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Am Heart J. 2018 Jan;195:115-129. doi: 10.1016/j.ahj.2017.09.006. Epub 2017 Sep 12.

A multinational clinical approach to assessing the effectiveness of catheter-based ultrasound renal denervation: The RADIANCE-HTN and REQUIRE clinical study designs.

Author information

1
Brigham and Women's Hospital, Boston, MA. Electronic address: lmauri1@partners.org.
2
Division of Cardiovascular Medicine, School of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.
3
Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H Johnson VA Medical Center, Charleston, SC.
4
Erasmus MC Thoraxcenter, 'S Gravendijkwal 230, Rotterdam, NL, the Netherlands.
5
Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
6
Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY.
7
Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA.
8
Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany.
9
Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York, NY.
10
Nishinomiya Hospital Affairs, Nishinomiya Municipal Central Hospital, Nishinomiya, Hyogo, Japan.
11
Université Paris-Descartes, Paris, France; AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DHU PARC, Paris, France; INSERM, CIC1418, Paris, France.

Abstract

Catheter-based renal denervation is a new approach to treat hypertension via modulation of the renal sympathetic nerves. Although nonrandomized and small, open-label randomized studies resulted in significant reductions in office blood pressure 6months after renal denervation with monopolar radiofrequency catheters, the first prospective, randomized, sham-controlled study (Symplicity HTN-3) failed to meet its blood pressure efficacy end point. New clinical trials with new catheters have since been designed to address the limitations of earlier studies. Accordingly, the RADIANCE-HTN and REQUIRE studies are multicenter, blinded, randomized, sham-controlled trials designed to assess the blood pressure-lowering efficacy of the ultrasound-based renal denervation system (Paradise) in patients with established hypertension either on or off antihypertensive medications, is designed to evaluate patients in 2 cohorts-SOLO and TRIO, in the United States and Europe. The SOLO cohort includes patients with essential hypertension, at low cardiovascular risk, and either controlled on 1 to 2 antihypertensive medications or uncontrolled on 0 to 2 antihypertensive medications. Patients undergo a 4-week medication washout period before randomization to renal denervation (treatment) or renal angiogram (sham). The TRIO cohort includes patients with hypertension resistant to at least 3 antihypertensive drugs including a diuretic. Patients will be stabilized on a single-pill, triple-antihypertensive-drug combination for 4weeks before randomization to treatment or sham. Reduction in daytime ambulatory systolic blood pressure (primary end point) will be assessed at 2months in both cohorts. A predefined medication escalation protocol, as needed for blood pressure control, is implemented between 2 and 6months in both cohorts by a study staff member blinded to the randomization process. At 6months, daytime ambulatory blood pressure and antihypertensive treatment score will be assessed. REQUIRE is designed to evaluate patients with resistant hypertension on standard of care medication in Japan and Korea. Reduction in 24-hour ambulatory systolic blood pressure will be assessed at 3months (primary end point). Both studies are enrolling patients, and their results are expected in 2018.

PMID:
29224639
DOI:
10.1016/j.ahj.2017.09.006
[Indexed for MEDLINE]

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