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Paper Chase

A controlled trial of renal denervation for resistant hypertension.

N. Engl. J. Med.. Apr 10, 2014;370(15):1393-401.
Bhatt DL, Kandzari DE, O'Neill WW, D'Agostino R, Flack JM, Katzen BT, Leon MB, Liu M, Mauri L, Negoita M, Cohen SA, Oparil S, Rocha-Singh K, Townsend RR, Bakris GL, Bakris G.

From Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B., L.M.), Boston University School of Public Health (R.D.), and Harvard Clinical Research Institute (R.D., L.M.) - all in Boston; Piedmont Heart Institute, Atlanta (D.E.K.); the Division of Cardiology, Henry Ford Hospital (W.W.O.), and Wayne State University and the Detroit Medical Center (J.M.F.) - all in Detroit; Baptist Cardiac and Vascular Institute, Miami (B.T.K.); New York Presbyterian Hospital, Columbia University Medical Center, and Cardiovascular Research Foundation, New York (M.B.L.); Medtronic CardioVascular, Santa Rosa, CA (M.L., M.N., S.A.C.); University of Alabama at Birmingham, Birmingham (S.O.); Prairie Heart Institute, Springfield, IL (K.R.-S.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.A.C., R.R.T.); and University of Chicago Medicine, Chicago (G.L.B.).

Abstract:

BACKGROUND

Prior unblinded studies have suggested that catheter-based renal-artery denervation reduces blood pressure in patients with resistant hypertension.

METHODS

We designed a prospective, single-blind, randomized, sham-controlled trial. Patients with severe resistant hypertension were randomly assigned in a 2:1 ratio to undergo renal denervation or a sham procedure. Before randomization, patients were receiving a stable antihypertensive regimen involving maximally tolerated doses of at least three drugs, including a diuretic. The primary efficacy end point was the change in office systolic blood pressure at 6 months; a secondary efficacy end point was the change in mean 24-hour ambulatory systolic blood pressure. The primary safety end point was a composite of death, end-stage renal disease, embolic events resulting in end-organ damage, renovascular complications, or hypertensive crisis at 1 month or new renal-artery stenosis of more than 70% at 6 months.

RESULTS

A total of 535 patients underwent randomization. The mean (±SD) change in systolic blood pressure at 6 months was -14.13±23.93 mm Hg in the denervation group as compared with -11.74±25.94 mm Hg in the sham-procedure group (P<0.001 for both comparisons of the change from baseline), for a difference of -2.39 mm Hg (95% confidence interval [CI], -6.89 to 2.12; P=0.26 for superiority with a margin of 5 mm Hg). The change in 24-hour ambulatory systolic blood pressure was -6.75±15.11 mm Hg in the denervation group and -4.79±17.25 mm Hg in the sham-procedure group, for a difference of -1.96 mm Hg (95% CI, -4.97 to 1.06; P=0.98 for superiority with a margin of 2 mm Hg). There were no significant differences in safety between the two groups.

CONCLUSIONS

This blinded trial did not show a significant reduction of systolic blood pressure in patients with resistant hypertension 6 months after renal-artery denervation as compared with a sham control. (Funded by Medtronic; SYMPLICITY HTN-3 ClinicalTrials.gov number, NCT01418261.).