Our previous study (Huang HC, Pan HY, Wang TD, Circ Cardiovasc Interv 2023;16:e012779) demonstrated that when renal artery stimulation continues to trigger systolic blood pressure increases (\>=20 mmHg increase compared to baseline) after the initial procedure, patients show poor blood pressure reduction 6 months following renal denervation. Based on this finding, we designed a proof-of-concept trial comparing two approaches: a guided strategy versus conventional renal denervation. In the guided strategy, we perform additional ablations of main and/or branch renal arteries if immediate post-procedure stimulation still elevates systolic blood pressure (\>=20 mmHg increase compared to baseline). The conventional approach involves no repeat procedures. This trial aims to determine whether the guided strategy leads to better clinical outcomes, measured by 6-month ambulatory blood pressure changes, and to establish the value of using intraprocedural feedback to assess and guide renal denervation treatment.
Patients with hypertension and are willing to undergo renal denervation.
Patients are treated with antihypertensive medications, or with an office systolic blood pressure (SBP) >140 mm Hg or diastolic blood pressure (DBP) >90 mm Hg, and 24-hour SBP of >130 mmHg or DBP >80 mm Hg, irrespective of antihypertensive treatment.
An unsuitable renal artery anatomy for renal denervation, assessed by computed tomographic angiography (main renal artery lumen diameter <3 mm or a total length <20 mm).
Secondary hypertension, including hyperaldosteronism, pheochromocytoma, and renal artery stenosis (>50% stenosis in one or both arteries).
Parallel
Radiofrequency ablation alone, re-denervation to main and/or branch renal artery
DeviceRe-denervation according to the site where renal artery stimulation can induce systolic blood pressure rise of \>= 20 mmHg. Main renal artery denervation if proximal main renal artery stimulation positive, while branch renal artery denervation if distal main renal artery stimulation positive.
Radiofrequency ablation alone, no further renal denervation
Procedure/SurgeryNo further renal denervation after standard renal denervation even renal artery stimulation-induced systolic blood pressure rise \>= 20 mmHg
24-hour systolic blood pressure reduction (compared to baseline)
24-hour diastolic blood pressure reduction (compared to baseline)
Awake and asleep systolic/diastolic blood pressure and heart rate changes (compared to baseline)
Serum creatinine and estimated glomerular filtration rate changes
24-hour blood pressure changes based on branch artery constriction following renal artery stimulation
24-hour blood pressure reduction (compared to baseline)
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National Taiwan University Hospital
Lead sponsor
Smart Health Technology Research and Development Center, National Taiwan University
Collaborator
Medtronic
Collaborator
