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Fengler K, Rommel KP, Blazek S, Besler C, Hartung P, von Roeder M, Petzold M, Winkler S, Höllriegel R, Desch S, Thiele H, Lurz P. A Three-Arm Randomized Trial of Different Renal Denervation Devices and Techniques in Patients With Resistant Hypertension (RADIOSOUND-HTN). Circulation 2019; 139:590-600. [PMID: 30586691 DOI: 10.1161/circulationaha.118.037654] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Both radiofrequency and ultrasound endovascular renal sympathetic denervation (RDN) have proven clinical efficacy for the treatment of hypertension. We performed a head-to-head comparison of these technologies. METHODS Patients with resistant hypertension were randomly assigned in a 1:1:1 manner to receive either treatment with (1) radiofrequency RDN of the main renal arteries; (2) radiofrequency RDN of the main renal arteries, side branches, and accessories; or (3) an endovascular ultrasound-based RDN of the main renal artery. The primary end point was change in systolic daytime ambulatory blood pressure at 3 months. RESULTS Between June 2015 and June 2018, 120 patients were enrolled (mean age, 64±9 years±SD; mean daytime blood pressure, 153/86±12/13 mm Hg). Of these, 39 were randomly assigned to radiofrequency main renal artery ablation, 39 to combined radiofrequency ablation of the main artery and branches, and 42 to ultrasound-based treatment. Baseline daytime blood pressure, clinical characteristics, and treatment were well balanced between the groups. At 3 months, systolic daytime ambulatory blood pressure decreased by 9.5±12.3 mm Hg ( P<0.001) in the whole cohort. Although blood pressure was significantly more reduced in the ultrasound ablation group than in the radiofrequency ablation group of the main renal artery (-13.2±13.7 versus -6.5±10.3 mm Hg; mean difference, -6.7 mm Hg; global P=0.038 by ANOVA, adjusted P=0.043), no significant difference was found between the radiofrequency ablation groups (-8.3±11.7 mm Hg for additional side branch ablation; mean difference, -1.8 mm Hg; adjusted P>0.99). Similarly, the blood pressure reduction was not found to be significantly different between the ultrasound and the side branch ablation groups. Frequencies of blood pressure response ≥5 mm Hg were not significantly different (global P=0.77). CONCLUSIONS In patients with resistant hypertension, endovascular ultrasound-based RDN was found to be superior to radiofrequency ablation of the main renal arteries only, whereas a combined approach of radiofrequency ablation of the main arteries, accessories, and side branches was not. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT02920034.
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Affiliation(s)
- Karl Fengler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Karl-Philipp Rommel
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Stephan Blazek
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Philipp Hartung
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Maximilian von Roeder
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Martin Petzold
- Leipzig Heart Institute at Heart Center Leipzig, Germany (M.P.)
| | - Sindy Winkler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Robert Höllriegel
- Technische Universität Dresden, Heart Center Dresden University Hospital, Germany (R.H.)
| | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.)
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