Skip to main content
Top
Published in: Trials 1/2019

Open Access 01-12-2019 | Neurotomy | Study protocol

Efficiency and safety of renal denervation via cryoablation (Cryo-RDN) in Chinese patients with uncontrolled hypertension: study protocol for a randomized controlled trial

Authors: Han Chen, Meng Ji, Yi Zhang, Yawei Xu, Lingjuan Qiao, Li Shen, Junbo Ge

Published in: Trials | Issue 1/2019

Login to get access

Abstract

Background

Clinical data show that due to the limited effects of lifestyle regulation and unsatisfactory drug adherence, only half of the hypertensive population have their blood pressure (BP) under control. In recent years, catheter-based renal denervation (RDN) has been used as a novel approach for treating uncontrolled hypertension. The safety and efficacy of catheter-based RDN have been confirmed by a number of studies and trials in which the participants were all non-Chinese and RDN was conducted via radiofrequency or ultrasound.

Methods/design

This study is a prospective multicenter randomized sham-controlled trial that aims to investigate the safety and efficacy of cryoablation RDN (cryo-RDN) using a novel dedicated cryoablation balloon catheter (Cryofocus, China). A total of 200 Chinese patients who have uncontrolled hypertension despite standard medical treatment will be enrolled. With drug standardization, eligible participants will be randomized in a 1:1 ratio to undergo cryo-RDN treatment or renal angiography alone as a sham treatment.
The primary endpoint is defined as the change in 24-h ambulatory systolic blood pressure from baseline to 6 months. Office BP and other 24-h ambulatory BP are included as secondary endpoints. Safety endpoints primarily include any adverse effects.

Discussion

This study was designed to verify the safety and efficacy of cryo-RDN with Cryofocus balloon catheters in uncontrolled hypertensive patients on polypharmacy. The aim is to provide a new way to improve the control of hypertension in China as a complement to drug therapy.

Trial registration

ChiCTR, ChiCTR1800017707​. Registered on 10 August 2018.
Appendix
Available only for authorised users
Literature
1.
go back to reference World Health Organization (2013) A global brief on hypertension—World Health Day 2013. World Health Organization (2013) A global brief on hypertension—World Health Day 2013.
2.
go back to reference Legido-Quigley H, Lopez PC, Balabanova D, et al. Patients’ knowledge, attitudes, behaviour and health care experiences on the prevention, detection, management and control of hypertension in Colombia: a qualitative study. PLoS One. 2015;10(4):e0122112.CrossRef Legido-Quigley H, Lopez PC, Balabanova D, et al. Patients’ knowledge, attitudes, behaviour and health care experiences on the prevention, detection, management and control of hypertension in Colombia: a qualitative study. PLoS One. 2015;10(4):e0122112.CrossRef
3.
go back to reference Prochnau D, Heymel S, Otto S, et al. Renal denervation with cryoenergy as second-line option is effective in the treatment of resistant hypertension in non-responders to radiofrequency ablation. EuroIntervention. 2014;10(5):640–5.CrossRef Prochnau D, Heymel S, Otto S, et al. Renal denervation with cryoenergy as second-line option is effective in the treatment of resistant hypertension in non-responders to radiofrequency ablation. EuroIntervention. 2014;10(5):640–5.CrossRef
4.
go back to reference Schlaich MP, Sobotka PA, Krum H, et al. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med. 2009;361:932–4.CrossRef Schlaich MP, Sobotka PA, Krum H, et al. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med. 2009;361:932–4.CrossRef
5.
go back to reference Mathiassen ON, Vase H, Bech JN, et al. Renal denervation in treatment-resistant essential hypertension. A randomized, Sham-controlled, double-blinded 24-h blood pressure-based trial. J Hypertens. 2016;34(8):1639–47.CrossRef Mathiassen ON, Vase H, Bech JN, et al. Renal denervation in treatment-resistant essential hypertension. A randomized, Sham-controlled, double-blinded 24-h blood pressure-based trial. J Hypertens. 2016;34(8):1639–47.CrossRef
6.
go back to reference Azizi M, Schmieder RE, Mahfoud F, et al. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial. Lancet. 2018;391(10137):2298–300.CrossRef Azizi M, Schmieder RE, Mahfoud F, et al. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial. Lancet. 2018;391(10137):2298–300.CrossRef
7.
go back to reference Townsend RR, Mahfoud F, Kandzari DE, et al. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet. 2017;390(10108):2160–70.CrossRef Townsend RR, Mahfoud F, Kandzari DE, et al. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet. 2017;390(10108):2160–70.CrossRef
8.
go back to reference Ji M, Shen L, et al. Short-term Safety and Efficiency of Cryoablation for Renal Sympathetic Denervation in a Swine Model. Chin Med J. 2015;128(6):790–4.CrossRef Ji M, Shen L, et al. Short-term Safety and Efficiency of Cryoablation for Renal Sympathetic Denervation in a Swine Model. Chin Med J. 2015;128(6):790–4.CrossRef
9.
go back to reference Lu J, Lu Y, Wang X, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet. 2017;390(10112):2549.CrossRef Lu J, Lu Y, Wang X, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet. 2017;390(10112):2549.CrossRef
10.
go back to reference Chen WW, Gao RL, Liu LS, et al. China Cardiovascular Disease report 2017. Chin Circ J. 2018;33(01):1–8. Chen WW, Gao RL, Liu LS, et al. China Cardiovascular Disease report 2017. Chin Circ J. 2018;33(01):1–8.
11.
go back to reference Krum H, Schlaich MP, Sobotka PA, et al. Percutaneous renal denervation in patients with treatment-resistant hypertension: final 3-year report of the Symplicity HTN-1 study. Lancet. 2014;383(9917):622–9.CrossRef Krum H, Schlaich MP, Sobotka PA, et al. Percutaneous renal denervation in patients with treatment-resistant hypertension: final 3-year report of the Symplicity HTN-1 study. Lancet. 2014;383(9917):622–9.CrossRef
12.
go back to reference Esler MD, et al. Catheter-based renal denervation for treatment of patients with treatment-resistant hypertension: 36month results from the SYMPLICITY HTN-2 randomized clinical trial. Eur Heart J. 2014;35(26):1752–9.CrossRef Esler MD, et al. Catheter-based renal denervation for treatment of patients with treatment-resistant hypertension: 36month results from the SYMPLICITY HTN-2 randomized clinical trial. Eur Heart J. 2014;35(26):1752–9.CrossRef
13.
go back to reference Bhatt DL, Kandzari DE, et al. A Controlled Trial of Renal Denervation for Resistant Hypertension. N Engl J Med. 2014;370(15):1393–401.CrossRef Bhatt DL, Kandzari DE, et al. A Controlled Trial of Renal Denervation for Resistant Hypertension. N Engl J Med. 2014;370(15):1393–401.CrossRef
14.
go back to reference Bakris GL, Townsend RR, Flack JM, et al. 12-Month Blood Pressure Results of Catheter-Based Renal Artery Denervation for Resistant Hypertension: The SYMPLICITY HTN-3 Trial. J Am Coll Cardiol. 2015;65(13):1314–21.CrossRef Bakris GL, Townsend RR, Flack JM, et al. 12-Month Blood Pressure Results of Catheter-Based Renal Artery Denervation for Resistant Hypertension: The SYMPLICITY HTN-3 Trial. J Am Coll Cardiol. 2015;65(13):1314–21.CrossRef
15.
go back to reference Mahfoud F, Bakris G, Bhatt DL, et al. Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry. Eur Heart J. 2017;38(2):93–100.PubMed Mahfoud F, Bakris G, Bhatt DL, et al. Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry. Eur Heart J. 2017;38(2):93–100.PubMed
16.
go back to reference Middlekauff HR. A mechanistic explanation for the minimal impact of renal denervation on 24-h ambulatory blood pressure in SIMPLICITY HTN-3. J Am Coll Cardiol. 2015;65(9):959.CrossRef Middlekauff HR. A mechanistic explanation for the minimal impact of renal denervation on 24-h ambulatory blood pressure in SIMPLICITY HTN-3. J Am Coll Cardiol. 2015;65(9):959.CrossRef
17.
go back to reference Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of. Blood Press. 2013;16(3):135. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of. Blood Press. 2013;16(3):135.
18.
go back to reference Kandzari DE, Böhm M, Mahfoud F, et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet. 2018;391(10137):2346–55.CrossRef Kandzari DE, Böhm M, Mahfoud F, et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet. 2018;391(10137):2346–55.CrossRef
19.
go back to reference De BT, Tselikas L, Woodrum D, et al. Evaluating Cryoablation of Metastatic Lung Tumors in Patients - Safety and Efficacy: The ECLIPSE trial - Interim analysis at 1-Year. J Thorac Oncol. 2015;10(10):1468–74.CrossRef De BT, Tselikas L, Woodrum D, et al. Evaluating Cryoablation of Metastatic Lung Tumors in Patients - Safety and Efficacy: The ECLIPSE trial - Interim analysis at 1-Year. J Thorac Oncol. 2015;10(10):1468–74.CrossRef
20.
go back to reference Aryana A, Baker JH, Ginic MAE, et al. Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation: A multicenter experience. Heart Rhythm. 2018;15(8):1121–9.CrossRef Aryana A, Baker JH, Ginic MAE, et al. Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation: A multicenter experience. Heart Rhythm. 2018;15(8):1121–9.CrossRef
21.
go back to reference Prochnau D, Romeike BF, Bischoff S, Schubert H, Figulla HR, Surber R. Reduction of neurofilaments following renal denervation with radiofrequency current in a sheep model. Int J Cardiol. 2013;168:4450–2.CrossRef Prochnau D, Romeike BF, Bischoff S, Schubert H, Figulla HR, Surber R. Reduction of neurofilaments following renal denervation with radiofrequency current in a sheep model. Int J Cardiol. 2013;168:4450–2.CrossRef
22.
go back to reference Prochnau D, Figulla HR, Romeike BF, et al. Percutaneous catheter-based cryoablation of the renal artery is effective for sympathetic denervation in a sheep model. Int J Cardiol. 2011;152:268–70.CrossRef Prochnau D, Figulla HR, Romeike BF, et al. Percutaneous catheter-based cryoablation of the renal artery is effective for sympathetic denervation in a sheep model. Int J Cardiol. 2011;152:268–70.CrossRef
23.
go back to reference Deisenhofer I, Zrenner B, Yin YH, et al. Cryoablation versus radiofrequency energy for the ablation of atrioventricular nodal reentrant tachycardia (the CYRANO Study): results from a large multicenter prospective randomized trial. Circulation. 2010;122:2239–45.CrossRef Deisenhofer I, Zrenner B, Yin YH, et al. Cryoablation versus radiofrequency energy for the ablation of atrioventricular nodal reentrant tachycardia (the CYRANO Study): results from a large multicenter prospective randomized trial. Circulation. 2010;122:2239–45.CrossRef
24.
go back to reference Malmborg H, Lonnerholm S, Lundqvist CB. A prospective randomised comparison of large-tip cryoablation and 8-mm-tip radiofrequency catheter ablation of atrial flutter. J Interv Card Electrophysiol. 2009;24:127–31.CrossRef Malmborg H, Lonnerholm S, Lundqvist CB. A prospective randomised comparison of large-tip cryoablation and 8-mm-tip radiofrequency catheter ablation of atrial flutter. J Interv Card Electrophysiol. 2009;24:127–31.CrossRef
25.
go back to reference Metzner A, Rausch P, Lemes C, et al. The incidence of phrenic nerve injury during pulmonary vein isolation using the second-generation 28 mm cryoballoon. J Cardiovasc Electrophysiol. 2014;25:466–70.CrossRef Metzner A, Rausch P, Lemes C, et al. The incidence of phrenic nerve injury during pulmonary vein isolation using the second-generation 28 mm cryoballoon. J Cardiovasc Electrophysiol. 2014;25:466–70.CrossRef
26.
go back to reference Martins RP, Hamon D, Césari O, et al. Safety and efficacy of a second-generation cryoballoon in the ablation of paroxysmal atrial fibrillation. Heart Rhythm. 2014;11:386–93.CrossRef Martins RP, Hamon D, Césari O, et al. Safety and efficacy of a second-generation cryoballoon in the ablation of paroxysmal atrial fibrillation. Heart Rhythm. 2014;11:386–93.CrossRef
27.
go back to reference Dorenkamp M, Bonaventura K, Leber AW, et al. Potential lifetime cost-effectiveness of catheter-based renal sympathetic denervation in patients with resistant hypertension. Eur Heart J. 2013;34(6):451.CrossRef Dorenkamp M, Bonaventura K, Leber AW, et al. Potential lifetime cost-effectiveness of catheter-based renal sympathetic denervation in patients with resistant hypertension. Eur Heart J. 2013;34(6):451.CrossRef
29.
go back to reference Berra E, Azizi M, Capron A, et al. Evaluation of adherence should become an integral part of assessment of patients with apparently treatment-resistant hypertension. Hypertension. 2016;68:297–306.CrossRef Berra E, Azizi M, Capron A, et al. Evaluation of adherence should become an integral part of assessment of patients with apparently treatment-resistant hypertension. Hypertension. 2016;68:297–306.CrossRef
Metadata
Title
Efficiency and safety of renal denervation via cryoablation (Cryo-RDN) in Chinese patients with uncontrolled hypertension: study protocol for a randomized controlled trial
Authors
Han Chen
Meng Ji
Yi Zhang
Yawei Xu
Lingjuan Qiao
Li Shen
Junbo Ge
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Trials / Issue 1/2019
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-019-3693-9

Other articles of this Issue 1/2019

Trials 1/2019 Go to the issue