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Schmieder RE, Mahfoud F, Mancia G, Narkiewicz K, Ruilope L, Hutton DW, Cao KN, Hettrick DA, Fahy M, Schlaich MP, Böhm M, Pietzsch JB. Clinical event reductions in high-risk patients after renal denervation projected from the global SYMPLICITY registry. Eur Heart J Qual Care Clin Outcomes 2023; 9:575-582. [PMID: 36057838 PMCID: PMC10495746 DOI: 10.1093/ehjqcco/qcac056] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/15/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
AIMS Renal denervation has been shown to lower blood pressure in sham-controlled trials and represents a device-based treatment option for hypertension. We sought to project clinical event reductions after radiofrequency renal denervation using a novel modelling approach. METHODS AND RESULTS The Global SYMPLICITY Registry is a global, prospective all-comer registry to evaluate safety and efficacy after renal denervation. For this analysis, change in office systolic blood pressure from baseline was calculated from reported follow-up in the Global SYMPLICITY Registry. Relative risks for death and other cardiovascular events as well as numbers needed to treat for event avoidance were obtained for the respective blood pressure reductions based on previously reported meta-regression analyses for the full cohort and high-risk subgroups including type 2 diabetes, chronic kidney disease, resistant hypertension, and high basal cardiovascular risk. Average baseline office systolic blood pressure and reduction estimates for the full cohort (N = 2651) were 166±25 and -14.8 ± 0.4 mmHg, respectively. Mean reductions in blood pressure ranged from -11.0--21.8 mmHg for the studied high-risk subgroups. Projected relative risks ranged from 0.57 for stroke in the resistant hypertension cohort to 0.92 for death in the diabetes cohort. Significant absolute reductions in major adverse cardiovascular events over 3 years compared with the projected control (8.6 ± 0.7% observed vs. 11.7 ± 0.9% for projected control; P < 0.01) were primarily due to reduced stroke incidence. The robustness of findings was confirmed in sensitivity and scenario analyses. CONCLUSION Model-based projections suggest radiofrequency renal denervation for patients with uncontrolled hypertension adds considerable clinical benefit across a spectrum of different cohort characteristics.
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Affiliation(s)
- Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Bavaria 91054, Germany
| | - Felix Mahfoud
- Internal Medicine and Cardiology, Saarland University Hospital, Homburg/Saar, Saarland 66421, Germany
| | - Giuseppe Mancia
- Department of Medicine, University of Milano-Bicocca, Monza, Lombardia 20126, Italy
| | - Krzysztof Narkiewicz
- Hypertension and Diabetology, Medical University of Gdansk, Gdansk 80-210, Poland
| | - Luis Ruilope
- Cardiorenal Investigation, Institute of Research, Hospital Universitario 12 de Octubre and CIBERCV and School of Doctoral Studies and Research, Universidad Europea de Madrid, Madrid 28041, Spain
| | - David W Hutton
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Khoa N Cao
- Wing Tech Inc., Menlo Park, CA 94025, USA
| | | | - Martin Fahy
- Coronary and Renal Denervation, Medtronic, Santa Rosa, CA 95403, USA
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine—Royal Perth Hospital Unit, The University of Western Australia, Perth, WA 6009, Australia
| | - Michael Böhm
- Internal Medicine and Cardiology, Saarland University Hospital, Homburg/Saar, Saarland 66421, Germany
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Mahfoud F, Mancia G, Schmieder RE, Ruilope L, Narkiewicz K, Schlaich M, Williams B, Ribichini F, Weil J, Almerri K, Sharif F, Lauder L, Wanten M, Fahy M, Böhm M. Outcomes Following Radiofrequency Renal Denervation According to Antihypertensive Medications: Subgroup Analysis of the Global SYMPLICITY Registry DEFINE. Hypertension 2023. [PMID: 37317866 DOI: 10.1161/hypertensionaha.123.21283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The Global SYMPLICITY Registry DEFINE investigates radiofrequency renal denervation (RDN) in a broad range of patients with hypertension. We evaluated whether the number or type of antihypertensive medications were associated with increased long-term blood pressure (BP) reductions and cardiovascular outcomes following radiofrequency RDN. METHODS Patients underwent radiofrequency RDN and were categorized by baseline number (0-3 and ≥4) and different combinations of medication classes. BP changes were compared between groups through 36 months. Individual and composite major adverse cardiovascular events were analyzed. RESULTS Of 2746 evaluable patients, 18% were prescribed 0 to 3 and 82% prescribed ≥4 classes. At 36 months, office systolic BP significantly decreased (P<0.0001) by -19.0±28.3 and -16.2±28.6 mm Hg in the 0 to 3 and ≥4 class groups, respectively. Twenty-four-hour mean systolic BP significantly decreased (P<0.0001) by -10.7±19.7 and -8.9±20.5 mm Hg, respectively. BP reduction was similar between the medication subgroups. Antihypertensive medication classes decreased from 4.6±1.4 to 4.3±1.5 (P<0.0001). Most decreased (31%) or had no changes (47%) to the number of medications, while 22% increased. The number of baseline antihypertensive medication classes was inversely related to the change in prescribed classes at 36 months (P<0.001). Cardiovascular event rates were generally low. More patients in the ≥4 compared with 0 to 3 medication classes had myocardial infarction at 36 months (2.8% versus 0.3%; P=0.009). CONCLUSIONS Radiofrequency RDN reduced BP safely through 36 months, independent of the number and type of baseline antihypertensive medication classes. More patients decreased than increased their number of medications. Radiofrequency RDN is a safe and effective adjunctive therapy regardless of antihypertensive medication regimen. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01534299.
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Affiliation(s)
- Felix Mahfoud
- Saarland University Hospital, Homburg, Germany (F.M., L.L., M.B.)
| | | | | | - Luis Ruilope
- Hospital Universitario 12 de Octubre and CIBERCV and School of Doctoral Studies and Research, Universidad Europea de Madrid, Spain (L.R.)
| | | | - Markus Schlaich
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit, The University of Western Australia (M.S.)
| | - Bryan Williams
- University College London and National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Flavio Ribichini
- Azienda Ospedaliera Universitaria Integrata Verona, Italy (F.R.)
| | | | | | - Faisal Sharif
- University Hospital Galway and National University of Ireland Galway (F.S.)
| | - Lucas Lauder
- Saarland University Hospital, Homburg, Germany (F.M., L.L., M.B.)
| | | | | | - Michael Böhm
- Saarland University Hospital, Homburg, Germany (F.M., L.L., M.B.)
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Mahfoud F, Mancia G, Schmieder RE, Ruilope L, Narkiewicz K, Schlaich M, Williams B, Ribichini F, Weil J, Kao HL, Rodriguez-Leor O, Noory E, Ong TK, Unterseeh T, de Araújo Gonçalves P, Zirlik A, Almerri K, Sharif F, Lauder L, Wanten M, Fahy M, Böhm M. Cardiovascular Risk Reduction After Renal Denervation According to Time in Therapeutic Systolic Blood Pressure Range. J Am Coll Cardiol 2022; 80:1871-1880. [DOI: 10.1016/j.jacc.2022.08.802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/12/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022]
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Rodriguez O, Mahfoud F, Schmieder R, Schlaich M, Narkiewicz K, Ruilope L, Williams B, Fahy M, Mancia G, Boehm M. Blood pressure reduction in higher cardiovascular risk patients in the Global SYMPLICITY Registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2209] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
The Global SYMPLICITY Registry (GSR) was designed to evaluate the safety and efficacy of renal denervation (RDN) in real-world patients. Inclusion and exclusion criteria are limited to allow assessment of the effects of RDN on patients with a wide range of comorbidities. The current analysis examines blood pressure (BP) reduction after RDN in higher cardiovascular risk patients.
Purpose
To evaluate blood pressure reduction after RDN in higher cardiovascular risk patients in GSR.
Methods
GSR is a prospective all-comers registry to evaluate the safety and efficacy of RDN. Patients are enrolled in GSR and receive radiofrequency RDN using the Symplicity Flex or Symplicity Spyral catheter. Office and ambulatory BP are measured at each follow-up (3, 6, 12, 24, and 36 months). In this post-hoc analysis, changes from baseline in office and 24-hour ambulatory systolic blood pressure were assessed in patients at higher cardiovascular risk. Higher risk was defined using baseline office systolic or diastolic BP as well as additional risk factors (Figure 1).
Results
As of March 2021, there were 2621 patients characterized as higher cardiovascular risk in GSR. Baseline characteristics included mean age 60.7±12.1 years, 57.6% male, 37.9% type 2 diabetes, 35.8% hypocholesterolemia, 19.7% eGFR <60 mL/min/1.73 m2, 16.2% left ventricular hypertrophy, 10.2% previous stroke and 9.3% previous myocardial infarction. Baseline office systolic BP (OSBP) was 168.8±22.7 mmHg and baseline ambulatory systolic BP (ASBP) 155.3±18.6 mmHg. Mean OSBP reductions after RDN in this higher risk population ranged from −13.1 mmHg at 3 months to −17.5 mmHg at 24 months and −18.9 mmHg at 36 months, and mean ASBP reductions ranged from −7.8 mmHg at 3 months to −9.8 mmHg at 24 months and −9.3 mmHg at 36 months (Figure).
Conclusions
Higher risk patients in GSR had sustained office and ambulatory systolic BP reductions out to 3 years after catheter-based radiofrequency RDN.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Medtronic
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Affiliation(s)
- O Rodriguez
- Germans Trias i Pujol Hospital , Barcelona , Spain
| | - F Mahfoud
- University hospital of Saarland (UKS) , Homburg/Saar , Germany
| | - R Schmieder
- University Hospital Erlangen , Erlangen , Germany
| | - M Schlaich
- The University of Western Australia , Perth , Australia
| | | | - L Ruilope
- University Hospital 12 de Octubre , Madrid , Spain
| | - B Williams
- University College of London , London , United Kingdom
| | - M Fahy
- Medtronic , Santa Rosa , United States of America
| | - G Mancia
- University of Milan-Bicocca , Monza , Italy
| | - M Boehm
- University hospital of Saarland (UKS) , Homburg/Saar , Germany
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Sarafidis P, Ruilope L, Anker SD, Agarwal R, Pitt B, Filippatos G, Rossing P, Tuttle K, Boletis I, Toto R, Wanner C, Zhi-Hong L, Ahlers C, Brinker M, Lawatscheck R, Joseph A, Bakris G. MO198: Outcomes with Finerenone in Patients with Stage 4 Chronic Kidney Disease and Type 2 Diabetes: A Fidelity Subgroup Analysis. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac066.100] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Patients with stage 4 chronic kidney disease (CKD) and type 2 diabetes (T2D) have a high residual risk of cardiovascular (CV) and kidney disease progression, and effective treatment options to reduce the risk are limited. The non-steroidal selective mineralocorticoid receptor antagonist finerenone has previously demonstrated significant cardiorenal benefits versus placebo in patients with stage 1–4 CKD [1–3]. This FIDELITY subgroup analysis investigated the effects of finerenone in patients with stage 4 CKD [estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2) versus those with stage 1–3 CKD (eGFR ≥ 30 mL/min/1.73 m2).
METHOD
FIDELIO-DKD and FIGARO-DKD were phase III trials of patients with CKD and T2D randomised 1:1 to finerenone or placebo. FIDELITY was an individual patient-level prespecified pooled efficacy and safety analysis of these studies. Efficacy outcomes included change in urine albumin-to-creatinine ratio (UACR) between baseline and month 4, change in eGFR over time, a kidney composite outcome (kidney failure, a sustained ≥57% decrease in eGFR from baseline over ≥ 4 weeks or renal death) and a CV composite outcome [CV death, non-fatal myocardial infarction, non-fatal stroke or hospitalization for heart failure (HHF)], as well as the individual components of these composite outcomes.
RESULTS
Of 13 023 patients included in the analysis, 890 patients (6.8%) had stage 4 CKD; key baseline characteristics are listed in Table 1. In patients with stage 4 CKD, finerenone reduced UACR by 31% vs placebo between baseline and month 4 [ratio of least-squares (LS) mean change 0.69; 95% confidence interval (CI) 0.63–0.77), an effect maintained for the duration of the study. Total eGFR slope (LS mean change in eGFR from randomisation to end of treatment) in patients with stage 4 CKD was –0.7 mL/min/1.73 m2/year with finerenone versus –1.6 mL/min/1.73 m2/year with placebo; the chronic eGFR slope (LS mean change in eGFR from month 4 to end of treatment) was –1.8 mL/min/1.73 m2/year with finerenone vs –3.2 mL/min/1.73 m2/year with placebo. The hazard ratio (HR) for risk of the kidney composite in stage 4 CKD was 1.01 (95% CI 0.75–1.37; Figure 1) for finerenone versus placebo. Reduction in risk of sustained ≥ 57% decrease in eGFR with finerenone (stage 4 CKD: HR 0.69, 95% CI 0.43–1.11) was similar between CKD subgroups (pinteraction = 0.71). Reduction in risk of the composite CV outcome (stage 4 CKD: HR 0.78, 95% CI 0.57–1.07) and HHF (stage 4 CKD: HR 0.99, 95% CI 0.62–1.58) was also consistent between CKD subgroups (pinteraction = 0.67 and 0.31, respectively). Overall, incidences of adverse events were balanced between treatment arms in patients with stage 4 CKD and stage 1–3 CKD. The incidence of hyperkalaemia leading to permanent discontinuation was low in patients with stage 4 CKD (3.2% versus 2.2% for finerenone versus placebo).
CONCLUSION
The cardiorenal benefits and safety profile of finerenone in FIDELITY were also observed in the subgroup of patients with stage 4 CKD.
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Affiliation(s)
- Pantelis Sarafidis
- Hippokration Hospital, Aristotle University of Thessaloniki, Department of Nephrology, Thessaloníki, Greece
| | - Luis Ruilope
- Institute of Research imas12, Cardiorenal Translational Laboratory and Hypertension Unit, Madrid, Spain
- Hospital Universitario 12 de Octubre, CIBER-CV, Madrid, Spain
- European University of Madrid, Faculty of Sport Sciences, Madrid, Spain
| | - Stefan D Anker
- German Centre for Cardiovascular Research Partner Site Berlin, Charité—Universitätsmedizin, Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
| | - Rajiv Agarwal
- Richard L. Roudebush VA Medical Center and Indiana University, Indianapolis, USA
| | - Bertram Pitt
- University of Michigan School of Medicine, Department of Medicine, Ann Arbor, USA
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark
| | - Katherine Tuttle
- Providence Medical Research Center, Providence Health Care, Spokane, USA
- University of Washington, Institute of Translational Health Sciences, Kidney Research Institute, and Nephrology Division, Seattle, USA
| | - Ioannis Boletis
- Athens, Greece
- Medical School, University of Athens, Laiko Hospital, Department of Nephrology and Renal Transplantation, Athens, Greece
| | - Robert Toto
- University of Texas Southwestern Medicine, Department of Internal Medicine, Dallas, USA
| | - Christoph Wanner
- University Hospital of Würzburg, Division of Nephrology, Würzburg, Germany
| | - Liu Zhi-Hong
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, P.R. China
| | | | - Meike Brinker
- Bayer AG, Cardiology and Nephrology Clinical Development, Wuppertal, Germany
| | - Robert Lawatscheck
- Bayer AG, Medical Affairs & Pharmacovigilance, Pharmaceuticals, Berlin, Germany
| | - Amer Joseph
- Bayer AG, Cardiology and Nephrology Clinical Development, Berlin, Germany
| | - George Bakris
- University of Chicago Medicine, Cardiology and Nephrology Clinical Development, Chicago, USA
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Schlaich M, Pietzsch JB, Mahfoud F, Wiliams B, Mancia G, Narkiewicz K, Ruilope L, Hettrick D, Böhm M, Schmieder RE. TCTAP A-048 Reduction of Clinical Events in High-Risk Hypertension Patients Treated With Renal Denervation: A Modeled Estimate From 36-Month Global SYMPLICTY Registry Data. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.03.070] [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: 11/29/2022]
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Mahfoud F, Mancia G, Ukena C, Schmieder R, Narkiewicz K, Ruilope L, Schlaich M, Williams B, Fahy M, Boehm M. Application of win ratio methodology in the Global SYMPLICITY Registry for patients with atrial fibrillation or obstructive sleep apnea. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2376] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
The win ratio is a new methodology which utilizes multiple hierarchical endpoints to evaluate clinical outcomes in trials. The win ratio may have added benefit in device therapy trials like renal denervation (RDN) where anti-hypertensive medication burden can influence blood pressure (BP) changes.
Purpose
In this analysis, we applied the win ratio to patients in the Global SYMPLICITY Registry (GSR) to quantify potential differences in RDN efficacy according to different comorbidities, specifically atrial fibrillation and obstructive sleep apnea.
Methods
All patients in GSR had an RDN procedure with the Symplicity Flex or Symplicity Spyral catheter. For the win ratio analysis, ambulatory systolic BP (ASBP) measurements, office systolic BP (OSBP) measurements and the number of prescribed anti-hypertensive medications at 6 months were included as hierarchical endpoints. Patients were divided into 1 of 2 groups: with or without atrial fibrillation (AF) at baseline. Each patient was compared with every other patient in the opposing group first according to ASBP to determine “win”, “lose” or “tie” with a threshold of 5 mmHg. Then, ties from the ASBP comparison underwent the comparison using OSBP with a threshold of 10 mmHg. Any tie for a pair comparing OSBP resulted in comparison of number of anti-hypertensive medications with a threshold of 1. Comparisons of ASBP and OSBP were adjusted for baseline SBPs by using residuals from a linear regression. The analysis was repeated for patients grouped according to history of obstructive sleep apnea (OSA) at baseline.
Results
In March 2020, 336 patients with AF at baseline and 2,394 patients with no AF were compared in GSR, resulting in 336 x 2394 = 804,384 pairwise comparisons for the win ratio analysis. A total of 285,709 “wins”, indicating greater ASBP reduction, OSBP reduction, and/or fewer number of anti-hypertensive medications occurred in the AF group compared to the no AF group. Conversely, 256,511 “losses”, meaning greater BP reduction and/or number of medications occurred in the no AF group. The win ratio was thus calculated as 1.11 (95% CI: 0.98, 1.28, p=0.081) indicating similar BP reduction and medication burden after RDN in patients with or without AF in GSR (Figure). Using these methods, the win ratio for patients with and without OSA was calculated to be 0.98 (95% CI: 0.85, 1.13, p=0.81), also indicating similar RDN efficacy regardless of presence of OSA at baseline (Figure). Previously published results of the win ratio analysis of RDN and sham control patients in the SPRYAL HTN-ON MED trial reported a win ratio in favor of RDN of 2.78 (95% CI: 1.58, 5.48, p<0.001).
Conclusions
Application of the win ratio methodology to patients in GSR demonstrated similar efficacy of RDN to patients regardless of whether they had comorbidities of atrial fibrillation or obstructive sleep apnea.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Medtronic
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Affiliation(s)
- F Mahfoud
- Saarland University Medical Center, Homburg/Saar, Germany
| | - G Mancia
- University of Milan-Bicocca, Milan, Italy
| | - C Ukena
- Saarland University Medical Center, Homburg/Saar, Germany
| | - R Schmieder
- University hospital Erlangen, Erlangen, Germany
| | | | - L Ruilope
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - B Williams
- University College London, London, United Kingdom
| | - M Fahy
- Medtronic, Santa Rosa, United States of America
| | - M Boehm
- Saarland University Medical Center, Homburg/Saar, Germany
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Ruilope L, Agarwal R, Anker SD, Filippatos G, Pitt B, Rossing P, Sarafidis P, Schmieder RE, Joseph A, Mentenich N, Nowack C, Bakris G. FC 090EFFECTS OF FINERENONE ON CARDIORENAL OUTCOMES IN BLOOD PRESSURE SUBGROUPS IN PATIENTS WITH CKD AND T2D. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab149.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Finerenone is a novel, selective, nonsteroidal mineralocorticoid receptor antagonist (MRA) that significantly reduced the risk of adverse kidney and cardiovascular (CV) outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the FIDELIO-DKD trial. In phase II studies, finerenone had modest effects on office blood pressure (BP) compared with the steroidal MRA spironolactone. We report an analysis of the relationship between baseline and changes in office systolic BP (SBP) and outcomes with finerenone in the FIDELIO-DKD trial.
Method
In FIDELIO-DKD, 5734 patients were randomised 1:1 to oral finerenone or placebo. Patients with T2D, urine albumin-to-creatine ratio (UACR) ≥30–<300 mg/g, estimated glomerular filtration rate (eGFR) ≥25–<60 ml/min/1.73 m2 and a history of diabetic retinopathy, or UACR ≥300–≤5000 mg/g and eGFR ≥25–<75 ml/min/1.73 m2, and treated with optimised renin–angiotensin system blockade were eligible. The primary endpoint was time to kidney failure, sustained eGFR decline ≥40% from baseline, or renal death. The key secondary endpoint was time to CV death, non-fatal myocardial infarction, non-fatal stroke, or hospitalisation for heart failure. A Cox proportional hazards model was used to investigate the relationship between treatments and efficacy outcomes adjusted for baseline SBP and change in SBP from baseline to month 4.
Results
A total of 5669 patients with available baseline SBP data were analysed. At baseline, the mean SBP and diastolic BP were 138.0 and 75.8 mmHg, respectively. Patients treated for hypertension at baseline received an average of 3.3 antihypertensive therapies. The study population was stratified by quartiles (Q) of SBP at baseline: ≤128.7 mmHg (Q1); >128.7–≤138.3 mmHg (Q2); >138.3–≤148.0 mmHg (Q3); and >148.0 mmHg (Q4). Patients in higher SBP categories tended to be older, with higher median UACR, but similar mean eGFR at baseline. Effects of finerenone, estimated as hazard ratios (HRs), were consistent across the quartiles for the primary endpoint (HR [95% CI]: Q1, 0.87 [0.66–1.15]; Q2, 0.76 [0.59–0.98]; Q3, 0.81 [0.65–1.02]; Q4, 0.86 [0.70–1.07]; p-value for interaction=0.87) and the key secondary endpoint (HR [95% CI]: Q1, 0.95 [0.69–1.29]; Q2, 0.81 [0.60–1.10]; Q3, 0.79 [0.60–1.03]; Q4, 0.91 [0.70–1.18]; p-value for interaction=0.78) (Figure). Finerenone treatment resulted in a modest reduction in SBP; over the duration of the trial, overall mean difference in SBP between treatment groups was –2.7 mmHg. Maximum differences in SBP between finerenone and placebo were observed at month 4; the mean change in SBP from baseline to month 4 across SBP quartiles were: Q1: 4.99 and 9.01 mmHg; Q2: –0.85 and 2.43 mmHg; Q3: –5.63 and –2.40 mmHg; Q4: –11.76 and –6.44 mmHg, for finerenone and placebo, respectively. Adjusting for baseline SBP and SBP change to month 4 resulted in small changes in treatment effect for the primary endpoint and the key secondary endpoint, with only slightly increased HRs for treatment compared with the unadjusted primary analysis (primary endpoint: HR: 0.85 vs 0.82; key secondary endpoint: HR: 0.90 vs 0.86) and no strong indication of an interaction between treatment and SBP.
Conclusion
In FIDELIO-DKD, a small proportion of the effect of finerenone on cardiorenal outcomes can be attributed to BP. However, most of the effect appears to be via BP-independent mechanisms. (Funded by Bayer AG; FIDELIO-DKD ClinicalTrials.gov number, NCT02540993)
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Affiliation(s)
- Luis Ruilope
- Institute of Research imas12, Cardiorenal Translational Laboratory and Hypertension Unit, Madrid, Spain
- University Hospital 12 de Octubre, CIBER-CV, Madrid, Spain
- European University of Madrid, Faculty of Sport Sciences, Madrid, Spain
| | - Rajiv Agarwal
- Indiana University, Richard L. Roudebush VA Medical Center, Indianapolis, United States of America
| | - Stefan D Anker
- Charité Universitätsmedizin, Department of Cardiology (CVK), and Berlin Institute of Health Center for Regenerative Therapies, German Centre for Cardiovascular Research Partner Site Berlin, Berlin, Germany
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, Attikon University Hospital, School of Medicine, Department of Cardiology, Athens, Greece
| | - Bertram Pitt
- University of Michigan School of Medicine, Department of Medicine, Ann Arbor, United States of America
| | - Peter Rossing
- Steno Diabetes Center, Copenhagen, Gentofte, Denmark
- University of Copenhagen, Department of Clinical Medicine, København, Denmark
| | - Pantelis Sarafidis
- Hippokration Hospital, Aristotle University of Thessaloniki, Department of Nephrology, Thessaloniki, Greece
| | - Roland E Schmieder
- University Hospital Erlangen, Department of Nephrology and Hypertension, Erlangen, Germany
| | - Amer Joseph
- Bayer AG, Cardiology and Nephrology Clinical Development, Berlin, Germany
| | | | - Christina Nowack
- Bayer AG, Research and Development, Clinical Development Operations, Wuppertal, Germany
| | - George Bakris
- University of Chicago Medicine, Department of Medicine, Chicago, United States of America
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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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10
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Pietzsch J, Mahfoud F, Williams B, Mancia G, Narkiewicz K, Ruilope L, Schlaich M, Hettrick D, Boehm M, Schmieder R. CLINICAL EVENT REDUCTIONS IN HIGH-RISK HYPERTENSION PATIENTS TREATED WITH RENAL DENERVATION: A MODEL-BASED ESTIMATE BASED ON 36-MONTH DATA FROM THE GLOBAL SYMPLICITY REGISTRY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03000-x] [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: 10/21/2022]
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11
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Agarwal R, Anker SD, Bakris G, Filippatos G, Pitt B, Rossing P, Ruilope L, Gebel M, Kolkhof P, Nowack C, Joseph A. Investigating new treatment opportunities for patients with chronic kidney disease in type 2 diabetes: the role of finerenone. Nephrol Dial Transplant 2020; 37:1014-1023. [PMID: 33280027 PMCID: PMC9130026 DOI: 10.1093/ndt/gfaa294] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
Despite the standard of care, patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) progress to dialysis, are hospitalized for heart failure and die prematurely. Overactivation of the mineralocorticoid receptor (MR) causes inflammation and fibrosis that damages the kidney and heart. Finerenone, a nonsteroidal, selective MR antagonist, confers kidney and heart protection in both animal models and Phase II clinical studies; the effects on serum potassium and kidney function are minimal. Comprising the largest CKD outcomes program to date, FIDELIO-DKD (FInerenone in reducing kiDnEy faiLure and dIsease prOgression in Diabetic Kidney Disease) and FIGARO-DKD (FInerenone in reducinG cArdiovascular moRtality and mOrbidity in Diabetic Kidney Disease) are Phase III trials investigating the efficacy and safety of finerenone on kidney failure and cardiovascular outcomes from early to advanced CKD in T2D. By including echocardiograms and biomarkers, they extend our understanding of pathophysiology; by including quality of life measurements, they provide patient-centered outcomes; and by including understudied yet high-risk cardiorenal subpopulations, they have the potential to widen the scope of therapy in T2D with CKD. Trial registration number: FIDELIO-DKD (NCT02540993) and FIGARO-DKD (NCT02545049)
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Affiliation(s)
- Rajiv Agarwal
- Richard L. Roudebush VA Medical Center and Indiana University, Indianapolis, IN, USA
| | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies, German Centre for Cardiovascular Research Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - George Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Luis Ruilope
- Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research imas12, Madrid, Spain.,IBER-CV, Hospital Universitario, 12 de Octubre, Madrid, Spain.,Faculty of Sport Sciences, European University of Madrid, Madrid, Spain
| | - Martin Gebel
- Research and Development, Statistics and Data Insights, Bayer AG, Berlin, Germany
| | - Peter Kolkhof
- Research and Development, Preclinical Research Cardiovascular, Bayer AG, Wuppertal, Germany
| | - Christina Nowack
- Research and Development, Clinical Development Operations, Bayer AG, Wuppertal, Germany
| | - Amer Joseph
- Cardiology and Nephrology Clinical Development, Bayer AG, Berlin, Germany
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12
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Mahfoud F, Böhm M, Schmieder R, Narkiewicz K, Ewen S, Ruilope L, Schlaich M, Williams B, Fahy M, Mancia G. Effects of renal denervation on kidney function and long-term outcomes: 3-year follow-up from the Global SYMPLICITY Registry. Eur Heart J 2020; 40:3474-3482. [PMID: 30907413 PMCID: PMC6837160 DOI: 10.1093/eurheartj/ehz118] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [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] [Received: 09/02/2018] [Revised: 11/01/2018] [Accepted: 02/20/2019] [Indexed: 12/12/2022] Open
Abstract
Aims Several studies and registries have demonstrated sustained reductions in blood pressure (BP) after renal denervation (RDN). The long-term safety and efficacy after RDN in real-world patients with uncontrolled hypertension, however, remains unknown. The objective of this study was to assess the long-term safety and efficacy of RDN, including its effects on renal function. Methods and results The Global SYMPLICITY Registry is a prospective, open-label registry conducted at 196 active sites worldwide in hypertensive patients receiving RDN treatment. Among 2237 patients enrolled and treated with the SYMPLICITY Flex catheter, 1742 were eligible for follow-up at 3 years. Baseline office and 24-h ambulatory systolic BP (SBP) were 166 ± 25 and 154 ± 18 mmHg, respectively. SBP reduction after RDN was sustained over 3 years, including decreases in both office (−16.5 ± 28.6 mmHg, P < 0.001) and 24-h ambulatory SBP (−8.0 ± 20.0 mmHg; P < 0.001). Twenty-one percent of patients had a baseline estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Between baseline and 3 years, renal function declined by 7.1 mL/min/1.73 m2 in patients without chronic kidney disease (CKD; eGFR ≥60 mL/min/1.73 m2; baseline eGFR 87 ± 17 mL/min/1.73 m2) and by 3.7 mL/min/1.73 m2 in patients with CKD (eGFR <60 mL/min/1.73 m2; baseline eGFR 47 ± 11 mL/min/1.73 m2). No long-term safety concerns were observed following the RDN procedure. Conclusion Long-term data from the Global SYMPLICITY Registry representing the largest available cohort of hypertensive patients receiving RDN in a real-world clinical setting demonstrate both the safety and efficacy of the procedure with significant and sustained office and ambulatory BP reductions out to 3 years. ![]()
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Affiliation(s)
- Felix Mahfoud
- Department of Internal Medicine, Saarland University Hospital, Geb. 41, Kirrberger Strasse 1, 66421 Homburg/Saar, Germany
| | - Michael Böhm
- Department of Internal Medicine, Saarland University Hospital, Geb. 41, Kirrberger Strasse 1, 66421 Homburg/Saar, Germany
| | - Roland Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Maximilianspl. 2, 91054 Erlangen, Germany
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Marii Skłodowska-Curie 3a, 80-210 Gdansk, Poland
| | - Sebastian Ewen
- Department of Internal Medicine, Saarland University Hospital, Geb. 41, Kirrberger Strasse 1, 66421 Homburg/Saar, Germany
| | - Luis Ruilope
- Department of Cardiovascular Risk, Hypertension Unit and Cardiorenal Translational Research Laboratory, Institute of Research i + 12, Hospital Universitario 12 de Octubre and CIBERCV, School of Doctoral Studies and Research, Universidad Europea de Madrid, Av. Cordoba, s/n, 28041 Madrid, Spain
| | - Markus Schlaich
- Department of Medicine, Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, The University of Western Australia, 197 Wellington St, Perth, WA 6000, Australia
| | - Bryan Williams
- Department of Medicine, Institute of Cardiovascular Sciences, University College London, National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, Gower St, Bloomsbury, London WC1E 6BT, UK
| | - Martin Fahy
- Coronary and Structural Heart Division, Medtronic PLC, 3576 Unocal Place, Santa Rosa, CA 95403, USA
| | - Giuseppe Mancia
- Professor Emeritus, University of Milano-Bicocca, P.za dei Daini, 4 - 20126 Milano, Italy
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13
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Mahfoud F, Mancia G, Schmieder R, Narkiewicz K, Ruilope L, Schlaich M, Whitbourn R, Zirlik A, Zeller T, Stawowy P, Cohen SA, Fahy M, Böhm M. Renal Denervation in High-Risk Patients With Hypertension. J Am Coll Cardiol 2020; 75:2879-2888. [DOI: 10.1016/j.jacc.2020.04.036] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/01/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
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Abstract
Since the association of microalbuminuria (MAU) with cardiovascular (CV) risk was described, a huge number of reports have emerged. MAU is a specific integrated marker of CV risk and targets organ damage in patients with hypertension, chronic kidney disease (CKD), and diabetes and its recognition is important for identifying patients at a high or very high global CV risk. The gold standard for diagnosis is albumin measured in 24-hour urine collection (normal values of less than 30 mg/day, MAU of 30 to 300 mg/day, macroalbuminuria of more than 300 mg/day) or, more practically, the determination of urinary albumin-to-creatinine ratio in a urine morning sample (30 to 300 mg/g). MAU screening is mandatory in individuals at risk of developing or presenting elevated global CV risk. Evidence has shown that intensive treatment could turn MAU into normoalbuminuria. Intensive treatment with the administration of an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker, in combination with other anti-hypertensive drugs and drugs covering other aspects of CV risk, such as mineralocorticoid receptor antagonists, new anti-diabetic drugs, and statins, can diminish the risk accompanying albuminuria in hypertensive patients with or without CKD and diabetes.
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Affiliation(s)
- Diego Francisco Márquez
- Unidad de Hipertensión Arterial-Servicio de Clínica Médica, Hospital San Bernardo, Salta, Argentina
| | - Gema Ruiz-Hurtado
- Instituto de Investigación Imas12 and Unidad de Hipertensión, Hospital 12 de Octubre, Madrid, Spain
| | - Julian Segura
- Instituto de Investigación Imas12 and Unidad de Hipertensión, Hospital 12 de Octubre, Madrid, Spain
| | - Luis Ruilope
- Instituto de Investigación Imas12 and Unidad de Hipertensión, Hospital 12 de Octubre, Madrid, Spain.,Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma, Madrid, Spain.,Escuela de Estudios Postdoctorales and Investigación, Universidad de Europa de Madrid, Madrid, Spain
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15
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Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. [2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)]. G Ital Cardiol (Rome) 2019; 19:3S-73S. [PMID: 30520455 DOI: 10.1714/3026.30245] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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Böhm M, Mahfoud F, Williams B, Ruilope L, Narkiewicz K, Schlaich M, Fahy M, Mancia G. TCT-84 Renal Denervation With Symplicity Spyral Catheter in the Global Symplicity Registry: Safety and Efficacy at 3 Years. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Mahfoud F, Mancia G, Schmieder R, Narkiewicz K, Ruilope L, Schlaich M, Williams B, Fahy M, Bohm M. 1199Reduction in blood pressure following renal denervation for patients with differing baseline cardiovascular risk. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Lowering blood pressure (BP) reduces clinical events. Renal denervation (RDN) is under investigation for treatment of uncontrolled hypertension and might represent a particularly attractive option for patients with high cardiovascular (CV) risk. To evaluate this proposal, it is important to determine whether baseline CV risk impacts the efficacy of RDN in lowering BP.
Purpose
We evaluated whether BP changes after RDN were dependent on baseline CV risk.
Methods
AHA/ACC Atherosclerosis CV Disease (ASCVD) risk score was calculated for patients in the Global Symplicity Registry (GSR; NCT01534299), a global registry of RDN in patients with uncontrolled hypertension, using baseline office systolic BP, total/HDL cholesterol measurements, diabetic and smoking status, gender, age, and number of baseline anti-hypertensive medications. Patients were separated into 3 groups based on ASCVD risk scores: <10%, ≥10% and <20% and ≥20%. Baseline demographics and 24-hour systolic BP changes at 6 months and 1, 2 and 3 years were compared between groups, as well as rates of adverse events at 3 years.
Results
Individual ASCVD risk scores were calculated for 1,434 patients in GSR. The median ASCVD risk score was 19.4% and 403 patients had a risk score of <10%, 326 a risk score of ≥10 and <20%, and 705 a risk score ≥20%. Patients with ASCVD risk score ≥20% had a higher baseline office systolic BP, were significantly older, and had higher rates of prior myocardial infarction and/or diabetes (all p<0.0001 compared to patients with lower risk scores). RDN reduced BP similarly across all groups of patients. Changes in 24-hour systolic BP at 6 months and 1, 2 and 3 years are shown in Figure 1. Adverse events at 3 years are shown in Table 1.
Adverse events at 3 years ASCVD risk score <10% ASCVD risk score ≥10% & <20% ASCVD risk score ≥20% p-value (N=265) (N=224) (N=468) Death 3 (1.1) 5 (2.2) 41 (8.8) <0.0001 Cardiovascular death 3 (1.1) 2 (0.9) 23 (4.9) 0.0017 Myocardial infarction 6 (2.3) 6 (2.7) 11 (2.4) 0.9513 Stroke 8 (3.0) 9 (4.0) 24 (5.1) 0.3894 Hospitalization for new onset heart failure 4 (1.5) 7 (3.1) 26 (5.6) 0.0194 Values are proportions reported as n (%).
Conclusions
BP changes after RDN were similar for patients with varying baseline ASCVD risk scores, suggesting uniform BP-lowering efficacy of RDN regardless of patients' baseline CV risk. The impact of baseline risk on clinical event reduction by RDN-induced BP reduction will need to be evaluated in further studies.
Acknowledgement/Funding
The Global SYMPLICITY Registry is funded by Medtronic.
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Affiliation(s)
- F Mahfoud
- Saarland University Hospital, Homburg, Germany
| | - G Mancia
- University of Milan-Bicocca, Monza, Italy
| | - R Schmieder
- University Hospital Erlangen, Erlangen, Germany
| | | | - L Ruilope
- University Hospital 12 de Octubre, Madrid, Spain
| | - M Schlaich
- The University of Western Australia, Perth, Australia
| | - B Williams
- University College Hospital, London, United Kingdom
| | - M Fahy
- Medtronic, Santa Rosa, United States of America
| | - M Bohm
- Saarland University Hospital, Homburg, Germany
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18
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Burnier M, Lin S, Ruilope L, Bader G, Durg S, Brunel P. Effect of angiotensin receptor blockers on blood pressure and renal function in patients with concomitant hypertension and chronic kidney disease: a systematic review and meta-analysis. Blood Press 2019; 28:358-374. [PMID: 31392910 DOI: 10.1080/08037051.2019.1644155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/13/2023]
Abstract
Objective: Angiotensin receptor blockers (ARB) are among the recommended first-line treatment options in patients with hypertension and chronic kidney disease (CKD). This meta-analysis evaluated the effect of ARB on blood pressure (BP) and renal function in patients with concomitant hypertension and CKD with or without diabetes.Methods: Literature search was performed in PubMed/MEDLINE, EMBASE and BIOSIS to identify parallel-group, randomized controlled trials (≥8 weeks) reporting the effects of ARB on office systolic/diastolic BP (SBP/DBP), estimated glomerular filtration rate (eGFR), serum creatinine (SCr), creatinine clearance (CrCl) or proteinuria in adults with hypertension and CKD. Mean difference (MD, generic inverse variance) with 95% confidence intervals (CIs) was used to report an outcome.Results: Among the 24 studies identified, 19 evaluated ARB as monotherapy, 4 evaluated ARB as combination therapy and one evaluated ARB both as monotherapy and combination therapy. Median (range) duration of the studies was 12 (1.84-54.0) months. ARB monotherapy significantly (p < 0.01) reduced BP (treatment ≥1 year: SBP [MD: -14.84 mmHg; 95% CI: -17.82 to -11.85]/DBP [-10.27 mmHg; -12.26 to -8.27]) and proteinuria (≥1 year [-0.90 g/L; -1.22 to -0.59]). Results were consistent for combination therapy. In these studies, non-significant changes were observed for eGFR, CrCl and SCr. The impact of SBP changes on eGFR was not significant; however, studies were of a relatively short duration.Conclusion: ARB had a favorable impact on BP and renal parameters such as proteinuria with monotherapy as well as with combination therapy, highlighting their potential benefits in patients with hypertension and CKD. During the short follow-up of these studies, no significant change in eGFR was observed.
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Affiliation(s)
- Michel Burnier
- Service of Nephrology, University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Shanyan Lin
- Huashan Hospital, Fudan University, Shanghai, China
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19
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Alexandrou ME, Sarafidis P, Loutradis C, Tsapas A, Boutou A, Piperidou A, Papadopoulou D, Papagianni A, Ruilope L, Bakris G. FP172EFFECTS OF MINERALOCORTICOID RECEPTOR ANTAGONISTS IN PROTEINURIC KIDNEY DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp172] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Pantelis Sarafidis
- Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Apostolos Tsapas
- Clinical Research and Evidence Based Medicine Unit, Aristotle Univesrity of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- General Hospital of Thessaloniki "George Papanikolaou", Thessaloniki, Greece
| | - Alexia Piperidou
- Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Luis Ruilope
- University Hospital 12 de Octubre, Madrid, Spain
| | - George Bakris
- University of Chicago Medicine, Chicago, United States of America
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20
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Mahfoud F, Mancia G, Schmieder R, Narkiewicz K, Ruilope L, Schlaich M, Williams B, Whitbourn R, Zirlik A, Zeller T, Fahy M, Boehm M. SUBGROUP ANALYSIS OF LONG-TERM BLOOD PRESSURE REDUCTION IN THE GLOBAL SYMPLICITY REGISTRY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32329-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. [2018 ESC/ESH Guidelines for the management of arterial hypertension]. Kardiol Pol 2019; 77:71-159. [PMID: 30816983 DOI: 10.5603/kp.2019.0018] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Bryan Williams
- Institute of Cardiovascular Science, University College London, Maple House, 1st Floor, Suite A, 149 Tottenham Court Road, W1T 7DN London, United Kingdom.
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22
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Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement D, Coca A, De Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen S, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder R, Shlyakhto E, Tsioufis K, Aboyans V, Desormais I. 2018 Practice guidelines for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Blood Press 2018; 27:314-340. [DOI: 10.1080/08037051.2018.1527177] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Bryan Williams
- University College London, London UCL, London, United Kingdom of Great Britain and Northern Ireland
| | - Giuseppe Mancia
- IRCCS Instituto Auxologico Italiano, University of Milano-Bicocca, Milano, Italy
| | - Wilko Spiering
- Department of Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Enrico Agabiti Rosei
- Universita degli Studi di Brescia Aree Disciplinari Medicina e Chirurgia, Brescia, Italy
| | | | - Michel Burnier
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Antonio Coca
- School of Medicine, University of Barcelona, Barcelona, Spain
| | - Giovanni De Simone
- Hypertension Research Center (CIRIAPA), Department of Translational Medical Sciences, Federico II University Hospital, Napoli, Italy
| | - Anna Dominiczak
- University of Glasgow, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | | | | | - Josep Redon
- Servicio de Medicina Interna del Hospital Clínico de Valencia, Catedrático de Medicina de la Universidad de Valencia, Valencia, Spain
| | | | | | | | - Sverre Kjeldsen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Reinhold Kreutz
- Institut für Klinische Pharmakologie und Toxikologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | - Gregory Y. H. Lip
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Richard McManus
- Nuffield Department of Primary Care, Nuffield, United Kingdom of Great Britain and Northern Ireland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Frank Ruschitzka
- Department of Cardiology, University of Zurich, Zurich, Switzerland
| | - Roland Schmieder
- Abteilung für Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Evgeny Shlyakhto
- Almazov Federal Heart, Blood and Endocrinology Centre, St Petersburg, Russian Federation
| | - Konstantinos Tsioufis
- Hippokration Hospital, First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France
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23
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Drawz PE, Brown R, De Nicola L, Fujii N, Gabbai FB, Gassman J, He J, Iimuro S, Lash J, Minutolo R, Phillips RA, Rudser K, Ruilope L, Steigerwalt S, Townsend RR, Xie D, Rahman M. Variations in 24-Hour BP Profiles in Cohorts of Patients with Kidney Disease around the World: The I-DARE Study. Clin J Am Soc Nephrol 2018; 13:1348-1357. [PMID: 29976600 PMCID: PMC6140571 DOI: 10.2215/cjn.13181117] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/24/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Ambulatory BP is increasingly recognized as a better measure of the risk for adverse outcomes related to hypertension, an important comorbidity in patients with CKD. Varying definitions of white-coat and masked hypertension have made it difficult to evaluate differences in prevalence of these BP patterns across CKD cohorts. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The International Database of Ambulatory BP in Renal Patients collaborative group established a large database of demographic, clinical, and ambulatory BP data from patients with CKD from cohorts in Italy, Spain, the Chronic Renal Insufficiency Cohort (CRIC) and the African American Study of Kidney Disease and Hypertension Cohort Study (AASK) in the United States, and the CKD Japan Cohort (CKD-JAC). Participants (n=7518) with CKD were included in the present analyses. Cutoffs for defining controlled BP were 140/90 mm Hg for clinic and 130/80 mm Hg for 24-hour ambulatory BP. RESULTS Among those with controlled clinic BP, compared with CKD-JAC, AASK participants were more likely to have masked hypertension (prevalence ratio [PR], 1.21; 95% confidence interval [95% CI], 1.04 to 1.41) whereas CRIC (PR, 0.82; 0.72 to 0.94), Italian (PR, 0.73; 0.56 to 0.95), and Spanish participants (PR, 0.75; 0.64 to 0.88) were less likely. Among those with elevated clinic BP, AASK participants were more likely to have sustained hypertension (PR, 1.22; 95% CI, 1.13 to 1.32) whereas Italian (PR, 0.78; 0.70 to 0.87) and Spanish participants (PR, 0.89; 0.82 to 0.96) were less likely, although CRIC participants had similar prevalence as CKD-JAC. Prevalence of masked and sustained hypertension was elevated in males, patients with diabetes, participants on four or more antihypertensives, and those with moderate-to-severe proteinuria. CONCLUSIONS In a large, multinational database, the prevalence of masked and sustained hypertension varied across cohorts independent of important comorbidities.
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Affiliation(s)
| | - Roland Brown
- Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Luca De Nicola
- Division of Nephrology, University of Campania L. Vanvitelli, Naples, Italy
| | - Naohiko Fujii
- Nephrology Unit, Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan
| | - Francis B. Gabbai
- Division of Nephrology-Hypertension, VA San Diego Healthcare System and University of California, San Diego, California
| | - Jennifer Gassman
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Satoshi Iimuro
- Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - James Lash
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois
| | - Roberto Minutolo
- Division of Nephrology, University of Campania L. Vanvitelli, Naples, Italy
| | - Robert A. Phillips
- Department of Cardiology, Houston Methodist, Houston, Texas
- Weill Cornell Medical College, New York, New York
| | - Kyle Rudser
- Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Luis Ruilope
- Department of Internal Medicine, Hypertension Unit and Institute of Research, Hospital 12 de Octubre, Madrid, Spain
- Department Preventive Medicine and Public Health, Universidad Autonoma, Madrid, Spain
- School of Doctoral Studies and Research, Universidad Europea, Madrid, Spain
| | | | | | - Dawei Xie
- Department of Biostatistics, Epidemiology and Informatics and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Mahboob Rahman
- Department of Medicine, Case Western University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
| | - the CRIC Study Investigators
- Divisions of Renal Diseases and Hypertension and
- Biostatistics, University of Minnesota, Minneapolis, Minnesota
- Division of Nephrology, University of Campania L. Vanvitelli, Naples, Italy
- Nephrology Unit, Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan
- Division of Nephrology-Hypertension, VA San Diego Healthcare System and University of California, San Diego, California
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois
- Department of Cardiology, Houston Methodist, Houston, Texas
- Weill Cornell Medical College, New York, New York
- Department of Internal Medicine, Hypertension Unit and Institute of Research, Hospital 12 de Octubre, Madrid, Spain
- Department Preventive Medicine and Public Health, Universidad Autonoma, Madrid, Spain
- School of Doctoral Studies and Research, Universidad Europea, Madrid, Spain
- Department of Medicine, Universidad Europea, Ann Arbor, Michigan
- Renal, Electrolyte and Hypertension Division and
- Department of Biostatistics, Epidemiology and Informatics and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
- Department of Medicine, Case Western University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
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24
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Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021-3104. [PMID: 30165516 DOI: 10.1093/eurheartj/ehy339] [Citation(s) in RCA: 5359] [Impact Index Per Article: 893.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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25
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Ruiz Hurtado G, Fernandez-Velasco M, Delgado C, Val-Blasco A, Rodriguez Sanchez E, Aceves-Ripoll J, Gonzalez-Lafuente L, Ruilope L, Navarro-Garcia JA. P929Soluble klotho, an antiaging factor, prevents cardiomyocyte calcium mishandling and arrhythmia in an experimental model of chronic kidney disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p929] [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)
- G Ruiz Hurtado
- University Hospital 12 de Octubre, Cardiorenal Translational Laboratory, Madrid, Spain
| | | | - C Delgado
- 3Instituto de Investigaciones Biomédicas Alberto Sols, CSIC, Madrid, Spain
| | | | - E Rodriguez Sanchez
- University Hospital 12 de Octubre, Cardiorenal Translational Laboratory, Madrid, Spain
| | - J Aceves-Ripoll
- University Hospital 12 de Octubre, Cardiorenal Translational Laboratory, Madrid, Spain
| | - L Gonzalez-Lafuente
- University Hospital 12 de Octubre, Cardiorenal Translational Laboratory, Madrid, Spain
| | - L Ruilope
- University Hospital 12 de Octubre, Cardiorenal Translational Laboratory, Madrid, Spain
| | - J A Navarro-Garcia
- University Hospital 12 de Octubre, Cardiorenal Translational Laboratory, Madrid, Spain
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Affiliation(s)
| | - Carlos Baladrón
- i+HeALTH, European University Miguel de Cervantes, Valladolid 47012, Spain
| | | | | | - Luis Ruilope
- Cardiovascular Risk and Cardiovascular Risk Group, Research Institute of Hospital 12 de Octubre, Madrid, Spain
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27
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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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28
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Affiliation(s)
| | | | - Luis Ruilope
- Research Institute of Hospital 12 de Octubre (i+12), Cardiovascular Risk and Cardiovascular Risk Group, Madrid, Spain
| | - Yannis P Pitsiladis
- Centre for Sport and Exercise Science and Medicine (SESAME), University of Brighton, Eastbourne BN20 7SN, UK.
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Abstract
Suboptimal drug adherence represents a major challenge to effective primary and secondary prevention of cardiovascular disease. While adherence is influenced by multiple considerations, polypharmacy and dosing frequency appear to be rate-limiting factors in patient satisfaction and subsequent adherence. The cardiovascular and metabolic therapeutic areas have recently benefited from a number of advances in drug therapy, in particular protease proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and incretin-based therapies, respectively. These drugs are administered subcutaneously and offer efficacious treatment options with reduced dosing frequency. Whilst patients with diabetes and diabetologists are well initiated to injectable therapies, the cardiovascular therapeutic arena has traditionally been dominated by oral agents. It is therefore important to examine the practical aspects of treating patients with these new lipid-lowering agents, to ensure they are optimally deployed in everyday clinical practice.
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Affiliation(s)
- Franck Boccara
- Cardiology Unit, Hôpital Saint-Antoine, AP-HP, Hôpitaux de l'Est Parisien, Paris, France.
- INSERM, UMR_S 938, Faculty of Medicine, Sorbonne Universities, UPMC University Paris 06, Paris, France.
| | - Ricardo Dent
- Amgen (Europe) GmbH, Zug, Switzerland
- Esperion Therapeutics Inc, Ann Arbor, MI, USA
| | - Luis Ruilope
- Institute of Research, Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain
| | - Paul Valensi
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, APHP, CRNH-IdF, CINFO, Paris Nord University, Bondy, France
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30
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Burnier M, Lin S, Ruilope L, Brunel P. P1348The role of angiotensin receptor blockers in the treatment of patients with hypertension and chronic kidney disease: a systematic review of clinical trials. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1348] [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: 11/14/2022] Open
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31
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Sarafidis PA, Persu A, Agarwal R, Burnier M, de Leeuw P, Ferro CJ, Halimi JM, Heine GH, Jadoul M, Jarraya F, Kanbay M, Mallamaci F, Mark PB, Ortiz A, Parati G, Pontremoli R, Rossignol P, Ruilope L, Van der Niepen P, Vanholder R, Verhaar MC, Wiecek A, Wuerzner G, London GM, Zoccali C. Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH). Nephrol Dial Transplant 2017; 32:620-640. [PMID: 28340239 DOI: 10.1093/ndt/gfw433] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [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: 11/12/2016] [Accepted: 11/14/2016] [Indexed: 01/07/2023] Open
Abstract
In patients with end-stage renal disease (ESRD) treated with haemodialysis or peritoneal dialysis, hypertension is common and often poorly controlled. Blood pressure (BP) recordings obtained before or after haemodialysis display a J- or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar haemodynamic setting related to dialysis treatment. Elevated BP detected by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnoea and the use of erythropoietin-stimulating agents may also be involved. Non-pharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium and volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient's comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the diagnosis, epidemiology, pathogenesis and treatment of hypertension in patients on dialysis, aiming to offer the renal physician practical recommendations based on current knowledge and expert opinion and to highlight areas for future research.
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Affiliation(s)
- Pantelis A Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandre Persu
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, and Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Rajiv Agarwal
- Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA
| | - Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
| | - Peter de Leeuw
- Department of Medicine, Maastricht University Medical Center, Maastricht and Zuyderland Medical Center, Geleen/Heerlen, The Netherlands
| | - Charles J Ferro
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jean-Michel Halimi
- Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, François-Rabelais University, Tours, France
| | - Gunnar H Heine
- Saarland University Medical Center, Internal Medicine IV-Nephrology and Hypertension, Homburg, Germany
| | - Michel Jadoul
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Faical Jarraya
- Department of Nephrology, Sfax University Hospital and Research Unit, Faculty of Medicine, Sfax University, Sfax, Tunisia
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT and REDINREN, Madrid, Spain
| | - Gianfranco Parati
- Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano and Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Roberto Pontremoli
- Università degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - Patrick Rossignol
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, UMR 1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists, and Association Lorraine de Traitement de l'Insuffisance Rénale, Nancy, France
| | - Luis Ruilope
- Hypertension Unit & Institute of Research i?+?12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Patricia Van der Niepen
- Department of Nephrology and Hypertension, Universitair Ziekenhuis Brussel - VUB, Brussels, Belgium
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Gent, Belgium
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice, Poland
| | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Carmine Zoccali
- CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy
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Abstract
Arterial hypertension and chronic kidney disease (CKD) are intimately related. The control of blood pressure (BP) levels is strongly recommended in patients with CKD in order to protect the kidney against the accompanying elevation in global cardiovascular (CV) risk. Actually, the goal BP in patients with CKD involves attaining values <140/90 mmHg except if albuminuria is present. In this case, it is often recommended to attain values <130/80 mmHg, although some guidelines still recommend <140/90 mmHg. Strict BP control to values of systolic BP around 120 mmHg was recently shown to be safe in CKD according to data from the SPRINT trial, albeit more data confirming this benefit are required. Usually, combination therapy initiated with an angiotensin receptor blocker (ARB) or angiotensin-converting enzyme inhibitor (ACEi) and commonly followed by the addition of a calcium channel blocker and a diuretic is needed. Further studies are required as well as new drugs in particular after the positive data obtained from new oral anti-diabetic drugs.
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Affiliation(s)
- Diego F Marquez
- Unidad de Hipertensión Arterial, Servicio de Medicina Clínica, Hospital San Bernardo, Salta, Argentina
| | - Gema Ruiz-Hurtado
- Instituto de Investigación Imas12 and Unidad de Hipertensión, Hospital 12 de Octubre, Madrid, Spain
| | - Luis Ruilope
- Instituto de Investigación Imas12 and Unidad de Hipertensión, Hospital 12 de Octubre, Madrid, Spain.,Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma, Madrid, Spain.,Escuela de Estudios Postdoctorales and Investigación, Universidad de Europa de Madrid, Madrid, Spain
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33
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Mahfoud F, Brilakis N, Böhm M, Narkiewicz K, Ruilope L, Schlaich M, Mancia G. TCT-761 Long-term (3-year) safety and effectiveness from the Global SYMPLICITY Registry of renal denervation in a real world patient population with uncontrolled hypertension. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Böhm M, Brilakis N, Mancia G, Narkiewicz K, Ruilope L, Schlaich M, Mahfoud F. TCT-762 Renal denervation treatment with the Symplicity Spyral multielectrode catheter: 6-month safety and blood pressure outcomes from the Global SYMPLICITY Registry. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.792] [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: 10/20/2022]
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35
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Hoshide S, Kario K, de la Sierra A, Bilo G, Schillaci G, Banegas JR, Gorostidi M, Segura J, Lombardi C, Omboni S, Ruilope L, Mancia G, Parati G. Ethnic Differences in the Degree of Morning Blood Pressure Surge and in Its Determinants Between Japanese and European Hypertensive Subjects. Hypertension 2015; 66:750-6. [DOI: 10.1161/hypertensionaha.115.05958] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/29/2015] [Indexed: 12/22/2022]
Abstract
Morning blood pressure (BP) surge has been reported to be a prognostic factor for cardiovascular events. Its determinants are still poorly defined, however. In particular, it is not clear whether ethnic differences play a role in determining morning surge (MS) size. Aim of our study was to explore whether differences exist in the size of MS between Japanese and Western European hypertensive patients. We included 2887 untreated hypertensive patients (age 62.3±8.8 years) from a European ambulatory BP monitoring database and 811 hypertensive patients from a Japanese database (Jichi Medical School Ambulatory Blood Pressure Monitoring WAVE1, age 72.3±9.8 years) following the same inclusion criteria. Their 24-hour ambulatory BP monitoring recordings were analyzed focusing on MS. Sleep-trough MS was defined as the difference between mean systolic BP during the 2 hours after awakening and mean systolic BP during the 1-hour night period that included the lowest sleep BP level. The sleep-trough MS was higher in Japanese than in European hypertensive patients after adjusting for age and 24-hour mean BP levels (40.1 [95% confidence interval 39.0–41.2] versus 23.0 [22.4–23.5] mm Hg;
P
<0.001). This difference remained significant after accounting for differences in night-time BP dipping. Age was independently associated with MS in the Japanese database, but not in the European subjects. Our results for the first time show the occurrence of substantial ethnic differences in the degree of MS. These findings may help in understanding the role of ethnic factors in cardiovascular risk assessment and in identifying possible ethnicity-related differences in the most effective measures to be implemented for prevention of BP-related cardiovascular events.
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Affiliation(s)
- Satoshi Hoshide
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Kazuomi Kario
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Alejandro de la Sierra
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Grzegorz Bilo
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Giuseppe Schillaci
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - José Ramón Banegas
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Manuel Gorostidi
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Julian Segura
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Carolina Lombardi
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Stefano Omboni
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Luis Ruilope
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Giuseppe Mancia
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
| | - Gianfranco Parati
- From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and
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Erdmann E, Califf R, Gerstein HC, Malmberg K, Ruilope L, Schwartz GG, Wedel H, Volz D, Ditmarsch M, Svensson A, Bengus M. Effects of the dual peroxisome proliferator-activated receptor activator aleglitazar in patients with Type 2 Diabetes mellitus or prediabetes. Am Heart J 2015; 170:117-22. [PMID: 26093872 DOI: 10.1016/j.ahj.2015.03.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 12/12/2014] [Accepted: 03/31/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Insulin-resistant states, including type 2 diabetes (T2D) and prediabetes, are associated with elevated cardiovascular (CV) risk. Aleglitazar is a dual peroxisome proliferator-activated receptor α/γ agonist with favorable insulin-sensitizing and glucose-lowering actions, favorable effects on blood lipids, and an acceptable safety profile in short-time studies. Therefore, it was hypothesized that aleglitazar would reduce CV morbidity and mortality in patients with T2D mellitus and prediabetes (defined as glycosylated hemoglobin ≥5.7% to <6.5%) with previous CV complications. STUDY DESIGN ALEPREVENT was a phase III, multicenter, randomized, double-blind, trial comparing aleglitazar 150 μg or placebo daily in patients with T2D or prediabetes with established, stable CV disease. The intended sample size was 19,000 with a primary efficacy measure of major adverse CV events. However, the trial was halted prematurely after 1,999 patients had been randomized because of futility and an unfavorable benefit risk ratio in another CV outcomes trial evaluating aleglitazar. RESULTS At study termination after 58 ± 38 days of treatment, data had been collected from 1,996 patients (1,581 with T2D and 415 with pre-T2D). Despite the brief duration of treatment, aleglitazar induced favorable changes in glycosylated hemoglobin and blood lipids, similar for participants with T2D or prediabetes. However, compared with placebo, aleglitazar increased the incidence of hypoglycemia (86 vs 166; P < .0001), and muscular events (3 vs12; P = .012). CONCLUSIONS Even within a short duration of exposure, aleglitazar was associated with excess adverse events, corroborating the findings of a larger and longer trial in T2D. Coupled with the previous failure of several other peroxisome proliferator-activated receptor α/γ activators, this class now holds little promise for CV therapeutics.
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Affiliation(s)
| | | | - Hertzel C Gerstein
- Department of Medicine and Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Klas Malmberg
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden; F Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Luis Ruilope
- Unidad de Hipertensión, Hospital 12 de Octubre, Madrid, Spain
| | | | - Hans Wedel
- Nordic School of Public Health, Frolunda, Sweden
| | | | - Marc Ditmarsch
- Former, F Hoffmann-La Roche Ltd; Current, Astra Zeneca, Mölndal, Sweden
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37
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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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Böhm M, Mahfoud F, Ukena C, Hoppe UC, Narkiewicz K, Negoita M, Ruilope L, Schlaich MP, Schmieder RE, Whitbourn R, Williams B, Zeymer U, Zirlik A, Mancia G. First report of the Global SYMPLICITY Registry on the effect of renal artery denervation in patients with uncontrolled hypertension. Hypertension 2015; 65:766-74. [PMID: 25691618 DOI: 10.1161/hypertensionaha.114.05010] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [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: 01/27/2023]
Abstract
UNLABELLED This study aimed to assess the safety and effectiveness of renal denervation using the Symplicity system in real-world patients with uncontrolled hypertension (NCT01534299). The Global SYMPLICITY Registry is a prospective, open-label, multicenter registry. Office and 24-hour ambulatory blood pressures (BPs) were measured. Change from baseline to 6 months was analyzed for all patients and for subgroups based on baseline office systolic BP, diabetic status, and renal function; a cohort with severe hypertension (office systolic pressure, ≥160 mm Hg; 24-hour systolic pressure, ≥135 mm Hg; and ≥3 antihypertensive medication classes) was also included. The analysis included protocol-defined safety events. Six-month outcomes for 998 patients, including 323 in the severe hypertension cohort, are reported. Mean baseline office systolic BP was 163.5±24.0 mm Hg for all patients and 179.3±16.5 mm Hg for the severe cohort; the corresponding baseline 24-hour mean systolic BPs were 151.5±17.0 and 159.0±15.6 mm Hg. At 6 months, the changes in office and 24-hour systolic BPs were -11.6±25.3 and -6.6±18.0 mm Hg for all patients (P<0.001 for both) and -20.3±22.8 and -8.9±16.9 mm Hg for those with severe hypertension (P<0.001 for both). Renal denervation was associated with low rates of adverse events. After the procedure through 6 months, there was 1 new renal artery stenosis >70% and 5 cases of hospitalization for a hypertensive emergency. In clinical practice, renal denervation resulted in significant reductions in office and 24-hour BPs with a favorable safety profile. Greater BP-lowering effects occurred in patients with higher baseline pressures. CLINICAL TRIAL REGISTRATION URL: www.clinicaltrials.gov. Unique identifier: NCT01534299.
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Affiliation(s)
- Michael Böhm
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.).
| | - Felix Mahfoud
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Christian Ukena
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Uta C Hoppe
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Krzysztof Narkiewicz
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Manuela Negoita
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Luis Ruilope
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Markus P Schlaich
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Roland E Schmieder
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Robert Whitbourn
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Bryan Williams
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Uwe Zeymer
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Andreas Zirlik
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Giuseppe Mancia
- From the Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany (M.B., F.M, C.U.); Department of Internal Medicine II, Paracelsus University Salzburg, Salzburg, Austria (U.C.H.);Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland (K.N.); Global Clinical Research, Coronary and Structural Heart Disease Management, Medtronic Inc, Santa Rosa, CA (M.N.); Institute of Research & Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain (L.R.); School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia (M.P.S.); Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (R.E.S.); Cardiovascular Research Centre, Interventional Cardiology, St. Vincent's Hospital, Melbourne, Australia (R.W.); Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.); Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany (U.Z.); Department of Cardiology and Angiology I, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany (A.Z.); and IRCCS Istituto Auxologico Italiano, Center of Epidemiology and Clinical Trials, University of Milano-Bicocca, Milan, Italy (G.M.)
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Ruilope L, Schaefer A. Erratum to: The fixed-dose combination of olmesartan/amlodipine was superior in central aortic blood pressure reduction compared with perindopril/amlodipine: a randomized, double-blind trial in patients with hypertension. Adv Ther 2015; 32:184-5. [PMID: 25712918 PMCID: PMC4349943 DOI: 10.1007/s12325-015-0186-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Luis Ruilope
- Hypertension Unit, Hospital 12 de Octubre, 28041, Madrid, Spain,
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Ruilope L, Hanefeld M, Lincoff AM, Viberti G, Meyer-Reigner S, Mudie N, Wieczorek Kirk D, Malmberg K, Herz M. Effects of the dual peroxisome proliferator-activated receptor-α/γ agonist aleglitazar on renal function in patients with stage 3 chronic kidney disease and type 2 diabetes: a Phase IIb, randomized study. BMC Nephrol 2014; 15:180. [PMID: 25407798 PMCID: PMC4364102 DOI: 10.1186/1471-2369-15-180] [Citation(s) in RCA: 17] [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: 12/23/2013] [Accepted: 09/22/2014] [Indexed: 02/07/2023] Open
Abstract
Background Type 2 diabetes is a major risk factor for chronic kidney disease, which substantially increases the risk of cardiovascular disease mortality. This Phase IIb safety study (AleNephro) in patients with stage 3 chronic kidney disease and type 2 diabetes, evaluated the renal effects of aleglitazar, a balanced peroxisome proliferator-activated receptor-α/γ agonist. Methods Patients were randomized to 52 weeks’ double-blind treatment with aleglitazar 150 μg/day (n = 150) or pioglitazone 45 mg/day (n = 152), followed by an 8-week off-treatment period. The primary endpoint was non-inferiority for the difference between aleglitazar and pioglitazone in percentage change in estimated glomerular filtration rate from baseline to end of follow-up. Secondary endpoints included change from baseline in estimated glomerular filtration rate and lipid profiles at end of treatment. Results Mean estimated glomerular filtration rate change from baseline to end of follow-up was –2.7% (95% confidence interval: –7.7, 2.4) with aleglitazar versus –3.4% (95% confidence interval: –8.5, 1.7) with pioglitazone, establishing non-inferiority (0.77%; 95% confidence interval: –4.5, 6.0). Aleglitazar was associated with a 15% decrease in estimated glomerular filtration rate versus 5.4% with pioglitazone at end of treatment, which plateaued to 8 weeks and was not progressive. Superior improvements in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglycerides, with similar effects on glycosylated hemoglobin were observed with aleglitazar versus pioglitazone. No major safety concerns were identified. Conclusions The primary endpoint in AleNephro was met, indicating that in stage 3 chronic kidney disease patients with type 2 diabetes, the decrease in estimated glomerular filtration rate after 52 weeks’ treatment with aleglitazar followed by 8 weeks off-treatment was reversible and comparable (non-inferior) to pioglitazone. Trial registration NCT01043029 January 5, 2010. Electronic supplementary material The online version of this article (doi:10.1186/1471-2369-15-180) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luis Ruilope
- Hospital 12 de Octubre, Clinical Science, Madrid, Spain.
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Ruilope L. Additional information regarding the SEVITENSION study. Adv Ther 2014; 31:777-9. [PMID: 25145548 PMCID: PMC4147241 DOI: 10.1007/s12325-014-0144-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Luis Ruilope
- Department of Preventive Medicine and Public Health, Universidad Autonoma, Madrid, Spain,
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Schmieder RE, Redon J, Grassi G, Kjeldsen SE, Mancia G, Narkiewicz K, Parati G, Ruilope L, van de Borne P, Tsioufis C. Updated ESH position paper on interventional therapy of resistant hypertension. EUROINTERVENTION 2014; 9 Suppl R:R58-66. [PMID: 23732157 DOI: 10.4244/eijv9sra11] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [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: 11/23/2022]
Abstract
Out of the overall hypertensive population it is estimated that approximately 10% have treatment resistant hypertension (TRH). Percutaneous catheter-based transluminal renal ablation (renal denervation [RDN] by delivery of radiofrequency energy) has emerged as a new approach to achieve sustained blood pressure reduction in patients with TRH. This innovative interventional technique is now available across Europe for severe TRH for those patients in whom pharmacologic strategies and lifestyle changes have failed to control blood pressure below target (usually <140/90 mmHg). In 2012, the "ESH position paper: renal denervation - an interventional therapy of resistant hypertension" was published to facilitate a better understanding of the effectiveness, safety, limitation and unresolved issues. We have now updated this position paper since numerous studies have been published over the last year providing more data about the rationale, therapeutic efficacy and safety of RDN. In the upcoming ESH/ESC guidelines for the management of arterial hypertension, therapeutic options of treatment resistant hypertension will be addressed, but only briefly, and thus it is the focus of this paper to provide detailed and updated information on this innovative interventional technique.
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Affiliation(s)
- Roland E Schmieder
- University Hospital Erlangen, Nephrology and Hypertension, Erlangen, Germany.
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Bakris G, Sarafidis P, Agarwal R, Ruilope L. Review of blood pressure control rates and outcomes. ACTA ACUST UNITED AC 2013; 8:127-41. [PMID: 24309125 DOI: 10.1016/j.jash.2013.07.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [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: 06/28/2013] [Revised: 07/29/2013] [Accepted: 07/29/2013] [Indexed: 01/22/2023]
Abstract
Despite the high prevalence of hypertension and documented benefits of blood pressure (BP) control, >40% of patients with hypertension are not controlled. A majority of uncontrolled hypertensive patients receive two or more antihypertensive drugs. The current review examined the relationship between antihypertensive combination drug therapy, achievement of goal BP, and cardiovascular (CV) outcomes. Articles were selected from a PubMed search using a prespecified search strategy. Randomized, controlled clinical trials of adult human subjects published in English between January 1991 and January 2013 were included. From 2319 identified articles, 28 met inclusion criteria and contained a total of 226,877 subjects. There were seven placebo-controlled studies and 21 treatment comparator and combination therapy studies. The studies included in this review reported a positive association between the degree of BP lowering, number of medications, and CV outcomes. As combination therapy became available, it was increasingly utilized in clinical trials and enabled an increased proportion of patients to achieve a prespecified BP target. Adverse events with monotherapy and combination therapy were as anticipated for the specific classes of antihypertensive therapy. Although many patients reach BP goal, combination antihypertensive therapy is often needed to reach BP goal. Effective BP lowering has been shown to result in improvements in CV outcomes.
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Affiliation(s)
- George Bakris
- ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL.
| | - Pantelis Sarafidis
- ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL
| | - Rajiv Agarwal
- Department of Medicine, Indiana University Medical Center, Indianapolis, IN
| | - Luis Ruilope
- Hypertension Unit, Hospital 12 de Octubre, Autonoma University, 28041, Madrid, Spain
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Herz M, Malmberg K, Hanefeld M, Ruilope L, Lincoff AM, Viberti G, Mudie N, Urbanowska T, Reigner SM. Effects of aleglitazar on cardiovascular risk factors in patients with stage 3 chronic kidney disease and type 2 diabetes. Atherosclerosis 2013. [DOI: 10.1016/j.atherosclerosis.2013.07.015] [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: 11/30/2022]
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Mahfoud F, Mancia G, Schlaich MP, Narkiewicz K, Ruilope L, Williams B, Schmieder RE, Bohm M. TCT-60 Clinical and Procedural Outcomes of Renal Artery Denervation In Real World Patients with Hypertension: An Update From the Global SYMPLICITY Registry. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schmieder R, Ruilope L, Haller H, Ott C, Raff U. Prevention of left ventricular remodeling in type-2 diabetes patients with the ARB olmesartan: ECG-LVH results from the ROADMAP-study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4254] [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: 11/14/2022] Open
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Boehm M, Schlaich M, Narkiewicz K, Ruilope L, Williams B, Schmieder R, Mahfoud F, Mancia G. The blood pressure lowering effects of renal denervation in a real world population of patients with uncontrolled hypertension: early outcomes from the Global SYMPLICITY registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.3786] [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: 11/14/2022] Open
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Böhm M, Mahfoud F, Ukena C, Bauer A, Fleck E, Hoppe UC, Kintscher U, Narkiewicz K, Negoita M, Ruilope L, Rump LC, Schlaich M, Schmieder R, Sievert H, Weil J, Williams B, Zeymer U, Mancia G. Rationale and design of a large registry on renal denervation: the Global SYMPLICITY registry. EUROINTERVENTION 2013; 9:484-92. [DOI: 10.4244/eijv9i4a78] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Myers M, Ruilope L. New approach to measurement of blood pressure in the office. Hipertensión y Riesgo Vascular 2012. [DOI: 10.1016/j.hipert.2012.04.002] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ruilope L, Izzo J, Haller H, Waeber B, Oparil S, Weber M, Bakris G, Sowers J. Prevention of microalbuminuria in patients with type 2 diabetes: what do we know? J Clin Hypertens (Greenwich) 2011; 12:422-30. [PMID: 20591087 DOI: 10.1111/j.1751-7176.2010.00289.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Cardiovascular and chronic kidney disease are epidemic throughout industrialized societies. Diabetes leads to premature cardiovascular disease and is regarded by many as the most common etiological factor for chronic kidney disease. Because most studies of blood-pressure lowering agents in people with diabetes and hypertension have been conducted in individuals who already have some target organ damage, it is unclear whether earlier intervention could prevent or delay the onset of renal or systemic vascular disease. In early disease there is only a low possibility of observing cardiovascular or renal events; thus intervention trials in this population must rely on disease markers such as microalbuminuria. Accordingly, the authors review the evidence to support the use of microalbuminuria as a disease marker in diabetic patients based on its strong association with renal and cardiovascular events, and discuss recent trials that examine the impact of preventing or delaying the onset of microalbuminuria.
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Affiliation(s)
- Luis Ruilope
- Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain.
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