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Effect of Arteriovenous Anastomosis on Blood Pressure Reduction in Patients With Isolated Systolic Hypertension Compared With Combined Hypertension

BACKGROUND: Options for interventional therapy to lower blood pressure (BP) in patients with treatment‐resistant hypertension include renal denervation and the creation of an arteriovenous anastomosis using the ROX coupler. It has been shown that BP response after renal denervation is greater in pat...

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Autores principales: Ott, Christian, Lobo, Melvin D., Sobotka, Paul A., Mahfoud, Felix, Stanton, Alice, Cockcroft, John, Sulke, Neil, Dolan, Eamon, van der Giet, Markus, Hoyer, Joachim, Furniss, Stephen S., Foran, John P., Witkowski, Adam, Januszewicz, Andrzej, Schoors, Danny, Tsioufis, Konstantinos, Rensing, Benno J., Saxena, Manish, Scott, Benjamin, Ng, G. André, Achenbach, Stephan, Schmieder, Roland E., Schmid, Michael, Jain, Ajay, Knight, Charles, Mathur, Anthony, Balmforth, Peter, Luitjens, Sandra F., Smits, Gerard, Mungur, Dhanraj, Prejbisz, Aleksander, Kadziela, Jacek, Florczak, Elżbieta, Galvin, Joseph, Dimitriadis, Kyriakos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5210451/
https://www.ncbi.nlm.nih.gov/pubmed/28003251
http://dx.doi.org/10.1161/JAHA.116.004234
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author Ott, Christian
Lobo, Melvin D.
Sobotka, Paul A.
Mahfoud, Felix
Stanton, Alice
Cockcroft, John
Sulke, Neil
Dolan, Eamon
van der Giet, Markus
Hoyer, Joachim
Furniss, Stephen S.
Foran, John P.
Witkowski, Adam
Januszewicz, Andrzej
Schoors, Danny
Tsioufis, Konstantinos
Rensing, Benno J.
Saxena, Manish
Scott, Benjamin
Ng, G. André
Achenbach, Stephan
Schmieder, Roland E.
Schmid, Michael
Jain, Ajay
Knight, Charles
Mathur, Anthony
Balmforth, Peter
Luitjens, Sandra F.
Smits, Gerard
Mungur, Dhanraj
Prejbisz, Aleksander
Kadziela, Jacek
Florczak, Elżbieta
Galvin, Joseph
Dimitriadis, Kyriakos
author_facet Ott, Christian
Lobo, Melvin D.
Sobotka, Paul A.
Mahfoud, Felix
Stanton, Alice
Cockcroft, John
Sulke, Neil
Dolan, Eamon
van der Giet, Markus
Hoyer, Joachim
Furniss, Stephen S.
Foran, John P.
Witkowski, Adam
Januszewicz, Andrzej
Schoors, Danny
Tsioufis, Konstantinos
Rensing, Benno J.
Saxena, Manish
Scott, Benjamin
Ng, G. André
Achenbach, Stephan
Schmieder, Roland E.
Schmid, Michael
Jain, Ajay
Knight, Charles
Mathur, Anthony
Balmforth, Peter
Luitjens, Sandra F.
Smits, Gerard
Mungur, Dhanraj
Prejbisz, Aleksander
Kadziela, Jacek
Florczak, Elżbieta
Galvin, Joseph
Dimitriadis, Kyriakos
author_sort Ott, Christian
collection PubMed
description BACKGROUND: Options for interventional therapy to lower blood pressure (BP) in patients with treatment‐resistant hypertension include renal denervation and the creation of an arteriovenous anastomosis using the ROX coupler. It has been shown that BP response after renal denervation is greater in patients with combined hypertension (CH) than in patients with isolated systolic hypertension (ISH). We analyzed the effect of ROX coupler implantation in patients with CH as compared with ISH. METHODS AND RESULTS: The randomized, controlled, prospective ROX Control Hypertension Study included patients with true treatment‐resistant hypertension (office systolic BP ≥140 mm Hg, average daytime ambulatory BP ≥135/85 mm Hg, and treatment with ≥3 antihypertensive drugs including a diuretic). In a post hoc analysis, we stratified patients with CH (n=31) and ISH (n=11). Baseline office systolic BP (177±18 mm Hg versus 169±17 mm Hg, P=0.163) and 24‐hour ambulatory systolic BP (159±16 mm Hg versus 154±11 mm Hg, P=0.463) did not differ between patients with CH and those with ISH. ROX coupler implementation resulted in a significant reduction in office systolic BP (CH: −29±21 mm Hg versus ISH: −22±31 mm Hg, P=0.445) and 24‐hour ambulatory systolic BP (CH: −14±20 mm Hg versus ISH: −13±15 mm Hg, P=0.672), without significant differences between the two groups. The responder rate (office systolic BP reduction ≥10 mm Hg) after 6 months was not different (CH: 81% versus ISH: 82%, P=0.932). CONCLUSIONS: Our data suggest that creation of an arteriovenous anastomosis using the ROX coupler system leads to a similar reduction of office and 24‐hour ambulatory systolic BP in patients with combined and isolated systolic hypertension. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01642498.
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spelling pubmed-52104512017-01-05 Effect of Arteriovenous Anastomosis on Blood Pressure Reduction in Patients With Isolated Systolic Hypertension Compared With Combined Hypertension Ott, Christian Lobo, Melvin D. Sobotka, Paul A. Mahfoud, Felix Stanton, Alice Cockcroft, John Sulke, Neil Dolan, Eamon van der Giet, Markus Hoyer, Joachim Furniss, Stephen S. Foran, John P. Witkowski, Adam Januszewicz, Andrzej Schoors, Danny Tsioufis, Konstantinos Rensing, Benno J. Saxena, Manish Scott, Benjamin Ng, G. André Achenbach, Stephan Schmieder, Roland E. Schmid, Michael Jain, Ajay Knight, Charles Mathur, Anthony Balmforth, Peter Luitjens, Sandra F. Smits, Gerard Mungur, Dhanraj Prejbisz, Aleksander Kadziela, Jacek Florczak, Elżbieta Galvin, Joseph Dimitriadis, Kyriakos J Am Heart Assoc Original Research BACKGROUND: Options for interventional therapy to lower blood pressure (BP) in patients with treatment‐resistant hypertension include renal denervation and the creation of an arteriovenous anastomosis using the ROX coupler. It has been shown that BP response after renal denervation is greater in patients with combined hypertension (CH) than in patients with isolated systolic hypertension (ISH). We analyzed the effect of ROX coupler implantation in patients with CH as compared with ISH. METHODS AND RESULTS: The randomized, controlled, prospective ROX Control Hypertension Study included patients with true treatment‐resistant hypertension (office systolic BP ≥140 mm Hg, average daytime ambulatory BP ≥135/85 mm Hg, and treatment with ≥3 antihypertensive drugs including a diuretic). In a post hoc analysis, we stratified patients with CH (n=31) and ISH (n=11). Baseline office systolic BP (177±18 mm Hg versus 169±17 mm Hg, P=0.163) and 24‐hour ambulatory systolic BP (159±16 mm Hg versus 154±11 mm Hg, P=0.463) did not differ between patients with CH and those with ISH. ROX coupler implementation resulted in a significant reduction in office systolic BP (CH: −29±21 mm Hg versus ISH: −22±31 mm Hg, P=0.445) and 24‐hour ambulatory systolic BP (CH: −14±20 mm Hg versus ISH: −13±15 mm Hg, P=0.672), without significant differences between the two groups. The responder rate (office systolic BP reduction ≥10 mm Hg) after 6 months was not different (CH: 81% versus ISH: 82%, P=0.932). CONCLUSIONS: Our data suggest that creation of an arteriovenous anastomosis using the ROX coupler system leads to a similar reduction of office and 24‐hour ambulatory systolic BP in patients with combined and isolated systolic hypertension. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01642498. John Wiley and Sons Inc. 2016-12-21 /pmc/articles/PMC5210451/ /pubmed/28003251 http://dx.doi.org/10.1161/JAHA.116.004234 Text en © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Ott, Christian
Lobo, Melvin D.
Sobotka, Paul A.
Mahfoud, Felix
Stanton, Alice
Cockcroft, John
Sulke, Neil
Dolan, Eamon
van der Giet, Markus
Hoyer, Joachim
Furniss, Stephen S.
Foran, John P.
Witkowski, Adam
Januszewicz, Andrzej
Schoors, Danny
Tsioufis, Konstantinos
Rensing, Benno J.
Saxena, Manish
Scott, Benjamin
Ng, G. André
Achenbach, Stephan
Schmieder, Roland E.
Schmid, Michael
Jain, Ajay
Knight, Charles
Mathur, Anthony
Balmforth, Peter
Luitjens, Sandra F.
Smits, Gerard
Mungur, Dhanraj
Prejbisz, Aleksander
Kadziela, Jacek
Florczak, Elżbieta
Galvin, Joseph
Dimitriadis, Kyriakos
Effect of Arteriovenous Anastomosis on Blood Pressure Reduction in Patients With Isolated Systolic Hypertension Compared With Combined Hypertension
title Effect of Arteriovenous Anastomosis on Blood Pressure Reduction in Patients With Isolated Systolic Hypertension Compared With Combined Hypertension
title_full Effect of Arteriovenous Anastomosis on Blood Pressure Reduction in Patients With Isolated Systolic Hypertension Compared With Combined Hypertension
title_fullStr Effect of Arteriovenous Anastomosis on Blood Pressure Reduction in Patients With Isolated Systolic Hypertension Compared With Combined Hypertension
title_full_unstemmed Effect of Arteriovenous Anastomosis on Blood Pressure Reduction in Patients With Isolated Systolic Hypertension Compared With Combined Hypertension
title_short Effect of Arteriovenous Anastomosis on Blood Pressure Reduction in Patients With Isolated Systolic Hypertension Compared With Combined Hypertension
title_sort effect of arteriovenous anastomosis on blood pressure reduction in patients with isolated systolic hypertension compared with combined hypertension
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5210451/
https://www.ncbi.nlm.nih.gov/pubmed/28003251
http://dx.doi.org/10.1161/JAHA.116.004234
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