SPYRAL HTN-ON MED Study of Renal Denervation With the Symplicity Spyral™ Multi-electrode Renal Denervation System
Global Clinical Study of Renal Denervation With the Symplicity Spyral™ Multi-electrode Renal Denervation System in Patients With Uncontrolled Hypertension on Standard Medical Therapy (SPYRAL HTN-ON MED)
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Kogarah, Australia
- St. George Hospital
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Perth, Australia
- Royal Perth
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Victoria
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Melbourne, Victoria, Australia, 3004
- Alfred Hospital
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Wels, Austria, 4600
- Klinikum Wels-Grieskirchen
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Ontario
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Hamilton, Ontario, Canada
- Hamilton Heath
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Toronto, Ontario, Canada
- St. Michael's Hospital
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Toulouse, France
- Clinique Pasteur
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Bad Krozingen, Germany, 79189
- Universitäts-Herzzentrum Freiburg - Bad Krozingen GmbH
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Erlangen, Germany, 91054
- Universitätsklinikum Erlangen
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Homburg, Germany, 66421
- Universitätsklinikum des Saarlandes
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Leipzig, Germany, 04289
- Herzzentrum Leipzig, Universitätsklinik
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Lübeck, Germany, 23560
- Sana Kliniken Lubeck
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Athens, Greece, 11527
- Hippokration General Hospital of Athens
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Thessaloniki, Greece, 54621
- University General Hospital of Thessaloniki (AHEPA)
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Galway, Ireland
- Galway University Hospital
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Osaka, Japan
- Saiseikai Nakatsu Hospital
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Hyōgo
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Takarazuka, Hyōgo, Japan
- Higashi Takarazuka Satoh Hospital
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Okamoto
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Kamakura, Okamoto, Japan
- Shonan Kamakura General Hospital
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Tochigi
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Shimotsuke, Tochigi, Japan, 329-0498
- Jichi Medical University Hospital
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Tokyo
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Chiyoda City, Tokyo, Japan, 101-8643
- Mitsui Memorial Hospital
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Bournemouth, United Kingdom
- Royal Bournemouth Hospital
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Cardiff, United Kingdom
- Cardiff and Vale University Health Board - University Hospital of Wales
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Exeter, United Kingdom, EX2 5DW
- Royal Devon & Exeter NHS Foundation Trust
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London, United Kingdom, W12 0HS
- Imperial College Healthcare NHS Trust
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Alabama
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Huntsville, Alabama, United States, 35801
- Heart Center Research, LLC
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California
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Stanford, California, United States, 94305
- Stanford Hospital and Clinics
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Connecticut
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New Haven, Connecticut, United States, 06520
- Yale New Haven Hospital
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District of Columbia
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Washington D.C., District of Columbia, United States, 20422
- Washington DC VA Medical Center
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Florida
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Jacksonville, Florida, United States, 32207
- Baptist Medical Center Jacksonville
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Jacksonville, Florida, United States, 32216
- Memorial Hospital Jacksonville
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Tallahassee, Florida, United States, 32308
- Tallahassee Research Institute
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Georgia
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Atlanta, Georgia, United States, 30308
- Emory University Hospital Midtown
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Atlanta, Georgia, United States, 30309
- Piedmont Heart Institute
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Iowa
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West Des Moines, Iowa, United States, 50266
- Iowa Heart Center
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Kentucky
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Lexington, Kentucky, United States, 40536
- University Of Kentucky
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Michigan
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Pontiac, Michigan, United States, 48341
- St Joseph Mercy Oakland
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Southfield, Michigan, United States, 48075
- Providence Hospital
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Minnesota
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Minneapolis, Minnesota, United States, 55407
- Minneapolis Heart Institute Foundation
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Mississippi
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Hattiesburg, Mississippi, United States, 39401
- Hattiesburg Clinic
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Tupelo, Mississippi, United States, 38801
- Cardiology Associates Research LLC
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Missouri
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St Louis, Missouri, United States, 63110
- Barnes-Jewish Hospital
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New Jersey
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Livingston, New Jersey, United States, 07039
- Saint Barnabas Medical Center
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New York
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Manhasset, New York, United States, 11030
- North Shore University Hospital
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New York, New York, United States, 10029
- Mount Sinai Medical Center
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New York, New York, United States, 10021
- Weill Cornell Medical College/The New York Presbyterian Hospital
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North Carolina
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Durham, North Carolina, United States, 27710
- Duke University Medical Center
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Ohio
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Cleveland, Ohio, United States, 44106
- University Hospitals Cleveland Medical Center
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Oregon
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Portland, Oregon, United States, 97239
- Oregon Health & Science University Hospital
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Pennsylvania
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Harrisburg, Pennsylvania, United States, 17011
- PinnacleHealth Cardiovascular Institute
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Philadelphia, Pennsylvania, United States, 19104
- Hospital of the University of Pennsylvania
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Rhode Island
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Providence, Rhode Island, United States, 02906
- The Miriam Hospital
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South Carolina
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Anderson, South Carolina, United States, 29621
- AnMed Health
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Tennessee
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Nashville, Tennessee, United States, 37203
- Centennial Medical Center
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Texas
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Dallas, Texas, United States, 75226
- Baylor Heart & Vascular Hospital
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West Virginia
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Charleston, West Virginia, United States, 25304
- Charleston Area Medical Center
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Wisconsin
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Milwaukee, Wisconsin, United States, 53215
- Aurora St. Luke's Medical Center
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Individual has office systolic blood pressure (SBP) ≥ 150 mmHg and <180 mmHg and a diastolic blood pressure (DBP) ≥ 90 mmHg when receiving a medication regimen of one, two, or three antihypertensive medication classes.
- Individual has 24-hour Ambulatory Blood Pressure Monitoring (ABPM) average SBP ≥ 140 mmHg and < 170 mmHg.
Exclusion Criteria:
- Individual lacks appropriate renal artery anatomy.
- Individual has estimated glomerular filtration rate (eGFR) of <45.
- Individual has type 1 diabetes mellitus or poorly-controlled type 2 diabetes mellitus.
- Individual has one or more episodes of orthostatic hypotension.
- Individual requires chronic oxygen support or mechanical ventilation other than nocturnal respiratory support for sleep apnea.
- Individual has primary pulmonary hypertension.
- Individual is pregnant, nursing or planning to become pregnant.
- Individual has frequent intermittent or chronic pain that results in treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) for two or more days per week over the month prior to enrollment
- Individual has stable or unstable angina within 3 months of enrollment, myocardial infarction within 3 months of enrollment; heart failure, cerebrovascular accident or transient ischemic attack, or atrial fibrillation at any time.
- Individual works night shifts.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
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Experimental: Renal Denervation
Renal angiography and Renal Denervation (Symplicity Spyral™ multi-electrode renal denervation system)
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After a renal angiography according to standard procedures, subjects remain blinded and are immediately treated with the renal denervation procedure after randomization.
Other Names:
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Sham Comparator: Sham Procedure
Renal angiography
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After a renal angiography according to standard procedures, subjects remain blinded and remain on the catheterization lab table for at least 20 minutes prior to introducer sheath removal.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Acute and Chronic Safety by Evaluating Incidence of Major Adverse Events
Time Frame: From baseline to 1 month post-procedure (6 months for new renal artery stenosis)
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The primary safety endpoint of the study is the incidence of Major Adverse Events (MAE), defined as a composite of the following events: All-cause mortality, End Stage Renal Disease (ESRD), Significant embolic event resulting in end-organ damage, Renal artery perforation requiring intervention, Renal artery dissection requiring intervention, Vascular complications, Hospitalization for hypertensive crisis not related to confirmed non-adherence with medications or the protocol, New renal artery stenosis >70%, confirmed by angiography and as a determined by the angiographic core laboratory, through one-month post-randomization (6- months for new renal artery stenosis).
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From baseline to 1 month post-procedure (6 months for new renal artery stenosis)
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Change in Systolic Blood Pressure as Measured by 24-hour Ambulatory Blood Pressure Monitoring (ABPM)
Time Frame: From baseline to 6 months post-procedure
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Baseline adjusted change (using Analysis of Covariance) in systolic blood pressure (SBP) from baseline (Screening Visit 2) to 6 months post-procedure as measured by 24-hour Ambulatory Blood Pressure Monitoring (ABPM).
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From baseline to 6 months post-procedure
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Antihypertensive Medication Usage and Changes to 6-months
Time Frame: From baseline to 6-month post-procedure
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Number of medications from baseline (Screening Visit 2) through 6 Months post-procedure
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From baseline to 6-month post-procedure
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Antihypertensive Medication Burden to 6-months
Time Frame: From baseline to 6 Months post-procedure
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Based on the prescribed medications reported, medication burden was calculated using Medication Index 2 score which is a composite index based on the doses of antihypertensive medications multiplied by the number of medications prescribed; all classes (ACE/ARB, calcium channel blockers, etc.) were considered equivalent in potency. Higher score indicates higher dosages being prescribed over the standard dose. Minimum value 0; No Maximum value |
From baseline to 6 Months post-procedure
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Medication Changes
Time Frame: Baseline to 6-months post-procedure
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Patients who had medication changes based on Medication Index 2 drug testing data.
Medication Index 2 score is a composite index based on the doses of antihypertensive medications multiplied by the number of medications prescribed; all classes (ACE/ARB, calcium channel blockers, etc.) were considered equivalent in potency.
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Baseline to 6-months post-procedure
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Incidence of Achieving Target Office Systolic Blood Pressure
Time Frame: From baseline to 6 months post-procedure
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Incidence of achieving target office systolic blood pressure (SBP<140 mmHg) at 6 months post- procedure.
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From baseline to 6 months post-procedure
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Change in Office Systolic Blood Pressure
Time Frame: From baseline to 6 months post-procedure
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Change in office systolic blood pressure from baseline (Screening Visit 2) to 6 months post-procedure
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From baseline to 6 months post-procedure
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Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Raymond Townsend, MD, University of Pennsylvania
- Principal Investigator: David Kandzari, MD, Piedmont Hospital
- Principal Investigator: Michael Böhm, MD, Universitätskliniken des Saarlandes
- Principal Investigator: Kazuomi Kario, MD, Jichi Medical University
Publications and helpful links
General Publications
- Mahfoud F, Kandzari DE, Kario K, Townsend RR, Weber MA, Schmieder RE, Tsioufis K, Pocock S, Dimitriadis K, Choi JW, East C, D'Souza R, Sharp ASP, Ewen S, Walton A, Hopper I, Brar S, McKenna P, Fahy M, Bohm M. Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial. Lancet. 2022 Apr 9;399(10333):1401-1410. doi: 10.1016/S0140-6736(22)00455-X. Epub 2022 Apr 4.
- Kandzari DE, Hickey GL, Pocock SJ, Weber MA, Bohm M, Cohen SA, Fahy M, Lamberti G, Mahfoud F. Prioritised endpoints for device-based hypertension trials: the win ratio methodology. EuroIntervention. 2021 Apr 2;16(18):e1496-e1502. doi: 10.4244/EIJ-D-20-01090.
- Kario K, Weber MA, Bohm M, Townsend RR, Mahfoud F, Schmieder RE, Tsioufis K, Cohen SA, Fahy M, Kandzari DE. Effect of renal denervation in attenuating the stress of morning surge in blood pressure: post-hoc analysis from the SPYRAL HTN-ON MED trial. Clin Res Cardiol. 2021 May;110(5):725-731. doi: 10.1007/s00392-020-01718-6. Epub 2020 Aug 1.
- Kandzari DE, Bohm M, Mahfoud F, Townsend RR, Weber MA, Pocock S, Tsioufis K, Tousoulis D, Choi JW, East C, Brar S, Cohen SA, Fahy M, Pilcher G, Kario K; SPYRAL HTN-ON MED Trial Investigators. 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 Jun 9;391(10137):2346-2355. doi: 10.1016/S0140-6736(18)30951-6. Epub 2018 May 23.
- Kandzari DE, Kario K, Mahfoud F, Cohen SA, Pilcher G, Pocock S, Townsend R, Weber MA, Bohm M. The SPYRAL HTN Global Clinical Trial Program: Rationale and design for studies of renal denervation in the absence (SPYRAL HTN OFF-MED) and presence (SPYRAL HTN ON-MED) of antihypertensive medications. Am Heart J. 2016 Jan;171(1):82-91. doi: 10.1016/j.ahj.2015.08.021. Epub 2015 Sep 11.
- Bohm M, Townsend RR, Kario K, Kandzari D, Mahfoud F, Weber MA, Schmieder RE, Tsioufis K, Hickey GL, Fahy M, DeBruin V, Brar S, Pocock S. Rationale and design of two randomized sham-controlled trials of catheter-based renal denervation in subjects with uncontrolled hypertension in the absence (SPYRAL HTN-OFF MED Pivotal) and presence (SPYRAL HTN-ON MED Expansion) of antihypertensive medications: a novel approach using Bayesian design. Clin Res Cardiol. 2020 Mar;109(3):289-302. doi: 10.1007/s00392-020-01595-z. Epub 2020 Feb 7.
- Kandzari DE, Mahfoud F, Townsend RR, Kario K, Weber MA, Schmieder RE, Tsioufis K, Pocock S, Liu M, DeBruin V, Brar S, Bohm M. Long-Term Safety and Efficacy of Renal Denervation: 24-Month Results From the SPYRAL HTN-ON MED Trial. Circ Cardiovasc Interv. 2025 Jul;18(7):e015194. doi: 10.1161/CIRCINTERVENTIONS.125.015194. Epub 2025 May 20.
- Townsend RR, Ferdinand KC, Kandzari DE, Kario K, Mahfoud F, Weber MA, Schmieder RE, Pocock S, Tsioufis K, David S, Steigerwalt S, Walton A, Hopper I, Bertolet B, Sharif F, Fengler K, Fahy M, Hettrick DA, Brar S, Bohm M. Impact of Antihypertensive Medication Changes After Renal Denervation Among Different Patient Groups: SPYRAL HTN-ON MED. Hypertension. 2024 May;81(5):1095-1105. doi: 10.1161/HYPERTENSIONAHA.123.22251. Epub 2024 Feb 5.
- Kandzari DE, Townsend RR, Kario K, Mahfoud F, Weber MA, Schmieder RE, Pocock S, Tsioufis K, Konstantinidis D, Choi J, East C, Lauder L, Cohen DL, Kobayashi T, Schmid A, Lee DP, Ma A, Weil J, Agdirlioglu T, Schlaich MP, Shetty S, Devireddy CM, Lea J, Aoki J, Sharp ASP, Anderson R, Fahy M, DeBruin V, Brar S, Bohm M; SPYRAL HTN-ON MED Investigators. Safety and Efficacy of Renal Denervation in Patients Taking Antihypertensive Medications. J Am Coll Cardiol. 2023 Nov 7;82(19):1809-1823. doi: 10.1016/j.jacc.2023.08.045.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimated)
First Posted
Study Record Updates
Last Update Posted (Estimated)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- SPYRAL HTN-ON MED
Drug and device information, study documents
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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