Hypertension
Conditions
Keywords
Hypertension, Renal denervation
Brief summary
The goal of this observational study is to learn about the effects of renal denervation in patients with resistant hypertension. The main question it aims to answer is: What are the long term effects of renal denervation on blood pressure and flow within the arteries? Participants will undergo an assessment of their blood pressure, echocardiogram and invasive measurements of blood pressure and flow in the aorta and renal arteries before undergoing the renal denervation procedure. 6 months later these assessments will be repeated.
Detailed description
Renal denervation is emerging as a succesful technique in the treatment of high blood pressure particularly for those people who's disease is resistant to drug therapy. It involves insertion of an catheter through the femoral artery and into the renal artery where it delivers a controlled radiofrequency ablation to the renal artery wall. The purpose of this ablation is to interupt the sympathetic nervous system which is inappropriately activated in hypertension. Its beneficial effects on BP reduction has been borne out in a recently published randomised clinical trial which demonstrated a reduction in blood pressure in patients who underwent denervation compared to those managed with medication alone and it is now being used worldwide to manage hypertensive patients. The safety of this procedure has been demonstrated in the peri-operative setting and short term particularly regarding anatomical changes and kidney function. However, its effects have not been demonstrated with invasive imaging or physiological testing in the long term. Therefore, the investigators recognise that a repeat assessment 6 months after denervation using invasive measures (to perform detailed assessments of the effects on aortic, flow and artery stiffness) would be of great benefit in stratifying this technique, which is likely to become widespread in the very near future. The investigators therefore plan to perform denervation in 20 patients and obtain detailed information on kidney and aortic blood pressure and flow. They will then reassess these parameters after 6 months in the same patients to ensure preservation of pressure, flow and energy transfer and document the effects of denervation on vascular stiffness.
Interventions
DEVICERenal denervation
Renal denervation (ReCor Medical)
Sponsors
Imperial College Healthcare NHS Trust
Philips Healthcare
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Inclusion criteria
* Systolic blood pressure \>160mmHg despite 3 antihypertensive agents * eGFR \>45
Exclusion criteria
* Secondary causes of hypertension * Prior renal artery intervention * Renal insufficiency * Significant stenotic valvular heart disease * Myocardial infarction, unstable angina or stroke within the preceding 6 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in systolic blood pressure | At baseline and at 6 months | Invasively measured aortic systolic pressure |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in diastolic pressure | At baseline and 6 months | Invasively measured aortic diastolic pressure |
| Change in renal artery pressure | At baseline and 6 months | Invasively measured |
| Change in renal artery flow | At baseline and 6 months | Invasively measured |
| Change in renal artery resistance | At baseline and 6 months | Invasively measured |
| Change in aortic reservoir pressure | At baseline and 6 months | Invasively measured |
| Change in aortic wavespeed | At baseline and 6 months | Invasively measured |
| Change in aortic reservoir wave intensity | At baseline and 6 months | Invasively measured |
| Change in left ventricular wall thickness | At baseline and 6 months | Assessed during echocardiography |
Countries
United Kingdom
Contacts
PRINCIPAL_INVESTIGATORSayan Sen, PhD
Consultant Cardiologist
Outcome results
None listed