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Filippone EJ, Naccarelli GV, Foy AJ. Controversies in Hypertension IV: Renal Denervation. Am J Med 2023; 136:857-868. [PMID: 37230403 DOI: 10.1016/j.amjmed.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Abstract
Renal denervation is not a cure for hypertension. Although more recent sham-controlled trials were positive, a significant minority of patients in each trial were unresponsive. The optimal patient or patients need to be defined. Combined systolic/diastolic hypertension appears more responsive than isolated systolic hypertension. It remains uncertain whether patients with comorbidities associated with higher adrenergic tone should be targeted, including obesity, diabetes, sleep apnea, and chronic kidney disease. No biomarker can adequately predict response. A key to a successful response is the adequacy of denervation, which currently cannot be assessed in real time. It is uncertain what is the optimal denervation methodology: radiofrequency, ultrasound, or ethanol injection. Radiofrequency requires targeting the distal main renal artery plus major branches and accessory arteries. Although denervation appears to be safe, conclusive data on quality of life, improved target organ damage, and reduced cardiovascular events/mortality are required before denervation can be generally recommended.
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Affiliation(s)
- Edward J Filippone
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pa.
| | - Gerald V Naccarelli
- Department of Medicine, Penn State University Heart and Vascular Institute; Penn State M.S Hershey Medical Center and College of Medicine, Hershey, Pa
| | - Andrew J Foy
- Department of Medicine, Penn State University Heart and Vascular Institute; Penn State M.S Hershey Medical Center and College of Medicine, Hershey, Pa
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2
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Messerli FH, Bavishi C, Brguljan J, Burnier M, Dobner S, Elijovich F, Ferdinand KC, Kjeldsen S, Laffer CL, S Ram CV, Rexhaj E, Ruilope LM, Shalaeva EV, Siontis GC, Staessen JA, Textor SC, Vongpatanasin W, Vogt L, Volpe M, Wang J, Williams B. Renal denervation in the antihypertensive arsenal - knowns and known unknowns. J Hypertens 2022; 40:1859-1875. [PMID: 36052518 PMCID: PMC10010701 DOI: 10.1097/hjh.0000000000003171] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 01/21/2023]
Abstract
Even though it has been more than a decade since renal denervation (RDN) was first used to treat hypertension and an intense effort on researching this therapy has been made, it is still not clear how RDN fits into the antihypertensive arsenal. There is no question that RDN lowers blood pressure (BP), it does so to an extent at best corresponding to one antihypertensive drug. The procedure has an excellent safety record. However, it remains clinically impossible to predict whose BP responds to RDN and whose does not. Long-term efficacy data on BP reduction are still unconvincing despite the recent results in the SPYRAL HTN-ON MED trial; experimental studies indicate that reinnervation is occurring after RDN. Although BP is an acceptable surrogate endpoint, there is complete lack of outcome data with RDN. Clear indications for RDN are lacking although patients with resistant hypertension, those with documented increase in activity of the sympathetic system and perhaps those who desire to take fewest medication may be considered.
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Affiliation(s)
- Franz H. Messerli
- Department of BioMedical Research, University of Bern, Bern, Switzerland
- Jagiellonian University Krakow, Krakow, Poland
| | - Chirag Bavishi
- Department of Cardiology, University of Missouri, Columbia, Missouri, USA
| | - Jana Brguljan
- University Medical Centre Ljubljana, Department of Hypertension, Medical University Ljubljana, Slovenia
| | - Michel Burnier
- University of Lausanne. Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Stephan Dobner
- Department of Cardiology, Bern University Hospital University of Bern, Bern, Switzerland
| | - Fernando Elijovich
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, USA
| | | | - Sverre Kjeldsen
- Department of Cardiology, University of Oslo Hospital, Oslo, Norway
| | - Cheryl L. Laffer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - C. Venkata S Ram
- Apollo Hospitals and Medical College, Hyderabad, Telangana, India
| | - Emrush Rexhaj
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Luis M. Ruilope
- Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research i+12, CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Evgeniya V. Shalaeva
- Division of Public Health Science, Westminster International University in Tashkent, Tashkent, Uzbekistan
- Department of Cardiology, Tashkent Medical Academy, Tashkent, Uzbekistan
| | - George C.M. Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan A. Staessen
- NPO Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
- Biomedical Science Group, Faculty of Medicine, Leuven, Belgium
| | - Stephen C. Textor
- Division of Hypertension and Nephrology, Mayo Clinic, Rochester, Minnesota, USA
| | - Wanpen Vongpatanasin
- Hypertension Section, Cardiology Division, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Liffert Vogt
- Department of Internal Medicine, section Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome, Italy
| | - Jiguang Wang
- The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, London, United Kingdom
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3
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Yang X, Liu H, Chen S, Dong P, Zhao D. Intravascular Renal Denervation Reduces Ambulatory and Office Blood Pressure in Patients with Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Trials. Kidney Blood Press Res 2022; 47:363-374. [PMID: 35385842 DOI: 10.1159/000524171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This meta-analysis was designed to evaluate the antihypertensive efficacy of intravascular renal denervation (RDN) in patients with essential hypertension, especially to determine the magnitude of blood pressure (BP) reduction with RDN therapy using second-generation catheters. METHODS PubMed was searched to identify randomized sham-controlled trials from inception through August 2021. The endpoints were changes in 24-h ambulatory BP or office BP. This meta-analysis was performed by calculating the weighted mean difference (WMD) with 95% confidence interval (CI) using the random-effects model when the I2 index was <50%. A fixed-effects model was used when the I2 index was ≥50%. RESULTS A total of 1,297 patients were included in 8 randomized, sham-controlled trials in this meta-analysis. Intravascular RDN reduced 24-h ambulatory systolic BP (SBP) -3.02 (WMD, 95% CI: -4.95, -1.10, p < 0.01) and diastolic BP (DBP) -1.66 (WMD, 95% CI: -2.44, -0.88, p < 0.001) mm Hg, respectively. In the studies using first-generation catheters, the WMDs of 24-h ambulatory SBP and DBP changes between intravascular RDN and sham control were -2.67 (95% CI: -5.08, -0.27; p < 0.05; I2 = 0%, p = 0.53) and -0.82 (95% CI: -2.19, 0.56; p > 0.05; I2 = 0%, p = 0.64) mm Hg. In the studies using second-generation catheters, the WMDs of 24-h ambulatory SBP and DBP changes between intravascular RDN and sham control were -3.14 (95% CI: -5.94, -0.33, p < 0.05; I2 = 71%, p = 0.008) and -2.06 (95% CI: -3.02, -1.11, p < 0.001; I2 = 50%, p = 0.09) mm Hg. Intravascular RDN using second-generation catheters reduced office SBP -6.30 (WMD, 95% CI: -7.67, -4.93, p < 0.001; I2 = 43%, p = 0.14) and DBP -3.88 (WMD, 95% CI: -4.44, -3.33, p < 0.001; I2 = 42%, p = 0.14) mm Hg, respectively. CONCLUSIONS Intravascular RDN using second-generation catheters reduces ambulatory and office BP in patients with essential hypertension. The selection of appropriate hypertensive patients may be the major challenge for the performance of intravascular RDN in routine clinical practice.
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Affiliation(s)
- Xiaoxv Yang
- Division of Cardiology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.,Cardiovascular Institute, Henan University of Science and Technology, Luoyang, China
| | - Hui Liu
- Division of Endocrinology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
| | - Shifang Chen
- Division of Cardiology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Pingshuan Dong
- Division of Cardiology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.,Cardiovascular Institute, Henan University of Science and Technology, Luoyang, China
| | - Di Zhao
- Cardiovascular Institute, Henan University of Science and Technology, Luoyang, China.,Division of Hypertension, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
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Pisano A, Iannone LF, Leo A, Russo E, Coppolino G, Bolignano D. Renal denervation for resistant hypertension. Cochrane Database Syst Rev 2021; 11:CD011499. [PMID: 34806762 PMCID: PMC8607757 DOI: 10.1002/14651858.cd011499.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Resistant hypertension is highly prevalent among the general hypertensive population and the clinical management of this condition remains problematic. Different approaches, including a more intensified antihypertensive therapy, lifestyle modifications or both, have largely failed to improve patients' outcomes and to reduce cardiovascular and renal risk. As renal sympathetic hyperactivity is a major driver of resistant hypertension, in the last decade renal sympathetic ablation (renal denervation) has been proposed as a possible therapeutic alternative to treat this condition. OBJECTIVES We sought to evaluate the short- and long-term effects of renal denervation in individuals with resistant hypertension on clinical end points, including fatal and non-fatal cardiovascular events, all-cause mortality, hospital admissions, quality of life, blood pressure control, left ventricular hypertrophy, cardiovascular and metabolic profile and kidney function, as well as the potential adverse events related to the procedure. SEARCH METHODS For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to 3 November 2020: Cochrane Hypertension's Specialised Register, CENTRAL (2020, Issue 11), Ovid MEDLINE, and Ovid Embase. The World Health Organization International Clinical Trials Registry Platform (via CENTRAL) and the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov were searched for ongoing trials. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA We considered randomised controlled trials (RCTs) that compared renal denervation to standard therapy or sham procedure to treat resistant hypertension, without language restriction. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed study risk of bias. We summarised treatment effects on available clinical outcomes and adverse events using random-effects meta-analyses. We assessed heterogeneity in estimated treatment effects using Chi² and I² statistics. We calculated summary treatment estimates as a mean difference (MD) or standardised mean difference (SMD) for continuous outcomes, and a risk ratio (RR) for dichotomous outcomes, together with their 95% confidence intervals (CI). Certainty of evidence has been assessed using the GRADE approach. MAIN RESULTS We found 15 eligible studies (1416 participants). In four studies, renal denervation was compared to sham procedure; in the remaining studies, renal denervation was tested against standard or intensified antihypertensive therapy. Most studies had unclear or high risk of bias for allocation concealment and blinding. When compared to control, there was low-certainty evidence that renal denervation had little or no effect on the risk of myocardial infarction (4 studies, 742 participants; RR 1.31, 95% CI 0.45 to 3.84), ischaemic stroke (5 studies, 892 participants; RR 0.98, 95% CI 0.33 to 2.95), unstable angina (3 studies, 270 participants; RR 0.51, 95% CI 0.09 to 2.89) or hospitalisation (3 studies, 743 participants; RR 1.24, 95% CI 0.50 to 3.11). Based on moderate-certainty evidence, renal denervation may reduce 24-hour ambulatory blood pressure monitoring (ABPM) systolic BP (9 studies, 1045 participants; MD -5.29 mmHg, 95% CI -10.46 to -0.13), ABPM diastolic BP (8 studies, 1004 participants; MD -3.75 mmHg, 95% CI -7.10 to -0.39) and office diastolic BP (8 studies, 1049 participants; MD -4.61 mmHg, 95% CI -8.23 to -0.99). Conversely, this procedure had little or no effect on office systolic BP (10 studies, 1090 participants; MD -5.92 mmHg, 95% CI -12.94 to 1.10). Moderate-certainty evidence suggested that renal denervation may not reduce serum creatinine (5 studies, 721 participants, MD 0.03 mg/dL, 95% CI -0.06 to 0.13) and may not increase the estimated glomerular filtration rate (eGFR) or creatinine clearance (6 studies, 822 participants; MD -2.56 mL/min, 95% CI -7.53 to 2.42). AUTHORS' CONCLUSIONS: In patients with resistant hypertension, there is low-certainty evidence that renal denervation does not improve major cardiovascular outomes and renal function. Conversely, moderate-certainty evidence exists that it may improve 24h ABPM and diastolic office-measured BP. Future trials measuring patient-centred instead of surrogate outcomes, with longer follow-up periods, larger sample size and more standardised procedural methods are necessary to clarify the utility of this procedure in this population.
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Affiliation(s)
- Anna Pisano
- Institute of Clinical Physiology, CNR - Italian National Council of Research, Reggio Calabria, Italy
| | | | - Antonio Leo
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Emilio Russo
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Coppolino
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Davide Bolignano
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
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5
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Kjeldsen SE, Narkiewicz K, Burnier M, Oparil S. The five RADIANCE-HTN and SPYRAL-HTN randomised studies suggest that the BP lowering effect of RDN corresponds to the effect of one antihypertensive drug. Blood Press 2021; 30:327-331. [PMID: 34714185 DOI: 10.1080/08037051.2021.1995975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, University of Oslo, Ullevaal Hospital, Oslo, Norway
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland
| | - Michel Burnier
- Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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6
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Schmieder RE. Renal denervation: where do we stand and what is the relevance to the nephrologist? Nephrol Dial Transplant 2020; 37:638-644. [DOI: 10.1093/ndt/gfaa237] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Indexed: 01/21/2023] Open
Abstract
Abstract
Catheter-based renal denervation to reduce high blood pressure (BP) has received well-deserved attention after a recent series of sham-controlled trials reported significant antihypertensive efficacy and very favourable tolerability and safety of the intervention. This emerging treatment option is of high relevance to nephrologists. Patients with chronic kidney disease (CKD) are at elevated risk of cardiovascular adverse events and often present with hypertension, which is very difficult to control with medication. Renal denervation promises a new tool to reduce BP and to prevent loss of renal function in this population. The current review considers the role of the kidney and neurohormonal activation in the development of hypertension and the rationale for renal denervation. The current state of the evidence for the effectiveness and tolerability of the procedure is considered from the nephrologists’ perspective, with a focus on the potential future role of renal denervation in the management of CKD patients with hypertension.
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Affiliation(s)
- Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany
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7
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Aronow HD, Sardar P. Renal Sympathetic Denervation for Hypertension: Outside-In and Inside-Out. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:538-539. [PMID: 32563528 DOI: 10.1016/j.carrev.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Herbert D Aronow
- Division of Cardiology, Warren Alpert Medical School at Brown University/Lifespan Cardiovascular Institute, Providence, RI, USA.
| | - Partha Sardar
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
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9
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Sardar P, Bhatt DL, Kirtane AJ, Kennedy KF, Chatterjee S, Giri J, Soukas PA, White WB, Parikh SA, Aronow HD. Sham-Controlled Randomized Trials of Catheter-Based Renal Denervation in Patients With Hypertension. J Am Coll Cardiol 2020; 73:1633-1642. [PMID: 30947915 DOI: 10.1016/j.jacc.2018.12.082] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are conflicting data regarding the relative effectiveness of renal sympathetic denervation (RSD) in patients with hypertension. OBJECTIVES The purpose of this study was to evaluate the blood pressure (BP) response after RSD in sham-controlled randomized trials. METHODS Databases were searched through June 30, 2018. Randomized trials (RCTs) with ≥50 patients comparing catheter-based RSD with a sham control were included. The authors calculated summary treatment estimates as weighted mean differences (WMD) with 95% confidence intervals (CIs) using random-effects meta-analysis. RESULTS The analysis included 977 patients from 6 trials. The reduction in 24-h ambulatory systolic blood pressure (ASBP) was significantly greater for patients treated with RSD than sham procedure (WMD -3.65 mm Hg, 95% CI: -5.33 to -1.98; p < 0.001). Compared with sham, RSD was also associated with a significant decrease in daytime ASBP (WMD -4.07 mm Hg, 95% CI: -6.46 to -1.68; p < 0.001), office systolic BP (WMD -5.53 mm Hg, 95% CI: -8.18 to -2.87; p < 0.001), 24-h ambulatory diastolic BP (WMD -1.71 mm Hg, 95% CI: -3.06 to -0.35; p = 0.01), daytime ambulatory diastolic BP (WMD -1.57 mm Hg, 95% CI: -2.73 to -0.42; p = 0.008), and office diastolic BP (WMD -3.37 mm Hg, 95% CI: -4.86 to -1.88; p < 0.001). Compared with first-generation trials, a significantly greater reduction in daytime ASBP was observed with RSD in second-generation trials (6.12 mm Hg vs. 2.14 mm Hg; p interaction = 0.04); however, this interaction was not significant for 24-h ASBP (4.85 mm Hg vs. 2.23 mm Hg; p interaction = 0.13). CONCLUSIONS RSD significantly reduced blood pressure compared with sham control. Results of this meta-analysis should inform the design of larger, pivotal trials to evaluate the long-term efficacy and safety of RSD in patients with hypertension.
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Affiliation(s)
- Partha Sardar
- Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, 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
| | - Kevin F Kennedy
- Mid America Heart and Vascular Institute, St. Luke's Hospital, Kansas City, Missouri
| | - Saurav Chatterjee
- Department of Cardiology, Saint Francis Hospital, Teaching Affiliate, University of Connecticut School of Medicine, Hartford, Connecticut
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter A Soukas
- Division of Cardiology, The Miriam Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - William B White
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Sahil A Parikh
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
| | - Herbert D Aronow
- Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island.
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Kjeldsen SE, Fadl Elmula FEM, Persu A. Future of Renal Sympathetic Denervation in the Treatment of Hypertension. J Am Coll Cardiol 2020; 73:1643-1645. [PMID: 30947916 DOI: 10.1016/j.jacc.2019.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Sverre E Kjeldsen
- Departments of Cardiology and Acute Medicine, Oslo University Hospital, Ullevaal, and the Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Fadl E M Fadl Elmula
- Departments of Cardiology and Acute Medicine, Oslo University Hospital, Ullevaal, and the Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Alexandre Persu
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, and Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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11
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Kiuchi MG, Ho JK, Lugo Gavidia LM, Schlaich MP. Shaping the future of renal denervation-the relevance of sham-controlled randomized trials and recent meta-analyses. Cardiovasc Diagn Ther 2020; 9:601-606. [PMID: 32038950 DOI: 10.21037/cdt.2019.07.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Márcio G Kiuchi
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, Australia
| | - Jan K Ho
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, Australia
| | - Leslie Marisol Lugo Gavidia
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia.,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
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12
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Sardar P, Aronow HD. Renal denervation for hypertension: we've come a long way! Cardiovasc Diagn Ther 2020; 9:607-608. [PMID: 32040094 DOI: 10.21037/cdt.2019.09.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Partha Sardar
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Herbert D Aronow
- Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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13
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Peixoto AJ. Is There a Role for Device Therapies in Resistant Hypertension?: The CON Side. KIDNEY360 2020; 1:9-13. [PMID: 35372851 PMCID: PMC8808493 DOI: 10.34067/kid.0000742019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Aldo J. Peixoto
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; and
- Hypertension Program, Yale New Haven Hospital Heart and Vascular Center, New Haven, Connecticut
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14
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Cheng X, Zhang D, Luo S, Qin S. Effect of Catheter-Based Renal Denervation on Uncontrolled Hypertension: A Systematic Review and Meta-analysis. Mayo Clin Proc 2019; 94:1695-1706. [PMID: 31402054 DOI: 10.1016/j.mayocp.2019.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 04/08/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of catheter-based renal denervation (RDN) for the treatment of uncontrolled hypertension by conducting a systematic review and a meta-analysis. METHODS The Medline, Cochrane Library, and Embase databases were searched for clinical studies between January 1, 2009, and July 16, 2018. Studies that evaluated the effect of RDN on uncontrolled hypertension were identified. The primary endpoints were changes in 24-hour ambulatory systolic blood pressure (BP) and office systolic BP. The secondary endpoints included changes in 24-hour ambulatory diastolic BP, office diastolic BP, and major adverse events. RESULTS After a literature search and detailed evaluation, 12 randomized controlled trials with a total of 1539 individuals were included in the quantitative analysis. Pooled analyses indicated that RDN was associated with a significantly greater reduction of 24-hour systolic BP (mean difference [MD], -4.02 mm Hg; 95% CI, -5.49 to -2.56; P<.001) and office systolic BP (MD, -8.93 mm Hg; 95% CI, -14.03 to -3.83; P<.001) than controls. Similarly, RDN significantly reduced 24-hour diastolic BP (MD, -2.05 mm Hg; 95% CI, -3.05 to -1.05; P<.001) and office diastolic BP (MD, -4.49 mm Hg; 95% CI, -6.46 to -2.52; P<.001). RDN was not associated with an increased risk of major adverse events (relative risk, 1.06; 95% CI, 0.72 to 1.57; P=.76). CONCLUSIONS Catheter-based RDN was associated with a significant BP-lowering benefit without increasing major adverse events.
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Affiliation(s)
- Xiaocheng Cheng
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dongying Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Suxin Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shu Qin
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Kvasnička J, Lambert L, Waldauf P, Zelinka T, Petrák O, Štrauch B, Holaj R, Indra T, Krátká Z, Klímová J, Václavík J, Kociánová E, Nykl I, Jiravský O, Rappová G, Táborský M, Branny M, Widimský J, Rosa J. (Prediction of long-term renal denervation efficacy). COR ET VASA 2019. [DOI: 10.1016/j.crvasa.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Agasthi P, Shipman J, Arsanjani R, Ashukem M, Girardo ME, Yerasi C, Venepally NR, Fortuin FD, Mookadam F. Renal Denervation for Resistant Hypertension in the contemporary era: A Systematic Review and Meta-analysis. Sci Rep 2019; 9:6200. [PMID: 30996305 PMCID: PMC6470219 DOI: 10.1038/s41598-019-42695-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/04/2019] [Indexed: 02/08/2023] Open
Abstract
Renal denervation (RDN) is a catheter-based ablation procedure designed to treat resistant hypertension (RH). The objective of our study is to determine the effect of RDN on blood pressure and renal function in patients with RH in comparison to medical therapy alone. We performed an extensive literature search for randomized control trials (RCT) reporting office and 24 hr. blood pressure changes and estimated glomerular filtration rate (eGFR) at baseline and 6 months. We calculated a weighted standardized mean difference of blood pressure and renal outcomes between RDN and control groups using random effects models. Our search yielded 608 studies of which we included 15 studies for the final analysis. A total of 857 patients were treated with RDN and 616 patients treated with medical therapy ± sham procedure. Only 5 studies were double-blinded RCT with sham control. The adjusted standardized mean difference in the change in office based systolic and diastolic pressures (p = 0.18; p = 0.14); 24 hr. systolic and diastolic pressures (p = 0.20; p = 0.18); and eGFR (p = 0.20) from baseline to 6 months is statistically insignificant with significant heterogeneity. Subgroup analysis showed that among sham controlled trials, 24 hr. systolic blood pressure showed a modest but statistically significant benefit favoring renal denervation in patients with RH. Our meta-analysis of 15 RCTs showed no significant benefit of RDN on blood pressure control in patients with resistant hypertension. Subgroup analysis of sham control studies showed a modest benefit in 24 hr. systolic blood pressure at 6 months with RDN.
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Affiliation(s)
- Pradyumna Agasthi
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA.
| | - Justin Shipman
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Reza Arsanjani
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Moses Ashukem
- Division of Cardiovascular Medicine, University of Arizona, Phoenix, Arizona, USA
| | - Marlene E Girardo
- Department of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Charan Yerasi
- Department of Cardiovascular Diseases, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nithin R Venepally
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Floyd David Fortuin
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Farouk Mookadam
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Wyatt CM, Textor SC. Emerging evidence on renal denervation for the treatment of hypertension. Kidney Int 2018; 94:644-646. [PMID: 30158056 DOI: 10.1016/j.kint.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/13/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Christina M Wyatt
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stephen C Textor
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
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18
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Kjeldsen SE, Narkiewicz K, Burnier M, Oparil S. Renal denervation achieved by endovascular delivery of ultrasound in RADIANCE-HTN SOLO or by radiofrequency energy in SPYRAL HTN-OFF and SPYRAL-ON lowers blood pressure. Blood Press 2018; 27:185-187. [DOI: 10.1080/08037051.2018.1486178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Sverre E. Kjeldsen
- Department of Cardiology, University of Oslo, Ullevaal Hospital, Oslo, Norway
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Burnier
- Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, AL, USA
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19
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Kjeldsen SE, Esler MD. Take a blood pressure pill or undergo renal denervation? Lancet 2018; 391:2298-2300. [PMID: 29803587 DOI: 10.1016/s0140-6736(18)31126-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 05/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Sverre E Kjeldsen
- Faculty of Medicine, University of Oslo, Oslo, Norway; Section for Cardiovascular and Renal Research and Department of Cardiology, Ullevaal University Hospital, Oslo N-0407, Norway.
| | - Murray D Esler
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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20
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de Jong MR, Hoogerwaard AF, Adiyaman A, Smit JJJ, Heeg JE, van Hasselt BAAM, Misier ARR, Elvan A. Renal nerve stimulation identifies aorticorenal innervation and prevents inadvertent ablation of vagal nerves during renal denervation. Blood Press 2018; 27:271-279. [DOI: 10.1080/08037051.2018.1463817] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mark R. de Jong
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | | | - Ahmet Adiyaman
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Jaap Jan J. Smit
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Jan-Evert Heeg
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | | | | | - Arif Elvan
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
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21
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George MJ, Marks DJB, Rezk T, Breckenridge R, Sofat R, Martin J, MacAllister R, Touyz RM, Staessen JA, Bursztyn M, Lappin D, Barigou M, Hingorani A. Resistant Hypertension: Trials and Tribulations. Hypertension 2018; 71:772-780. [PMID: 29610269 DOI: 10.1161/hypertensionaha.118.10864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marc J George
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Daniel J B Marks
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Tamer Rezk
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Ross Breckenridge
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Reecha Sofat
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - John Martin
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Raymond MacAllister
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Rhian M Touyz
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Jan A Staessen
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Michael Bursztyn
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - David Lappin
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Mohammed Barigou
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Aroon Hingorani
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
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22
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Jalil F, White WB. A New Era of Renal Denervation Trials for Patients With Hypertension? Am J Kidney Dis 2018; 71:615-618. [PMID: 29352604 DOI: 10.1053/j.ajkd.2017.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/08/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Fatima Jalil
- The University of Connecticut School of Medicine, Farmington, CT
| | - William B White
- The University of Connecticut School of Medicine, Farmington, CT.
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23
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Townsend RR, Mahfoud F, Kandzari DE, Kario K, Pocock S, Weber MA, Ewen S, Tsioufis K, Tousoulis D, Sharp ASP, Watkinson AF, Schmieder RE, Schmid A, Choi JW, East C, Walton A, Hopper I, Cohen DL, Wilensky R, Lee DP, Ma A, Devireddy CM, Lea JP, Lurz PC, Fengler K, Davies J, Chapman N, Cohen SA, DeBruin V, Fahy M, Jones DE, Rothman M, Böhm M. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet 2017; 390:2160-2170. [PMID: 28859944 DOI: 10.1016/s0140-6736(17)32281-x] [Citation(s) in RCA: 499] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous randomised renal denervation studies did not show consistent efficacy in reducing blood pressure. The objective of our study was to evaluate the effect of renal denervation on blood pressure in the absence of antihypertensive medications. METHODS SPYRAL HTN-OFF MED was a multicentre, international, single-blind, randomised, sham-controlled, proof-of-concept trial. Patients were enrolled at 21 centres in the USA, Europe, Japan, and Australia. Eligible patients were drug-naive or discontinued their antihypertensive medications. Patients with an office systolic blood pressure (SBP) of 150 mm Hg or greater and less than 180 mm Hg, office diastolic blood pressure (DBP) of 90 mm Hg or greater, and a mean 24-h ambulatory SBP of 140 mm Hg or greater and less than 170 mm Hg at second screening underwent renal angiography and were randomly assigned to renal denervation or sham control. Patients, caregivers, and those assessing blood pressure were blinded to randomisation assignments. The primary endpoint, change in 24-h blood pressure at 3 months, was compared between groups. Drug surveillance was done to ensure patient compliance with absence of antihypertensive medication. The primary analysis was done in the intention-to-treat population. Safety events were assessed at 3 months. This study is registered with ClinicalTrials.gov, number NCT02439749. FINDINGS Between June 25, 2015, and Jan 30, 2017, 353 patients were screened. 80 patients were randomly assigned to renal denervation (n=38) or sham control (n=42) and followed up for 3 months. Office and 24-h ambulatory blood pressure decreased significantly from baseline to 3 months in the renal denervation group: 24-h SBP -5·5 mm Hg (95% CI -9·1 to -2·0; p=0·0031), 24-h DBP -4·8 mm Hg (-7·0 to -2·6; p<0·0001), office SBP -10·0 mm Hg (-15·1 to -4·9; p=0·0004), and office DBP -5·3 mm Hg (-7·8 to -2·7; p=0·0002). No significant changes were seen in the sham-control group: 24-h SBP -0·5 mm Hg (95% CI -3·9 to 2·9; p=0·7644), 24-h DBP -0·4 mm Hg (-2·2 to 1·4; p=0·6448), office SBP -2·3 mm Hg (-6·1 to 1·6; p=0·2381), and office DBP -0·3 mm Hg (-2·9 to 2·2; p=0·8052). The mean difference between the groups favoured renal denervation for 3-month change in both office and 24-h blood pressure from baseline: 24-h SBP -5·0 mm Hg (95% CI -9·9 to -0·2; p=0·0414), 24-h DBP -4·4 mm Hg (-7·2 to -1·6; p=0·0024), office SBP -7·7 mm Hg (-14·0 to -1·5; p=0·0155), and office DBP -4·9 mm Hg (-8·5 to -1·4; p=0·0077). Baseline-adjusted analyses showed similar findings. There were no major adverse events in either group. INTERPRETATION Results from SPYRAL HTN-OFF MED provide biological proof of principle for the blood-pressure-lowering efficacy of renal denervation. FUNDING Medtronic.
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Affiliation(s)
- Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Felix Mahfoud
- Department of Internal Medicine III, University Hospital of Saarland, Saarland University, Homburg/Saar, Germany; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Kazuomi Kario
- Jichi Medical University School of Medicine, Tochigi, Japan
| | - Stuart Pocock
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sebastian Ewen
- Department of Internal Medicine III, University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
| | | | | | | | | | | | - Axel Schmid
- University Hospital Erlangen, Erlangen, Germany
| | - James W Choi
- Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Cara East
- Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Anthony Walton
- The Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | | | - Debbie L Cohen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Medtronic PLC, Santa Rosa, CA, USA
| | - Robert Wilensky
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David P Lee
- Stanford Hospital & Clinics, Stanford, CA, USA
| | - Adrian Ma
- Stanford Hospital & Clinics, Stanford, CA, USA
| | | | - Janice P Lea
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Karl Fengler
- University of Leipzig-Heart Center, Leipzig, Germany
| | - Justin Davies
- Imperial College and Hammersmith Hospital, Imperial, London, UK
| | - Neil Chapman
- Imperial College and Hammersmith Hospital, Imperial, London, UK
| | - Sidney A Cohen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Medtronic PLC, Santa Rosa, CA, USA
| | | | | | | | - Martin Rothman
- Medtronic PLC, Santa Rosa, CA, USA; Barts Health Trust, London, UK
| | - Michael Böhm
- Department of Internal Medicine III, University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
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24
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Bulsei J, Darlington M, Durand-Zaleski I, Azizi M. How to perform a cost-effectiveness analysis with surrogate endpoint: renal denervation in patients with resistant hypertension (DENERHTN) trial as an example. Blood Press 2017; 27:66-72. [DOI: 10.1080/08037051.2017.1394160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Julie Bulsei
- URC Eco IdF, Health Economics and Health Policy Research Unit, AP-HP Paris, Paris, France
| | - Meryl Darlington
- URC Eco IdF, Health Economics and Health Policy Research Unit, AP-HP Paris, Paris, France
| | | | - Michel Azizi
- INSERM, Centre d'Investigation Clinique, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hypertension Unit, Hôpital Européen Georges Pompidou, Paris, France
- Paris-Descartes University, Hypertension Unit, Paris, France
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25
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Abstract
Spironolactone has been marketed for over half a century as a ‘potassium-sparing diuretic’, used primarily in patients with ascites. With the realization that primary aldosteronism is the most common (5-13%) form of secondary hypertension, it has become widely used as a mineralocorticoid receptor antagonist. More recently, in the wake of the RALES trial, spironolactone in addition to standard therapy has been shown to be very beneficial in heart failure with a reduced ejection fraction. Despite the failure of the TOPCAT trial, spironolactone is being increasingly used in diastolic heart failure (i.e. with a preserved ejection fraction). The third currently accepted role for spironolactone is in hypertension resistant to three conventional antihypertensives including a diuretic, where it has been proven to be effective, in contra-distinction to renal artery denervation. Finally, brief consideration will be given to ‘areas in waiting’ – pulmonary hypertension/fibrosis, cancer – where spironolactone may play very useful roles.
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Affiliation(s)
- John W Funder
- Hudson Institute, Monash Medical Centre and Monash University, 27-31 Wright St Clayton, VIC, 3168, Australia
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26
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Jacobs L, Persu A, Huang QF, Lengelé JP, Thijs L, Hammer F, Yang WY, Zhang ZY, Renkin J, Sinnaeve P, Wei FF, Pasquet A, Fadl Elmula FEM, Carlier M, Elvan A, Wunder C, Kjeldsen SE, Toennes SW, Janssens S, Verhamme P, Staessen JA. Results of a randomized controlled pilot trial of intravascular renal denervation for management of treatment-resistant hypertension. Blood Press 2017; 26:321-331. [DOI: 10.1080/08037051.2017.1320939] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Lotte Jacobs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - 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
| | - Qi-Fang Huang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jean-Philippe Lengelé
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- Department of Nephrology, Grand Hôpital de Charleroi, Gilly, Belgium
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Frank Hammer
- Division of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jean Renkin
- 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
| | - Peter Sinnaeve
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Fang-Fei Wei
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Agnès Pasquet
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Marc Carlier
- Department of Cardiology, Grand Hôpital de Charleroi, Gilly, Belgium
| | - Arif Elvan
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Cora Wunder
- Department of Forensic Toxicology, Institute of Legal Medicine, University of Frankfurt, Frankfurt, Germany
| | - Sverre E. Kjeldsen
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Stefan W. Toennes
- Department of Forensic Toxicology, Institute of Legal Medicine, University of Frankfurt, Frankfurt, Germany
| | - Stefan Janssens
- Division of Cardiology, Department Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verhamme
- Division of Cardiology, Department Internal Medicine, University Hospitals Leuven, Leuven, Belgium
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan A. Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
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