Now Available for Public Comment: Notice of Proposed Rulemaking (NPRM) for FDAAA 801 and NIH Draft Reporting Policy for NIH-Funded Trials

Renal Denervation in Treatment Resistant Hypertension

This study is currently recruiting participants. (see Contacts and Locations)
Verified April 2013 by University of Erlangen-Nürnberg Medical School
Sponsor:
Information provided by (Responsible Party):
University of Erlangen-Nürnberg Medical School
ClinicalTrials.gov Identifier:
NCT01687725
First received: September 13, 2012
Last updated: April 16, 2013
Last verified: April 2013

September 13, 2012
April 16, 2013
November 2010
October 2014   (final data collection date for primary outcome measure)
  • office BP [ Time Frame: baseline, 6 months ] [ Designated as safety issue: No ]
    change in office blood pressure from baseline to 6 months post-renal denervation
  • 24-ABPM [ Time Frame: baseline, 6 months ] [ Designated as safety issue: No ]
    change in 24 hour ambulatory blood pressure (ABPM) from baseline to 6 months post-renal denervation
  • Magnetic resonance imaging (MRI) [ Time Frame: baseline, 3 and 6 months ] [ Designated as safety issue: No ]
    • change in total sodium content measured by MRI from baseline to 6 months post-renal denervation
    • change in renal perfusion measured by MRI from baseline to 3 months post-renal denervation
  • Albuminuria [ Time Frame: baseline, 6 months ] [ Designated as safety issue: No ]
    change in urinary albumin/creatinine ratio from baseline to 6 months post-renal denervation
  • Systemic RAS activity [ Time Frame: baseline, 6 months ] [ Designated as safety issue: No ]
    • change in sodium, potassium and creatinine from baseline to 6 months post-renal denervation
    • change in aldosterone excretion from baseline to 6 months post-renal denervation
    • change in sodium/potassium ratio from baseline to 6 months post-renal denervation
    • change in plasma renin activity and angiotensin II concentration at least 30 minutes of rest in a supine position and immediately after standing from baseline to 6 months post-renal denervation
  • Vascular structure and function of large and small arteries [ Time Frame: baseline, 6 months ] [ Designated as safety issue: No ]
    • change in flow-mediated vasodilation (FMD)from baseline to 6 months post-renal denervation
    • change in scanning laser Doppler flowmetry (SLDF) from baseline to 6 months post-renal denervation
    • change in funduscopy from baseline to 6 months post-renal denervation
    • change in pulse wave analysis (PWA) from baseline to 6 months post-renal denervation
    • change in pulse wave velocity (PWV) from baseline to 6 months post-renal denervation
    • change in urinary albumine/creatinine ratio (UACR) of the morning spot urine sample from baseline to 6 months post-renal denervation
  • Local RAS activity [ Time Frame: baseline, 6 months ] [ Designated as safety issue: No ]
    change in urinary angiotensinogen concentration from the morning spot urine from baseline to 6 months post-renal denervation
Same as current
Complete list of historical versions of study NCT01687725 on ClinicalTrials.gov Archive Site
  • BP [ Time Frame: 3 and 12 months ] [ Designated as safety issue: No ]
    • change in office BP from baseline to 3 and 12 months post-renal denervation
    • change in 24 hour ABPM from baseline to 3 and 12 months post-renal denervation
  • MRI [ Time Frame: 1 day and 12 months ] [ Designated as safety issue: No ]
    • change in total sodium content measured by MRI from baseline to 12 months post-renal denervation
    • change in renal perfusion measured by MRI spin labelling technique from baseline to 1 day post-renal denervation
  • Local RAS activity [ Time Frame: 1 day, 3 and 12 months ] [ Designated as safety issue: No ]
    change urinary angiotensinogen concentration from the morning spot urine from baseline to 1 day, 3 and 12 months post-renal denervation
  • Systemic RAS activity [ Time Frame: 1 day, 3 and 12 months ] [ Designated as safety issue: No ]
    • change in sodium potassium and creatinine from baseline to 1 day, 3 and 12 months post-renal denervation
    • change in aldosterone excretion from baseline to 1 day, 3 and 12 months post-renal denervation
    • change in sodium/potassium ratio from baseline to 1 day, 3 and 12 months post-renal denervation
    • change in plasma renin activity and angiotensin II concentration at least 30 minutes of rest in a supine position and immediately after standing from baseline to 1 day, 3 and 12 months post-renal denervation
  • Albuminuria [ Time Frame: 3 and 12 months ] [ Designated as safety issue: No ]
    - change in albuminuria from baseline to 3 and 12 months post-renal denervation
  • Vascular structure and function of large and small arteries [ Time Frame: 3 and 12 months ] [ Designated as safety issue: No ]
    • change in flow mediated vasodilation (FMD) from baseline to 12 months post-renal denervation
    • change in scanning laser Doppler flowmetry (SLDF) from baseline to 12 months post-renal denervation
    • change in funduscopy from baseline to 3 and 12 months post-renal denervation
    • change in pulse wave analysis (PWA) from baseline to 12 months post-renal denervation
    • change in pulse wave velocity (PWV) from baseline to 12 months post-renal denervation
    • change in urinary albumine/creatinine ratio of the morning spot urine sample from baseline to 3 and 12 months post-renal denervation
Same as current
Not Provided
Not Provided
 
Renal Denervation in Treatment Resistant Hypertension
Renal Denervation in Treatment Resistant Hypertension

In patients with treatment resistant hypertension renal nerve ablation emerged as an effective interventional approach of treating hypertensive disease with a progressively increasing fall in blood pressure. Decreased activity of the sympathetic nervous system is one of the major underlying pathogenetic mechanism of the fall in blood pressure but the precise mechanisms that causes the fall in blood pressure in the short-term and, in particular, long-term remains elusive. The objective of the study is to understand the pathogenetic mechanisms of renal denervation beyond the reduced activity of the sympathetic nervous system. In 100 hypertensive patients most advanced technology will be applied, before and repeatedly after renal denervation, throughout the follow-up period of 1 year. Systemic activity of the renin angiotensin aldosterone system, renal perfusion (by MRI spin labeling technique), local activity of the renin angiotensin system in the kidney (urinary angiotensinogen concentrations), sodium excretion and total sodium content (23 Na-MRI technique) and vascular remodelling of small (retinal arterioles 50 - 150 µm) and large arteries (carotid - femoral pulse wave velocity and augmentation index, both measured over 24 hours) will be assessed. Identification of the pathogenetic mechanisms involved in the fall in blood pressure after renal denervation may help to identify those hypertensive patients that profit most from renal nerve ablation in terms of blood pressure reduction.

The investigators propose the following hypotheses why a progressive decrease in blood pressure happens, in addition to the decreased activity of the central nervous system, after renal nerve ablation:

Short term effects:

A)Preservation of renal function and perfusion B)Reduction of local RAS activity in the kidney C)Exaggerated sodium excretion immediately after renal nerve ablation

Long term effects:

D)Decrease of total sodium content after 6 and 12 months E)Improvement of vascular wall properties after 6 and 12 months

Not Provided
Observational
Observational Model: Cohort
Time Perspective: Prospective
Not Provided
Not Provided
Non-Probability Sample

treatment resistant hypertensive adults

Hypertension
Device: Renal denervation using Symplicity Catheter system
percutaneous selective renal sympathetic nerve ablation with the use of the Symplicity Catheter system
Renal denervation
Renal denervation using Symplicity Catheter system
Intervention: Device: Renal denervation using Symplicity Catheter system
Ott C, Mahfoud F, Schmid A, Ditting T, Sobotka PA, Veelken R, Spies A, Ukena C, Laufs U, Uder M, Böhm M, Schmieder RE. Renal denervation in moderate treatment-resistant hypertension. J Am Coll Cardiol. 2013 Nov 12;62(20):1880-6. doi: 10.1016/j.jacc.2013.06.023. Epub 2013 Jul 10.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
100
October 2014
October 2014   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • treatment resistant hypertension
  • male of female aged over 18 years
  • written informed consent
  • agreement to attend all study visits as planned in the protocol

Exclusion Criteria:

  • chronic kidney disease 3 - 5
  • any contradictions for MRI
  • claustrophobia
  • strabismus
  • severe ocular diseases
  • history of epilepsia
Both
18 Years to 85 Years
No
Contact: Christian Ott, MD 0049-9131-85 ext 36245 christian.ott@uk-erlangen.de
Germany
 
NCT01687725
RD-TRH
No
University of Erlangen-Nürnberg Medical School
University of Erlangen-Nürnberg Medical School
Not Provided
Principal Investigator: Roland E Schmieder, MD University of Erlangen-Nürnberg
University of Erlangen-Nürnberg Medical School
April 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP