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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EDespite the availability of safe and effective pharmacological therapies, only about 50% of patients achieve adequate blood pressure control. Many patients develop resistant hypertension, which is characterized by an inability to achieve BP targets despite multiple drug therapies at the highest tolerated dose. Patients with chronic uncontrolled hypertension are at high risk for major cardiovascular events, including early death, strokes, and renal disease. This article discusses 2 late-breaking clinical trials evaluated novel nonpharmacologic options for the treatment of resistant hypertension.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EDespite the availability of safe and effective pharmacological therapies, only about 50% of patients achieve adequate blood pressure control. Many patients develop resistant hypertension, which is characterized by an inability to achieve blood pressure targets despite multiple drug therapies at the highest tolerated dose. Patients with chronic uncontrolled hypertension are at high risk for major cardiovascular events, including early death, strokes, and renal disease.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAt the American College of Cardiology 58th Annual Scientific Session, 2 late-breaking clinical trials evaluated novel nonpharmacologic options for the treatment of resistant hypertension.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECatheter-Based Renal Denervation\u003C\/h2\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EDisruption of the renal sympathetic nerves via catheter-based radiofrequency ablation markedly reduces blood pressure levels in patients with refractory hypertension, according to findings from a proof-of-concept study (\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00483808\u0026amp;atom=%2Fspmdc%2F9%2F2%2F22.atom\u0022\u003ENCT00483808\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe renal sympathetic nerves play a key role in the progression of hypertensive disease. A new catheter-based system uses radiofrequency ablation to disrupt renal sympathetic nerves without affecting other abdominal, pelvic, or lower extremity nerves. In this trial, the renal denervation system was evaluated in 45 patients with a mean baseline blood pressure of 177\/101 mm Hg and a mean heart rate of 72 bpm. Five additional patients enrolled but did not undergo ablation due to complicated anatomical features.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EHenry Krum, PhD, Monash University and Alfred Hospital, Melbourne, Australia, presented findings from the trial, which were simultaneously published online in \u003Cem\u003EThe Lancet.\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EAmong treated patients, mean blood pressure fell by 14\/10 mm Hg within 1 month of the ablation procedure (p\u0026lt;0.001) and dropped by 27\/17 mm Hg after 1 year (p=0.02). By comparison, blood pressure levels increased among the 5 patients who were enrolled but did not receive renal denervation. After 1 year, the mean blood pressure rose by 26\/17 mm Hg.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EPhysicians were instructed not to alter treatment unless medically required, and so most patients remained on their antihypertensive drug regimen throughout the follow-up period. Three patients required reduction of their medications after their blood pressures normalized. Nine patients had their medications increased, including 5 patients who had blood pressure reductions of at least 10 mm Hg and 4 who did not respond to the procedure.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003ENo major complications were observed in either the renal artery or the kidney, and there was no apparent effect on renal function. The mean glomerular filtration rate (GFR) was 79 mL\/min\/1.73m\u003Csup\u003E2\u003C\/sup\u003E prior to the procedure and 83 mL\/min\/1.73m\u003Csup\u003E2\u003C\/sup\u003E 6 months following renal denervation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EPercutaneous renal sympathetic denervation represents a simple and effective approach to the management of hypertension in patients who are refractory to conventional pharmacologic therapy, Dr. Krum concluded. Future trials will define the long-term efficacy of renal denervation in resistant hypertension and other disorders, he said.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EActivation of the Carotid Baroreflex\u003C\/h2\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EAn implantable device that activates the baroreceptors of the carotid sinus significantly reduces blood pressure in patients with refractory hypertension, according to results from a small phase 2 feasibility study.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EIn hypertensive patients, blood pressure receptors within the carotid sinus do not detect elevated intravascular blood pressure, leading to an inadequate autonomic response. The Rheos\u003Csup\u003Ereg;\u003C\/sup\u003E hypertension system consists of a pulse generator, implanted near the collarbone, and carotid sinus leads. The device electrically stimulates the carotid sinus to activate blood pressure reflexes that lower heart rate, dilate blood vessels, and induce diuresis.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EThe phase 2 trial included 61 patients with systolic blood pressure \u2265160 mm Hg who were resistant to 3 or more antihypertensive medications, including diuretics. After the Rheos device was surgically implanted and activated, blood pressure levels were measured at 1 year, 2 years, and 3 years. Marcos Rothstein, MD, Washington University School of Medicine, St. Louis, MO, presented findings in a late-breaking clinical trials session.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EMean blood pressure at baseline was 183\/105 mm Hg despite treatment with a mean of 5.1 antihypertensive medications. On average, systolic blood pressure dropped by 25 mm Hg after 1 year, 22 mm Hg after 2 years, and 31 mm Hg after 3 years (p\u0026lt;0.001 at all time points). Diastolic blood pressure dropped by 15 mm Hg at 1 and 2 years and by 21 mm Hg by 3 years (p\u0026lt;0.001 at all time points).\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EMean heart rate also fell by 7 bpm at 1 year (p\u0026lt;0.005), 8 bpm at 2 years (p\u0026lt;0.005), and 5 bpm at 3 years (p=0.15). Dr. Rothstein also observed a significant improvement in cardiac structure and function at 1 year, as measured by a decrease in left ventricular mass (p\u0026lt;0.05), left atrial dimension (p\u0026lt;0.05), and mitral A-wave velocity (p\u0026lt;0.05).\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EBased on promising early-phase results, the Rheos hypertension system is currently under evaluation in a phase 2 prospective, randomized, double-blind, placebo-controlled, multicenter trial with a target enrollment of 300 patients.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/2\/22.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmknd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}