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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\u003ERenal denervation (RDN) is a novel treatment of resistant hypertension, based on the Renal Denervation in Patients with Uncontrolled Hypertension study [Symplicity HTN-2; Symplicity HTN-2 Investigators. \u003Cem\u003ELancet\u003C\/em\u003E 2010]. Yet, the magnitude and determinants of office and ambulatory blood pressure (BP) response to RDN have not been established. This article discusses the results of the first patient-level meta-analysis of the BP changes 6 months post RDN at 10 expert centers participating in the European Network Coordinating Research on Renal Denervation study [ENCOReD].\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\u003EInterventional Radiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertension \u0026amp; Kidney Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Radiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertension \u0026amp; Kidney Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ERenal denervation (RDN) is a novel treatment of resistant hypertension, based on the Renal Denervation in Patients With Uncontrolled Hypertension study [Symplicity HTN-2; Symplicity HTN-2 Investigators. \u003Cem\u003ELancet\u003C\/em\u003E 2010]. Yet, the magnitude and determinants of office and ambulatory blood pressure (BP) response to RDN have not been established due to the lack of randomized studies, few reports of postprocedural changes in ambulatory BP (or their lack of significance), and publication bias [Persu A et al. \u003Cem\u003EExpert Rev Cardiovasc Ther\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAlexandre Persu, MD, Universit\u00e9 Catholique de Louvain, Brussels, Belgium, presented the results of the first patient-level meta-analysis of the BP changes 6 months post RDN at 10 expert centers participating in the European Network Coordinating Research on Renal Denervation study [ENCOReD].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe study objective was to compare the BP changes in the ENCOReD RDN patients and those observed in the treatment and placebo arms of the Systolic Hypertension in Europe study [Syst-Eur; Staessen JA et al. \u003Cem\u003EJ Hypertens\u003C\/em\u003E 1994; Staessen JA et al. \u003Cem\u003ELancet\u003C\/em\u003E 1997], and the Symplicity HTN-2 study.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EFor the comparison with Syst-Eur, the three patient groups were ENCOReD RDN (n=109), Syst-Eur placebo (n=73), and Syst-Eur active treatment (n=79). The RDN patients were younger than the other groups (mean age, 58.2 vs 71.4 vs 70.3 years, respectively), more overweight (body mass index, 29.5 vs 26.3 vs 26.0 kg\/m\u003Csup\u003E2\u003C\/sup\u003E), and had more target organ damage. The estimated glomerular filtration rate was greater in the RDN group (RDN, 82.2 mL\/min\/1.73 m\u003Csup\u003E2\u003C\/sup\u003E; Syst-Eur placebo, 67.9 mL\/min\/1.73 m\u003Csup\u003E2\u003C\/sup\u003E; Syst-Eur active, 67.2 mL\/min\/1.73 m\u003Csup\u003E2\u003C\/sup\u003E). The baseline systolic BP (SBP) levels were similar for office (175 to 178 mm Hg) and ambulatory (153 to 157 mm Hg) measures. Nearly half of each group was women and nearly all were white.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EIn the RDN group, the office SBP was reduced by 17.6 mm Hg and the 24-hour ambulatory SBP (ASBP) by 5.9 mm Hg from baseline to 6 months (p\u0026lt;0.03 for both) at 6 months. Reduction from baseline to 6 months in office, ambulatory, daytime, and night-time SBP values in the RDN group were between the respective values for the Syst-Eur placebo and Syst-Eur active groups (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). The reduction in ASBP was only one-third that on office BP measure. The less impressive decrease in ASBP may reflect a specific effect of RDN on white coat hypertension (WCH), noted Prof. Persu. WCH was decreased in each group.\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\/13\/9\/7\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Change From Baseline to 6 Months in SBP\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1864889985\u0022 data-figure-caption=\u0022Change From Baseline to 6 Months in SBP\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\/13\/9\/7\/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\/13\/9\/7\/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\/13\/9\/7\/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\/13440\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\u003EChange From Baseline to 6 Months in SBP\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ERDN=renal denervation; SyE=Syst-Eur. p values for comparison with RDN group.\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\u003EThe nonresponder rate for a reduction in office SBP at 6 months was 23% for RDN, 33% for Syst-Eur placebo, and 8% for Syst-Eur active. The nonresponder rate for ASBP at 6 months was 35% in the RDN, 45% in the Syst-Eur placebo, and 17% in the Syst-Eur active group.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003ECompared with the RDN group in Symplicity HTN-2, there was a significantly lower proportion of responders and controlled patients in the ENCOReD RDN group at 6 months (p=0.003 and p=0.04, respectively; \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E). For the patients with a baseline SBP \u2265160 mm Hg, the responder rate at 6 months was similar in the ENCOReD and Symplicity HTN-2 RDN groups (72% vs 84%; p=0.12), but significantly fewer ENCOReD RDN patients had BP control (16% vs 39%; p=0.005).\u003C\/p\u003E\u003Cdiv id=\u0022F2\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\/13\/9\/7\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022BP Response Over 6 Months in RDN and Symplicity HTN-2 Patients\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1864889985\u0022 data-figure-caption=\u0022BP Response Over 6 Months in RDN and Symplicity HTN-2 Patients\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/9\/7\/F2.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\/13\/9\/7\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\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\/13\/9\/7\/F2.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\/13442\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 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EBP Response Over 6 Months in RDN and Symplicity HTN-2 Patients\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003ERDN=renal denervation; SBP=systolic blood pressure.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EIn ENCOReD RDN patients, a higher baseline SBP predicted better 24-hour ASBP control, whereas a higher serum creatinine predicted a lower probability of control.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EThe meta-analysis suggests an important impact of the placebo or Hawthorne effects, and\/or regression to the mean. RDN should be the last resort for truly resistant hypertension until there is sufficient evidence to identify reliable predictors of BP response.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\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\/13\/9\/7.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?nznue1\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?nznue1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}