6 research outputs found
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 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