Eligibility for renal denervation

experience at 11 European expert centers

Alexandre Persu, Yu Jin, Marie Baelen, Eva Vink, Willemien L Verloop, Bernhard Schmidt, Marie K Blicher, Francesca Severino, Grégoire Wuerzner, Alison Taylor, Antoinette Pechère-Bertschi, Fadi Jokhaji, Fadl Elmula M Fadl Elmula, Jan Rosa, Danuta Czarnecka, Georg Ehret, Thomas Kahan, Jean Renkin, Jiři Widimsky, Lotte Jacobs & 10 andre Wilko Spiering, Michel Burnier, Patrick B Mark, Jan Menne, Michael H Olsen, Peter J Blankestijn, Sverre Kjeldsen, Michiel L Bots, Jan A Staessen, European Network Coordinating research on REnal Denervation Consortium

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Based on the SYMPLICITY studies and CE (Conformité Européenne) certification, renal denervation is currently applied as a novel treatment of resistant hypertension in Europe. However, information on the proportion of patients with resistant hypertension qualifying for renal denervation after a thorough work-up and treatment adjustment remains scarce. The aim of this study was to investigate the proportion of patients eligible for renal denervation and the reasons for noneligibility at 11 expert centers participating in the European Network COordinating Research on renal Denervation in treatment-resistant hypertension (ENCOReD). The analysis included 731 patients. Age averaged 61.6 years, office blood pressure at screening was 177/96 mm Hg, and the number of blood pressure-lowering drugs taken was 4.1. Specialists referred 75.6% of patients. The proportion of patients eligible for renal denervation according to the SYMPLICITY HTN-2 criteria and each center's criteria was 42.5% (95% confidence interval, 38.0%-47.0%) and 39.7% (36.2%-43.2%), respectively. The main reasons of noneligibility were normalization of blood pressure after treatment adjustment (46.9%), unsuitable renal arterial anatomy (17.0%), and previously undetected secondary causes of hypertension (11.1%). In conclusion, after careful screening and treatment adjustment at hypertension expert centers, only ≈40% of patients referred for renal denervation, mostly by specialists, were eligible for the procedure. The most frequent cause of ineligibility (approximately half of cases) was blood pressure normalization after treatment adjustment by a hypertension specialist. Our findings highlight that hypertension centers with a record in clinical experience and research should remain the gatekeepers before renal denervation is considered.

OriginalsprogEngelsk
TidsskriftHypertension
Vol/bind63
Udgave nummer6
Sider (fra-til)1319-25
ISSN0194-911X
DOI
StatusUdgivet - jun. 2014

Fingeraftryk

Kidney
Certification
Research
Confidence Intervals
Pharmaceutical Preparations

Citer dette

Persu, A., Jin, Y., Baelen, M., Vink, E., Verloop, W. L., Schmidt, B., ... European Network Coordinating research on REnal Denervation Consortium (2014). Eligibility for renal denervation: experience at 11 European expert centers. Hypertension, 63(6), 1319-25. https://doi.org/10.1161/HYPERTENSIONAHA.114.03194
Persu, Alexandre ; Jin, Yu ; Baelen, Marie ; Vink, Eva ; Verloop, Willemien L ; Schmidt, Bernhard ; Blicher, Marie K ; Severino, Francesca ; Wuerzner, Grégoire ; Taylor, Alison ; Pechère-Bertschi, Antoinette ; Jokhaji, Fadi ; Fadl Elmula, Fadl Elmula M ; Rosa, Jan ; Czarnecka, Danuta ; Ehret, Georg ; Kahan, Thomas ; Renkin, Jean ; Widimsky, Jiři ; Jacobs, Lotte ; Spiering, Wilko ; Burnier, Michel ; Mark, Patrick B ; Menne, Jan ; Olsen, Michael H ; Blankestijn, Peter J ; Kjeldsen, Sverre ; Bots, Michiel L ; Staessen, Jan A ; European Network Coordinating research on REnal Denervation Consortium. / Eligibility for renal denervation : experience at 11 European expert centers. I: Hypertension. 2014 ; Bind 63, Nr. 6. s. 1319-25.
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title = "Eligibility for renal denervation: experience at 11 European expert centers",
abstract = "Based on the SYMPLICITY studies and CE (Conformit{\'e} Europ{\'e}enne) certification, renal denervation is currently applied as a novel treatment of resistant hypertension in Europe. However, information on the proportion of patients with resistant hypertension qualifying for renal denervation after a thorough work-up and treatment adjustment remains scarce. The aim of this study was to investigate the proportion of patients eligible for renal denervation and the reasons for noneligibility at 11 expert centers participating in the European Network COordinating Research on renal Denervation in treatment-resistant hypertension (ENCOReD). The analysis included 731 patients. Age averaged 61.6 years, office blood pressure at screening was 177/96 mm Hg, and the number of blood pressure-lowering drugs taken was 4.1. Specialists referred 75.6{\%} of patients. The proportion of patients eligible for renal denervation according to the SYMPLICITY HTN-2 criteria and each center's criteria was 42.5{\%} (95{\%} confidence interval, 38.0{\%}-47.0{\%}) and 39.7{\%} (36.2{\%}-43.2{\%}), respectively. The main reasons of noneligibility were normalization of blood pressure after treatment adjustment (46.9{\%}), unsuitable renal arterial anatomy (17.0{\%}), and previously undetected secondary causes of hypertension (11.1{\%}). In conclusion, after careful screening and treatment adjustment at hypertension expert centers, only ≈40{\%} of patients referred for renal denervation, mostly by specialists, were eligible for the procedure. The most frequent cause of ineligibility (approximately half of cases) was blood pressure normalization after treatment adjustment by a hypertension specialist. Our findings highlight that hypertension centers with a record in clinical experience and research should remain the gatekeepers before renal denervation is considered.",
keywords = "Aged, Europe, Female, Humans, Hypertension, Kidney, Logistic Models, Male, Middle Aged, Referral and Consultation, Sympathectomy",
author = "Alexandre Persu and Yu Jin and Marie Baelen and Eva Vink and Verloop, {Willemien L} and Bernhard Schmidt and Blicher, {Marie K} and Francesca Severino and Gr{\'e}goire Wuerzner and Alison Taylor and Antoinette Pech{\`e}re-Bertschi and Fadi Jokhaji and {Fadl Elmula}, {Fadl Elmula M} and Jan Rosa and Danuta Czarnecka and Georg Ehret and Thomas Kahan and Jean Renkin and Jiři Widimsky and Lotte Jacobs and Wilko Spiering and Michel Burnier and Mark, {Patrick B} and Jan Menne and Olsen, {Michael H} and Blankestijn, {Peter J} and Sverre Kjeldsen and Bots, {Michiel L} and Staessen, {Jan A} and {European Network Coordinating research on REnal Denervation Consortium}",
year = "2014",
month = "6",
doi = "10.1161/HYPERTENSIONAHA.114.03194",
language = "English",
volume = "63",
pages = "1319--25",
journal = "Hypertension",
issn = "0194-911X",
publisher = "Lippincott Williams & Wilkins",
number = "6",

}

Persu, A, Jin, Y, Baelen, M, Vink, E, Verloop, WL, Schmidt, B, Blicher, MK, Severino, F, Wuerzner, G, Taylor, A, Pechère-Bertschi, A, Jokhaji, F, Fadl Elmula, FEM, Rosa, J, Czarnecka, D, Ehret, G, Kahan, T, Renkin, J, Widimsky, J, Jacobs, L, Spiering, W, Burnier, M, Mark, PB, Menne, J, Olsen, MH, Blankestijn, PJ, Kjeldsen, S, Bots, ML, Staessen, JA & European Network Coordinating research on REnal Denervation Consortium 2014, 'Eligibility for renal denervation: experience at 11 European expert centers', Hypertension, bind 63, nr. 6, s. 1319-25. https://doi.org/10.1161/HYPERTENSIONAHA.114.03194

Eligibility for renal denervation : experience at 11 European expert centers. / Persu, Alexandre; Jin, Yu; Baelen, Marie; Vink, Eva; Verloop, Willemien L; Schmidt, Bernhard; Blicher, Marie K; Severino, Francesca; Wuerzner, Grégoire; Taylor, Alison; Pechère-Bertschi, Antoinette; Jokhaji, Fadi; Fadl Elmula, Fadl Elmula M; Rosa, Jan; Czarnecka, Danuta; Ehret, Georg; Kahan, Thomas; Renkin, Jean; Widimsky, Jiři; Jacobs, Lotte; Spiering, Wilko; Burnier, Michel; Mark, Patrick B; Menne, Jan; Olsen, Michael H; Blankestijn, Peter J; Kjeldsen, Sverre; Bots, Michiel L; Staessen, Jan A; European Network Coordinating research on REnal Denervation Consortium.

I: Hypertension, Bind 63, Nr. 6, 06.2014, s. 1319-25.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Eligibility for renal denervation

T2 - experience at 11 European expert centers

AU - Persu, Alexandre

AU - Jin, Yu

AU - Baelen, Marie

AU - Vink, Eva

AU - Verloop, Willemien L

AU - Schmidt, Bernhard

AU - Blicher, Marie K

AU - Severino, Francesca

AU - Wuerzner, Grégoire

AU - Taylor, Alison

AU - Pechère-Bertschi, Antoinette

AU - Jokhaji, Fadi

AU - Fadl Elmula, Fadl Elmula M

AU - Rosa, Jan

AU - Czarnecka, Danuta

AU - Ehret, Georg

AU - Kahan, Thomas

AU - Renkin, Jean

AU - Widimsky, Jiři

AU - Jacobs, Lotte

AU - Spiering, Wilko

AU - Burnier, Michel

AU - Mark, Patrick B

AU - Menne, Jan

AU - Olsen, Michael H

AU - Blankestijn, Peter J

AU - Kjeldsen, Sverre

AU - Bots, Michiel L

AU - Staessen, Jan A

AU - European Network Coordinating research on REnal Denervation Consortium

PY - 2014/6

Y1 - 2014/6

N2 - Based on the SYMPLICITY studies and CE (Conformité Européenne) certification, renal denervation is currently applied as a novel treatment of resistant hypertension in Europe. However, information on the proportion of patients with resistant hypertension qualifying for renal denervation after a thorough work-up and treatment adjustment remains scarce. The aim of this study was to investigate the proportion of patients eligible for renal denervation and the reasons for noneligibility at 11 expert centers participating in the European Network COordinating Research on renal Denervation in treatment-resistant hypertension (ENCOReD). The analysis included 731 patients. Age averaged 61.6 years, office blood pressure at screening was 177/96 mm Hg, and the number of blood pressure-lowering drugs taken was 4.1. Specialists referred 75.6% of patients. The proportion of patients eligible for renal denervation according to the SYMPLICITY HTN-2 criteria and each center's criteria was 42.5% (95% confidence interval, 38.0%-47.0%) and 39.7% (36.2%-43.2%), respectively. The main reasons of noneligibility were normalization of blood pressure after treatment adjustment (46.9%), unsuitable renal arterial anatomy (17.0%), and previously undetected secondary causes of hypertension (11.1%). In conclusion, after careful screening and treatment adjustment at hypertension expert centers, only ≈40% of patients referred for renal denervation, mostly by specialists, were eligible for the procedure. The most frequent cause of ineligibility (approximately half of cases) was blood pressure normalization after treatment adjustment by a hypertension specialist. Our findings highlight that hypertension centers with a record in clinical experience and research should remain the gatekeepers before renal denervation is considered.

AB - Based on the SYMPLICITY studies and CE (Conformité Européenne) certification, renal denervation is currently applied as a novel treatment of resistant hypertension in Europe. However, information on the proportion of patients with resistant hypertension qualifying for renal denervation after a thorough work-up and treatment adjustment remains scarce. The aim of this study was to investigate the proportion of patients eligible for renal denervation and the reasons for noneligibility at 11 expert centers participating in the European Network COordinating Research on renal Denervation in treatment-resistant hypertension (ENCOReD). The analysis included 731 patients. Age averaged 61.6 years, office blood pressure at screening was 177/96 mm Hg, and the number of blood pressure-lowering drugs taken was 4.1. Specialists referred 75.6% of patients. The proportion of patients eligible for renal denervation according to the SYMPLICITY HTN-2 criteria and each center's criteria was 42.5% (95% confidence interval, 38.0%-47.0%) and 39.7% (36.2%-43.2%), respectively. The main reasons of noneligibility were normalization of blood pressure after treatment adjustment (46.9%), unsuitable renal arterial anatomy (17.0%), and previously undetected secondary causes of hypertension (11.1%). In conclusion, after careful screening and treatment adjustment at hypertension expert centers, only ≈40% of patients referred for renal denervation, mostly by specialists, were eligible for the procedure. The most frequent cause of ineligibility (approximately half of cases) was blood pressure normalization after treatment adjustment by a hypertension specialist. Our findings highlight that hypertension centers with a record in clinical experience and research should remain the gatekeepers before renal denervation is considered.

KW - Aged

KW - Europe

KW - Female

KW - Humans

KW - Hypertension

KW - Kidney

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Referral and Consultation

KW - Sympathectomy

U2 - 10.1161/HYPERTENSIONAHA.114.03194

DO - 10.1161/HYPERTENSIONAHA.114.03194

M3 - Journal article

VL - 63

SP - 1319

EP - 1325

JO - Hypertension

JF - Hypertension

SN - 0194-911X

IS - 6

ER -

Persu A, Jin Y, Baelen M, Vink E, Verloop WL, Schmidt B et al. Eligibility for renal denervation: experience at 11 European expert centers. Hypertension. 2014 jun;63(6):1319-25. https://doi.org/10.1161/HYPERTENSIONAHA.114.03194