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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\u003EThis article discusses the results of the first human randomized controlled trial of sympathetic renal denervation as a treatment for treatment-resistant hypertension, which showed substantial reductions in systolic blood pressure.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertension \u0026amp; Kidney Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Radiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe role of the sympathetic nervous system in hypertension has been known for some time, but its potential as a therapeutic avenue has been overshadowed by drug therapy. Murray D. Esler, MD, Baker IDI Heart and Diabetes Institute, Melbourne, Australia, presented the results of the first human randomized controlled trial of sympathetic renal denervation as a treatment for treatment-resistant hypertension, which showed substantial reductions in systolic blood pressure (SBP).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe International, Multicenter, Prospective, Randomized, Controlled Trial of Endovascular Selective Renal Sympathetic Denervation for the Treatment of Hypertension (Symplicity HTN-2; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00888433\u0026amp;atom=%2Fspmdc%2F10%2F10%2F18.atom\u0022\u003ENCT00888433\u003C\/a\u003E) was conducted in 24 centers in Europe, Australia, and New Zealand. The primary study endpoint was change in office-based automated SBP between baseline and 6 months. Secondary endpoints included acute and chronic procedural safety issues and home\/ambulatory BP reductions.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EPatients aged between 18 and 85 years with an office SBP \u2265160 mm Hg (\u2265150 mm Hg in individuals with type 2 diabetes) and a bilateral single main renal artery \u0026gt;20 mm long and 4 mm in diameter who were taking at least 3 antihypertensive medications were eligible for this trial. Patients with renal artery duplication or stenosis, eGFR \u0026lt;45 mL\/min, type 1 diabetes, or unstable angina\/recent cerebrovascular accidents were excluded.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EA total of 190 patients were screened, and 106 were randomly assigned to renal denervation (RDN) plus continuing medical therapy (n=52) or continuing medical therapy only (n=54). Interestingly, 19% of the screened failures were patients who did not meet the SBP threshold after 2 weeks of documented medication compliance. Another 16% of screened failures were due to ineligible anatomy (eg, multiple renal arteries). Study participants had a mean age of 58 years, mean baseline SPB of 178 mm Hg, and average BMI 31 kg\/m\u003Csup\u003E2\u003C\/sup\u003E and were taking 5.3 antihypertensive medications on average. More than 75% of study participants had been taking antihypertensive medications for more than 5 years. Almost all participants were taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs). Other drug classes included calcium channel blockers (79% of RDN patients vs 83% of control patients), beta-blockers (83% vs 69%), and diuretics (89% vs 91%). Mean eGFR was 77 ml\/min\/1.73 m\u003Csup\u003E2\u003C\/sup\u003E in the denervation group versus 86 ml\/min\/1.73 m\u003Csup\u003E2\u003C\/sup\u003E in the control group (p=0.013)\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EBilateral RDN was performed successfully in all 52 patients who were assigned to this study arm. At 6 months, patients in the RDN-treated group demonstrated significant decreases in SBP and DBP (33\/11 mm Hg; p\u0026lt;0.0001) relative to control (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E), with 84% of patients who were undergoing RDN experiencing a \u226510-mm Hg decrease in SBP (vs 35% of controls; p\u0026lt;0.0001). Similar decreases were noted for home and 24-hour ambulatory BP. BP reductions were progressive over the observation period, indicating the possibility of greater benefits over time. Use of antihypertensive medications declined in 20% of patients who were assigned to RDN versus 6% of control patients (p=0.04).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/10\/18\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Primary Endpoint.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-39111646\u0022 data-figure-caption=\u0022Primary Endpoint.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/10\/18\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/10\/18\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/10\/18\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11369\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EPrimary Endpoint.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from M. Esler, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EThere were no serious device- or procedure-related complications. No acute renal artery damage or radiofrequency dosing-related abnormalities were detected in the 6-month follow-up period.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThis treatment appears promising for hypertensive patients whose blood pressure does not achieve the treatment goal using currently available therapies and affirms the crucial relevance of renal nerves in the persistence of elevated BP. \u201cThis procedure provides a revolutionary, nondrug method for controlling high blood pressure in patients who are unresponsive to multiple antihypertensive drugs,\u201d Dr. Esler said.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EA randomized US-based trial is in development, while the future application of the technique in patients with less severe essential hypertension is also under consideration.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EThis article was published simultaneously in \u003Cem\u003EThe Lancet.\u003C\/em\u003E Symplicity HTN-2 Investigators\u003Cem\u003E. Lancet\u003C\/em\u003E 2010.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 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\/10\/10\/18.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_figures.js?nzmn71\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmn71\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}