Member, Cardiovascular Institute
Predictors of blood pressure response in the SYMPLICITY HTN-3 trial.
European heart journal
2015; 36 (4): 219-227
The SYMPLICITY HTN-3 randomized, blinded, sham-controlled trial confirmed the safety of renal denervation (RDN), but did not meet its primary efficacy endpoint. Prior RDN studies have demonstrated significant and durable reductions in blood pressure. This analysis investigated factors that may help explain these disparate results.Patients with resistant hypertension were randomized 2 : 1 to RDN (n = 364) or sham (n = 171). The primary endpoint was the difference in office systolic blood pressure (SBP) change at 6 months. A multivariable analysis identified predictors of SBP change. Additional analyses examined the influence of medication changes, results in selected subgroups and procedural factors. Between randomization and the 6-month endpoint, 39% of patients underwent medication changes. Predictors of office SBP reduction at 6 months were baseline office SBP ≥180 mmHg, aldosterone antagonist use, and non-use of vasodilators; number of ablations was a predictor in the RDN group. Non-African-American patients receiving RDN had a significantly greater change in office SBP than those receiving sham; -15.2 ± 23.5 vs. -8.6 ± 24.8 mmHg, respectively (P = 0.012). Greater reductions in office and ambulatory SBP, and heart rate were observed with a higher number of ablations and energy delivery in a four-quadrant pattern.Post hoc analyses, although derived from limited patient cohorts, reveal several potential confounding factors that may partially explain the unexpected blood pressure responses in both the sham control and RDN groups. These hypothesis-generating data further inform the design of subsequent research to evaluate the potential role of RDN in the treatment of resistant hypertension.NCT01418261.
View details for DOI 10.1093/eurheartj/ehu441
View details for PubMedID 25400162
View details for PubMedCentralID PMC4301597
MEDICAL THERAPY OF PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
SURGICAL CLINICS OF NORTH AMERICA
1995; 75 (4): 569-579
Lowering the overall morbidity rate of peripheral vascular disease requires a systematic approach to the patient with atherosclerosis. This includes comprehensive assessments of risk factors, appropriate modifications of diet and lifestyle as well as an effective and sustaining exercise regimen. The role of new pharmacologic agents is discussed.
View details for Web of Science ID A1995RN07700004
View details for PubMedID 7638705
NEW INSIGHTS ON RENOVASCULAR HYPERTENSION
CURRENT OPINION IN CARDIOLOGY
1994; 9 (5): 598-605
Although activation of the endocrine renin-angiotensin system with consequent vasoconstriction and salt retention have long been known as the hallmarks of the early phase of renovascular hypertension, the recent recognition of a local vascular angiotensin system and the understanding of the process of vascular remodeling provide new insights into the pathophysiology of this form of hypertension. New pathophysiologic insights as well as technological advances are beginning to alter longstanding clinical approaches to this disease. For example, the captopril renogram has emerged as the screening test of choice in diagnostic evaluation. In addition, new imaging modalities such as magnetic resonance angiography and spiral computed tomography show promise for providing noninvasive anatomical characterization of renovascular disease. Moreover, therapeutic strategies have advanced as a result of better understanding of the natural history of the disease, more effective pharmacologic therapy, and advances in revascularization techniques, such as intravascular stents. This review focuses on these intriguing new developments.
View details for Web of Science ID A1994PE13500015
View details for PubMedID 7987040