ROX Medical Inc, San Clemente, CA (P.A.S.)
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De Jager RL, Sanders MF, Bots ML, Lobo MD, Ewen S, Beeftink MMA, Böhm M, Daemen J, Dörr O, Hering D, Mahfoud F, Nef H, Ott C, Saxena M, Schmieder RE, Schlaich MP, Spiering W, Tonino PAL, Verloop WL, Vink EE, Vonken EJ, Voskuil M, Worthley SG, Blankestijn PJ. Renal denervation in hypertensive patients not on blood pressure lowering drugs. Clin Res Cardiol 2016; 105:755-62. [PMID: 27105858 PMCID: PMC4989018 DOI: 10.1007/s00392-016-0984-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/30/2016] [Indexed: 12/11/2022]
Abstract
Introduction Studies on the blood pressure lowering effect of renal denervation (RDN) in resistant hypertensive patients have produced conflicting results. Change in medication usage during the studies may be responsible for this inconsistency. To eliminate the effect of medication usage on blood pressure we focused on unmedicated hypertensive patients who underwent RDN. Methods and results Our study reports on a cohort of patients, who were not on blood pressure lowering drugs at baseline and during follow-up, from eight tertiary centers. Data of patients were used when they were treated with RDN and had a baseline office systolic blood pressure (SBP) ≥140 mmHg and/or 24-h ambulatory SBP ≥130 mmHg. Our primary outcome was defined as change in office and 24-h SBP at 12 months after RDN, compared to baseline. Fifty-three patients were included. There were three different reasons for not using blood pressure lowering drugs: (1) documented intolerance or allergic reaction (57 %); (2) temporary cessation of medication for study purposes (28 %); and (3) reluctance to take antihypertensive drugs (15 %). Mean change in 24-h SBP was −5.7 mmHg [95 % confidence interval (CI) −11.0 to −0.4; p = 0.04]. Mean change in office SBP was −13.1 mmHg (95 % CI −20.4 to −5.7; p = 0.001). No changes were observed in other variables, such as eGFR, body–mass-index and urinary sodium excretion. Conclusion This explorative study in hypertensive patients, who are not on blood pressure lowering drugs, suggests that at least in some patients RDN lowers blood pressure. Electronic supplementary material The online version of this article (doi:10.1007/s00392-016-0984-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosa L De Jager
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Room F03.220, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Margreet F Sanders
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Room F03.220, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Michiel L Bots
- The Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Melvin D Lobo
- William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Martine M A Beeftink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Oliver Dörr
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Dagmara Hering
- School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Perth, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Holger Nef
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital of Erlangen, Erlangen, Germany
| | - Manish Saxena
- William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital of Erlangen, Erlangen, Germany
| | - Markus P Schlaich
- School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Perth, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim A L Tonino
- Department of Cardiology, Heartcenter Catharina Hospital, Eindhoven, The Netherlands
| | - Willemien L Verloop
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eva E Vink
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Room F03.220, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Evert-Jan Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stephen G Worthley
- Cardiovascular Research Centre, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Room F03.220, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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Lobo MD. Hypertension Landmark Trials 2015: A European Perspective of the Practicing Clinician. J Am Coll Cardiol 2016; 67:1372-4. [PMID: 26988960 DOI: 10.1016/j.jacc.2016.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Melvin D Lobo
- Barts BP Centre of Excellence, Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; and the William Harvey Research Institute, Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, United Kingdom.
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40
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Lobo MD, Paton JFR. CardioPulse. The use of devices to treat hypertension. Eur Heart J 2016; 37:927-929. [PMID: 27453969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
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41
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Burchell AE, Chan K, Ratcliffe LEK, Hart EC, Saxena M, Collier DJ, Jain AK, Mathur A, Knight CJ, Caulfield MJ, Paton JFR, Nightingale AK, Lobo MD, Baumbach A. Controversies Surrounding Renal Denervation: Lessons Learned From Real-World Experience in Two United Kingdom Centers. J Clin Hypertens (Greenwich) 2016; 18:585-92. [PMID: 26857092 DOI: 10.1111/jch.12789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/18/2015] [Accepted: 12/20/2015] [Indexed: 11/27/2022]
Abstract
Renal denervation (RDN) is a therapy that targets treatment-resistant hypertension (TRH). The Renal Denervation in Patients With Uncontrolled Hypertension (Symplicity) HTN-1 and Symplicity HTN-2 trials reported response rates of >80%; however, sham-controlled Symplicity HTN-3 failed to reach its primary blood pressure (BP) outcome. The authors address the current controversies surrounding RDN, illustrated with real-world data from two centers in the United Kingdom. In this cohort, 52% of patients responded to RDN, with a 13±32 mm Hg reduction in office systolic BP (SBP) at 6 months (n=29, P=.03). Baseline office SBP and number of ablations correlated with office SBP reduction (R=-0.47, P=.01; R=-0.56, P=.002). RDN appears to be an effective treatment for some patients with TRH; however, individual responses are highly variable. Selecting patients for RDN is challenging, with only 10% (33 of 321) of the screened patients eligible for the study. Medication alterations and nonadherence confound outcomes. Adequate ablation is critical and should impact future catheter design/training. Markers of procedural success and improved patient selection parameters remain key research aims.
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Affiliation(s)
- Amy E Burchell
- CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.,School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Kenneth Chan
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.,Barts Blood Pressure Clinic, Barts Health NHS Trust, London, UK
| | - Laura E K Ratcliffe
- CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.,School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK
| | - Emma C Hart
- CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.,School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK
| | - Manish Saxena
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.,Barts Blood Pressure Clinic, Barts Health NHS Trust, London, UK
| | - David J Collier
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Ajay K Jain
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.,Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.,Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
| | - Charles J Knight
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.,Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
| | - Mark J Caulfield
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.,Barts Blood Pressure Clinic, Barts Health NHS Trust, London, UK
| | - Julian F R Paton
- CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.,School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK
| | - Angus K Nightingale
- CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Melvin D Lobo
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.,Barts Blood Pressure Clinic, Barts Health NHS Trust, London, UK
| | - Andreas Baumbach
- CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.,School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK
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42
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Affiliation(s)
- Melvin D Lobo
- William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London EC1M 6BQ, UK.
| | | | | | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, Friedrich-Alexander University-Erlangen-Nürnberg, Erlangen, Germany
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Kapil V, Sobotka PA, Saxena M, Mathur A, Knight C, Dolan E, Stanton A, Lobo MD. Central iliac arteriovenous anastomosis for hypertension: targeting mechanical aspects of the circulation. Curr Hypertens Rep 2015; 17:585. [PMID: 26228235 PMCID: PMC4521087 DOI: 10.1007/s11906-015-0585-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Raised blood pressure is the leading attributable risk factor for global morbidity and mortality. Real world data demonstrates that half of treated patients are at elevated cardiovascular risk because of inadequately controlled BP. In addition to pharmacotherapy, certain interventional strategies to reduce blood pressure and cardiovascular risk in hypertension can be considered according to international guidelines. One of the newer technologies entering this field is a proprietary arteriovenous coupler device that forms a fixed flow arteriovenous conduit in the central vasculature. In this review, we examine the development of and rationale for the creation of a central arteriovenous anastomosis in patients with hypertension and review the proposed mechanisms by which it may ameliorate hypertension. We critically review the clinical trial evidence base to date and postulate on future therapeutic directions.
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Affiliation(s)
- Vikas Kapil
- />Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew’s Hospital, W Smithfield, London, EC1A 7BE UK
- />William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, Queen Mary University London, London, EC1M 6BQ UK
| | - Paul A. Sobotka
- />Department of Internal Medicine, Division of Cardiovascular Diseases, The Ohio State University, Columbus, OH 43210 USA
- />ROX Medical, 150 Calle Iglesia # A, San Clemente, CA 92672 USA
| | - Manish Saxena
- />Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew’s Hospital, W Smithfield, London, EC1A 7BE UK
- />William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, Queen Mary University London, London, EC1M 6BQ UK
| | - Anthony Mathur
- />Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew’s Hospital, W Smithfield, London, EC1A 7BE UK
- />Department of Cardiology, Barts Heart Centre, St Bartholomew’s Hospital, W Smithfield, London, EC1A 7BE UK
| | - Charles Knight
- />Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew’s Hospital, W Smithfield, London, EC1A 7BE UK
- />Department of Cardiology, Barts Heart Centre, St Bartholomew’s Hospital, W Smithfield, London, EC1A 7BE UK
| | - Eamon Dolan
- />Department of Medicine for the Elderly, Connolly Hospital, Mill Road, Blanchardstown, Dublin 15 Dublin, Ireland
| | - Alice Stanton
- />Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, 123 Saint Stephen’s Green, Dublin 2 Dublin, Ireland
| | - Melvin D. Lobo
- />Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew’s Hospital, W Smithfield, London, EC1A 7BE UK
- />William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, Queen Mary University London, London, EC1M 6BQ UK
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Brier TJ, Jain AK, Lobo MD. Central arteriovenous anastomosis for hypertension: it is not all about sympathomodulation. Future Cardiol 2015; 11:503-6. [DOI: 10.2217/fca.15.34] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Tim J Brier
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK
- William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, E1 4NS, UK
| | - Ajay K Jain
- Department of Cardiology, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Melvin D Lobo
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK
- William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, E1 4NS, UK
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Antoniou S, Saxena M, Hamedi N, de Cates C, Moghul S, Lidder S, Kapil V, Lobo MD. Management of Hypertensive Patients With Multiple Drug Intolerances: A Single-Center Experience of a Novel Treatment Algorithm. J Clin Hypertens (Greenwich) 2015; 18:129-38. [PMID: 26306794 PMCID: PMC5049677 DOI: 10.1111/jch.12637] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 06/18/2015] [Accepted: 06/27/2015] [Indexed: 02/05/2023]
Abstract
Multiple drug intolerance to antihypertensive medications (MDI-HTN) is an overlooked cause of nonadherence. In this study, 55 patients with MDI-HTN were managed with a novel treatment algorithm utilizing sequentially initiated monotherapies or combinations of maximally tolerated doses of fractional tablet doses, liquid formulations, transdermal preparations, and off-label tablet medications. A total of 10% of referred patients had MDI-HTN, resulting in insufficient pharmacotherapy and baseline office blood pressure (OBP) of 178±24/94±15 mm Hg. At baseline, patients were intolerant to 7.6±3.6 antihypertensives; they were receiving 1.4±1.1 medications. After 6 months on the novel MDI-HTN treatment algorithm, both OBP and home blood pressure (HBP) were significantly reduced, with patients receiving 2.0±1.2 medications. At 12 months, OBP was reduced from baseline by 17±5/9±3 mm Hg (P<.01, P<.05) and HBP was reduced by 11±5/12±3 mm Hg (P<.01 for both) while patients were receiving 1.9±1.1 medications. Application of a stratified medicine approach allowed patients to tolerate increased numbers of medications and achieved significant long-term lowering of blood pressure.
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Affiliation(s)
- Sotiris Antoniou
- Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Department of Pharmacy, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Manish Saxena
- Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Nadya Hamedi
- Department of Pharmacy, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Catherine de Cates
- Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Sakib Moghul
- Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Satnam Lidder
- Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Vikas Kapil
- Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Melvin D Lobo
- Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK
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Mahfoud F, Böhm M, Azizi M, Pathak A, Durand Zaleski I, Ewen S, Tsioufis K, Andersson B, Blankestijn PJ, Burnier M, Chatellier G, Gafoor S, Grassi G, Joner M, Kjeldsen SE, Lüscher TF, Lobo MD, Lotan C, Parati G, Redon J, Ruilope L, Sudano I, Ukena C, van Leeuwen E, Volpe M, Windecker S, Witkowski A, Wijns W, Zeller T, Schmieder RE. Proceedings from the European clinical consensus conference for renal denervation: considerations on future clinical trial design: Figure 1. Eur Heart J 2015; 36:2219-27. [DOI: 10.1093/eurheartj/ehv192] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/27/2015] [Indexed: 01/08/2023] Open
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Lobo MD, Sobotka PA, Stanton A, Cockcroft JR, Sulke N, Dolan E, van der Giet M, Hoyer J, Furniss SS, Foran JP, Witkowski A, Januszewicz A, Schoors D, Tsioufis K, Rensing BJ, Scott B, Ng GA, Ott C, Schmieder RE. Central arteriovenous anastomosis for the treatment of patients with uncontrolled hypertension (the ROX CONTROL HTN study): a randomised controlled trial. Lancet 2015; 385:1634-41. [PMID: 25620016 DOI: 10.1016/s0140-6736(14)62053-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hypertension contributes to cardiovascular morbidity and mortality. We assessed the safety and efficacy of a central iliac arteriovenous anastomosis to alter the mechanical arterial properties and reduce blood pressure in patients with uncontrolled hypertension. METHODS We enrolled patients in this open-label, multicentre, prospective, randomised, controlled trial between October, 2012, and April, 2014. Eligible patients had baseline office systolic blood pressure of 140 mm Hg or higher and average daytime ambulatory blood pressure of 135 mm Hg or higher systolic and 85 mm Hg or higher diastolic despite antihypertensive treatment. Patients were randomly allocated in a 1:1 ratio to undergo implantation of an arteriovenous coupler device plus current pharmaceutical treatment or to maintain current treatment alone (control). The primary endpoint was mean change from baseline in office and 24 h ambulatory systolic blood pressure at 6 months. Analysis was by modified intention to treat (all patients remaining in follow-up at 6 months). This trial is registered with ClinicalTrials.gov, number NCT01642498. FINDINGS 83 (43%) of 195 patients screened were assigned arteriovenous coupler therapy (n=44) or normal care (n=39). Mean office systolic blood pressure reduced by 26·9 (SD 23·9) mm Hg in the arteriovenous coupler group (p<0·0001) and by 3·7 (21·2) mm Hg in the control group (p=0·31). Mean systolic 24 h ambulatory blood pressure reduced by 13·5 (18·8) mm Hg (p<0·0001) in arteriovenous coupler recipients and by 0·5 (15·8) mm Hg (p=0·86) in controls. Implantation of the arteriovenous coupler was associated with late ipsilateral venous stenosis in 12 (29%) of 42 patients and was treatable with venoplasty or stenting. INTERPRETATION Arteriovenous anastomosis was associated with significantly reduced blood pressure and hypertensive complications. This approach might be a useful adjunctive therapy for patients with uncontrolled hypertension. FUNDING ROX Medical.
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Affiliation(s)
- Melvin D Lobo
- William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.
| | - Paul A Sobotka
- ROX Medical, San Clemente, CA, USA; Cardiovascular Medicine, Ohio State University, Columbus, OH, USA
| | - Alice Stanton
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
| | - John R Cockcroft
- Cardiology Department, Wales Heart Research Institute, Cardiff, UK
| | - Neil Sulke
- Cardiology Department, Eastbourne District General Hospital, East Sussex, UK
| | - Eamon Dolan
- Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland
| | - Markus van der Giet
- Department of Endocinrology and Nephrology, Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Hoyer
- Department of Internal Medicine and Nephrology, Universitätsklinikum Gießen und Marburg GmbH, Marburg, Germany
| | - Stephen S Furniss
- Department of Cardiology, East Sussex Healthcare NHS Trust, East Sussex, UK
| | - John P Foran
- Cardiac Department, Royal Brompton Hospital, London, UK; Cardiology Department, St Helier Hospital, Surrey, UK
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | | | - Danny Schoors
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Benno J Rensing
- Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Benjamin Scott
- Department of Cardiology, ZNA-Cardio Middelheim, Antwerp, Belgium
| | - G André Ng
- Department of Cardiovascular Sciences, University of Leicester Glenfield Hospital/NIHR Leicester Cardiovascular Biomedical Research, Leicester, UK
| | - Christian Ott
- Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Erlangen, Germany
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Lobo MD, de Belder MA, Cleveland T, Collier D, Dasgupta I, Deanfield J, Kapil V, Knight C, Matson M, Moss J, Paton JFR, Poulter N, Simpson I, Williams B, Caulfield MJ. Joint UK societies' 2014 consensus statement on renal denervation for resistant hypertension. Heart 2014; 101:10-6. [PMID: 25431461 PMCID: PMC4283620 DOI: 10.1136/heartjnl-2014-307029] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Resistant hypertension continues to pose a major challenge to clinicians worldwide and has serious implications for patients who are at increased risk of cardiovascular morbidity and mortality with this diagnosis. Pharmacological therapy for resistant hypertension follows guidelines-based regimens although there is surprisingly scant evidence for beneficial outcomes using additional drug treatment after three antihypertensives have failed to achieve target blood pressure. Recently there has been considerable interest in the use of endoluminal renal denervation as an interventional technique to achieve renal nerve ablation and lower blood pressure. Although initial clinical trials of renal denervation in patients with resistant hypertension demonstrated encouraging office blood pressure reduction, a large randomised control trial (Symplicity HTN-3) with a sham-control limb, failed to meet its primary efficacy end point. The trial however was subject to a number of flaws which must be taken into consideration in interpreting the final results. Moreover a substantial body of evidence from non-randomised smaller trials does suggest that renal denervation may have an important role in the management of hypertension and other disease states characterised by overactivation of the sympathetic nervous system. The Joint UK Societies does not recommend the use of renal denervation for treatment of resistant hypertension in routine clinical practice but remains committed to supporting research activity in this field. A number of research strategies are identified and much that can be improved upon to ensure better design and conduct of future randomised studies.
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Affiliation(s)
- Melvin D Lobo
- On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | - Mark A de Belder
- The British Cardiovascular Society The British Cardiovascular Intervention Society Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK
| | - Trevor Cleveland
- The British Society for Interventional Radiology Sheffield Vascular Institute, Sheffield Teaching Hospitals NHSFT, Northern General Hospital, Sheffield, UK
| | - David Collier
- On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Indranil Dasgupta
- The Renal Association Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK
| | - John Deanfield
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK The National Institute for Cardiovascular Outcomes Research, University College London, London, UK
| | - Vikas Kapil
- On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | - Charles Knight
- Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK The British Cardiovascular Society
| | - Matthew Matson
- The British Society for Interventional Radiology Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Jonathan Moss
- The British Society for Interventional Radiology Interventional Radiology Unit, Gartnavel General Hospital, Glasgow, UK
| | - Julian F R Paton
- On behalf of the British Hypertension Society School of Physiology & Pharmacology, Bristol Cardiovascular Medical Sciences Building, University of Bristol, Bristol, UK
| | - Neil Poulter
- On behalf of the British Hypertension Society International Centre for Circulatory Health, Imperial College, London, UK
| | - Iain Simpson
- The British Cardiovascular Society Wessex Regional Cardiac Unit, University Hospital Southampton, UK
| | - Bryan Williams
- On behalf of the British Hypertension Society Institute of Cardiovascular Sciences, University College London, London, UK
| | - Mark J Caulfield
- On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK
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Affiliation(s)
- Amy E. Burchell
- From the CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust (A.E.B., J.F.R.P.) and School of Clinical Sciences (A.E.B.), University of Bristol, UK; William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK (M.D.L.); Barts Hypertension Clinic, Department of
| | - Melvin D. Lobo
- From the CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust (A.E.B., J.F.R.P.) and School of Clinical Sciences (A.E.B.), University of Bristol, UK; William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK (M.D.L.); Barts Hypertension Clinic, Department of
| | - Neil Sulke
- From the CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust (A.E.B., J.F.R.P.) and School of Clinical Sciences (A.E.B.), University of Bristol, UK; William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK (M.D.L.); Barts Hypertension Clinic, Department of
| | - Paul A. Sobotka
- From the CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust (A.E.B., J.F.R.P.) and School of Clinical Sciences (A.E.B.), University of Bristol, UK; William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK (M.D.L.); Barts Hypertension Clinic, Department of
| | - Julian F.R. Paton
- From the CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust (A.E.B., J.F.R.P.) and School of Clinical Sciences (A.E.B.), University of Bristol, UK; William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK (M.D.L.); Barts Hypertension Clinic, Department of
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Kapil V, Jain AK, Lobo MD. Renal Sympathetic Denervation - A Review of Applications in Current Practice. Interv Cardiol 2014; 9:54-61. [PMID: 29588780 PMCID: PMC5808654 DOI: 10.15420/icr.2011.9.1.54] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/18/2014] [Indexed: 02/07/2023] Open
Abstract
Resistant hypertension is associated with high morbidity and mortality despite numerous pharmacological strategies. A wealth of preclinical and clinical data have demonstrated that resistant hypertension is associated with elevated renal and central sympathetic tone. The development of interventional therapies to modulate the sympathetic nervous system potentially represents a paradigm shift in the strategy for blood pressure control in this subset of patients. Initial first-in-man and pivotal, randomised controlled trials of endovascular, radio-frequency renal sympathetic denervation have spawned numerous iterations of similar technology, as well as many novel concepts for achieving effective renal sympatholysis. This review details the current knowledge of these devices and the evidence base behind each technology.
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Affiliation(s)
- Vikas Kapil
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts Hypertension Clinic, Department of Clinical Pharmacology, Barts Health NHS Trust, London, UK
| | - Ajay K Jain
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
| | - Melvin D Lobo
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts Hypertension Clinic, Department of Clinical Pharmacology, Barts Health NHS Trust, London, UK
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