Key result
Ultrasound renal denervation lowers medication burden but fails to significantly reduce daytime SBP versus sham.
Why the study?
Following previously reported blood pressure-lowering efficacy and safety of ultrasound renal denervation at 2 and 6 months, longer-term 12-month outcomes after patient unblinding remained to be evaluated.
Does endovascular ultrasound renal denervation reduce blood pressure and medication burden in patients with hypertension?
RCT (n=146)
Unblinded at 6 months
Does endovascular ultrasound renal denervation reduce blood pressure and medication burden in patients with hypertension?
Mean Difference: -2.3 (95% CI -5.9–1.3)
p-value: p=0.201
Ultrasound renal denervation maintained blood pressure lowering effects at 12 months with a significantly lower antihypertensive medication burden compared to sham.
Ultrasound RDN sustains BP reduction at 12 months with fewer medications; extends 6-month RCT efficacy into unblinded follow-up.
OBJECTIVES: This study reports the 12-month results of the RADIANCE-HTN (A Study of the ReCor Medical Paradise System in Clinical Hypertension) SOLO trial following unblinding of patients at 6 months. BACKGROUND: The blood pressure (BP)-lowering efficacy and safety of endovascular ultrasound renal denervation (RDN) in the absence (2 months) and presence (6 months) of antihypertensive medications were previously reported. METHODS: Patients with daytime ambulatory BP ≥135/85 mm Hg after 4 weeks off medication were randomized to RDN (n = 74) or sham (n = 72) and maintained off medication for 2 months. A standardized medication escalation protocol was instituted between 2 and 5 months (blinded phase). Between 6 and 12 months (unblinded phase), patients received antihypertensive medications at physicians' discretion. Outcomes at 12 months included medication burden, change in daytime ambulatory systolic BP (dASBP) and office or home systolic BP (SBP), visit-to-visit variability in SBP, and safety. RESULTS: Sixty-five of 74 RDN patients and 67 of 72 sham patients had 12-month dASBP measurements. The proportion of patients on ≥2 medications (27.7% vs. 44.8%; p = 0.041), the number of medications (0 vs. 1.4; p = 0.015), and defined daily dose (1.4 vs. 2.2; p = 0.007) were less with RDN versus sham. The decrease in dASBP from baseline in the RDN group (-16.5 ± 12.9 mm Hg) remained stable at 12 months. The RDN versus sham adjusted difference at 12 months was -2.3 mm Hg (95% confidence interval [CI]: -5.9 to 1.3 mm Hg; p = 0.201) for dASBP, -6.3 mm Hg (95% CI: -11.1 to -1.5 mm Hg; p = 0.010) for office SBP, and -3.4 mm Hg (95% CI: -6.9 to 0.1 mm Hg; p = 0.062) for home SBP. Visit-to-visit variability in SBP was smaller in the RDN group. No renal artery injury was detected on computed tomographic or magnetic resonance angiography. CONCLUSIONS: Despite unblinding, the BP-lowering effect of RDN was maintained at 12 months with fewer prescribed medications compared with sham.
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Azizi et al. (2020) conducted an RCT in Hypertension (n=146). Endovascular ultrasound renal denervation vs. Sham was evaluated on Change in daytime ambulatory systolic BP (dASBP) at 12 months (MD -2.3 mm Hg, 95% CI -5.9 to 1.3, p=0.201). Ultrasound renal denervation maintained BP-lowering effects at 12 months with fewer medications than sham, despite a non-significant difference in daytime ambulatory SBP (MD -2.3 mm Hg; P=0.201).
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