Catheter-based alcohol-mediated renal denervation for the treatment of uncontrolled hypertension: design of two sham-controlled, randomized, blinded trials in the absence (TARGET BP OFF-MED) and presence (TARGET BP I) of antihypertensive medications
Mahfoud, Felix; Weber, Michael; Schmieder, Roland E; Lobo, Melvin D; Blankestijn, Peter J; Persu, Alexandre; Fischell, Tim A; Parise, Helen; Pathak, Atul; Kandzari, David E
(2021) American Heart Journal, volume 239, pp. 90 - 99
(Article)
Abstract
BACKGROUND: Arterial hypertension is a common and life-threatening condition and poses a large global health burden. Device-based treatments have been developed as adjunctive or alternative therapy, to be used with or without antihypertensive medication for treating uncontrolled hypertension. The safety and feasibility of chemical renal denervation (RDN) using the Peregrine
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Catheter and alcohol were demonstrated in a first-in-man and open-label clinical trials, prompting the initiation of the ongoing TARGET BP OFF-MED and TARGET BP I trials. DESIGN: The TARGET BP trials are randomized, blinded, sham-controlled trials designed to assess the safety and efficacy of alcohol-mediated RDN for the treatment of uncontrolled hypertension in the absence of antihypertensive medications (TARGET BP OFF-MED) or in addition to prescribed antihypertensive medications (TARGET BP I). Subjects with confirmed uncontrolled hypertension and suitable renal artery anatomy are randomized (1:1) to receive either RDN using the Peregrine Kit with alcohol (0.6 mL per renal artery) infused through the Peregrine Catheter or diagnostic renal angiography only (sham procedure). TARGET BP OFF-MED completed enrollment and randomized 96 subjects. TARGET BP I will randomize approximately 300 subjects and will transition to an open-label safety cohort of approximately 300 subjects receiving RDN once the primary efficacy endpoint of the Randomized Controlled Trial (RCT) cohort has been met. Primary endpoints are change in mean 24-hour ambulatory systolic blood pressure from baseline to 8 weeks (TARGET BP OFF-MED) and 3 months (TARGET BP I) post-procedure. CONCLUSION: The TARGET BP trials are the first large-scale, international, randomized trials aimed to investigate the safety and BP lowering efficacy of a novel RDN method, with perivascular alcohol delivery using the Peregrine Kit.
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Keywords: Cardiology and Cardiovascular Medicine, Journal Article
ISSN: 0002-8703
Publisher: Mosby Inc.
Note: Funding Information: A. Persu reports having received travel grants from Ablative Solutions. D. Kandzari reports institutional research/grant support from Medtronic and Ablative Solutions , personal consulting honoraria from Medtronic, and is a shareholder in Biostar Ventures, although no equity related to Ablative Solutions. M. D. Lobo received consulting honoraria from Medtronic, ReCor Medical, Ablative Solutions, CVRx, Rox Medical and Vascular Dynamics and has had educational grants from Medtronic and ReCor Medical . Funding Information: The TARGET BP trials are funded by Ablative Solutions, Inc. F. Mahfoud is supported by Deutsche Gesellschaft für Kardiologie (DGK), and Deutsche Forschungsgemeinschaft (SFB TRR219) and has received scientific support and speaker honoraria from Bayer, Boehringer Ingelheim, Medtronic and ReCor Medical. P. J. Blankestijn reports research support from ReCor Medical and Ablative Solutions, and advisory board fee from Medtronic. All payments were done to the institution.A. Persu reports having received travel grants from Ablative Solutions. D. Kandzari reports institutional research/grant support from Medtronic and Ablative Solutions, personal consulting honoraria from Medtronic, and is a shareholder in Biostar Ventures, although no equity related to Ablative Solutions. M. D. Lobo received consulting honoraria from Medtronic, ReCor Medical, Ablative Solutions, CVRx, Rox Medical and Vascular Dynamics and has had educational grants from Medtronic and ReCor Medical. Publisher Copyright: © 2021
(Peer reviewed)