Perirenal Adipose Tissue Modification Therapy for Resistant Hypertension (PATH-RHT)

The Efficacy and Safety of Perirenal Adipose Tissue Modification Therapy by Focused Power Ultrasound for Resistant Hypertension

The goal of this clinical trial is to investigate if focused power ultrasound (FPU) targeted perirenal adipose tissue modification therapy would be effective and safe in treating resistant hypertension. The primary outcome of the study is the difference in the reduction of 24h mean systolic blood pressure between treatment and sham procedure groups 6 months after treatment. The secondary outcomes include the reduction of clinic blood pressure 1, 3, and 6 months after treatment, the reduction of 24h mean blood pressure 1, 3, and 6 months after treatment, and the drug burden of antihypertensive treatment. The safety evaluation includes the incidence of all-cause death, cardiovascular events (stroke and myocardial infarction), renal failure, and other adverse events.

Study Overview

• Status: Not yet recruiting
• Conditions: Resistant Hypertension
• Intervention / Treatment: Procedure: Perirenal adipose tissue modification by focused power ultrasound; Procedure: Sham

Detailed Description

Hypertension is the most common cardiovascular disease. However, the control rate of hypertension in China is very low. Resistant hypertension is defined as uncontrolled blood pressure despite optimal lifestyle modifications and the use of three appropriately tolerated, maximally dosed antihypertensive drugs (including a diuretic), or controlled blood pressure with four antihypertensive drugs. Resistant hypertension is associated with increased cardiovascular risk and poor prognosis.

Previous studies have shown that bilateral perirenal adipose tissue (PRAT) ablation or denervation leads to a long-term blood pressure reduction in spontaneous hypertensive rats. Focused power ultrasound (FPU) targeted PRAT modification therapy is a novel intervention aiming to physically or chemically modify PRAT using ultrasound energy, remove nerve fibers, and treat hypertension. Preliminary feasibility and safety was proved in a pilot study of 20 patients. However, a larger, randomized trial is needed to prove efficacy and long-term safety of the treatment.

Participants with resistant hypertension will be recruited in 10 centers and then to investigate whether PRAT modification therapy by FPU is effective and safe for patients with resistant hypertension.

• Study Type: Interventional
• Enrollment (Estimated): 220
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Yan Li, Professor; Phone Number: 675101 021-64370045; Email: liyanshcn@163.com

Study Locations

• China
  • Shanghai Municipality
    • Shanghai, Shanghai Municipality, China, 200025
      • Ruijin Hospital
      • Principal Investigator: Yan Li, Professor
      • Contact: Yan Li, Professor; Phone Number: 675101 021-64370045; Email: liyanshcn@163.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Male or female participants aged 18-75 years old;
2. 24h ambulatory systolic BP ≥130mmHg and <150mmHg, and 24h ambulatory diastolic BP <100mmHg after at least 4 weeks of combined treatment with 3 antihypertensive drugs (including a diuretic);
3. The ultrasound measured inferior perirenal adipose tissue ≥8 cm3 (with the superior-inferior diameter, left-right diameter, and anterior-posterior diameter all needing to be ≥20 mm);
4. Be willing to participate in the trial, and be able to visit doctors by himself or herself;
5. Sign the informed consent form.

Exclusion Criteria:

1. Secondary hypertension;
2. Occurrence of myocardial infarction, malignant arrhythmia, severe renal failure, or stroke within 6 months;
3. Ambulatory BP monitoring was invalid (<70% valid readings, or <20 daytime readings or <7 nighttime readings);
4. Alanine transaminase (ALT), aspartate transaminase (AST), or total bilirubin (TBL) above twice the normal range; eGFR (CKD-EPI) <45mL/min/1.73m2;
5. Type 1 diabetes mellitus or uncontrolled Type 2 diabetes mellitus (glycated hemoglobin ≥8.5%);
6. Single functionally normal kidney or presence of renal malignant tumor;
7. Bilateral skin diseases at renal region that are not suitable for the therapy;
8. Women in pregnancy, lactating, or planning for pregnancy;
9. Other concomitant diseases that are considered not suitable for participation in the trial;
10. Patients have contraindications to angiotensin receptor-neprilysin inhibitor (ARNIs), thiazide-like diuretic drugs, or calcium channel blocker (CCBs);
11. Non-compliant patients.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Perirenal adipose tissue modification by focused power ultrasound; Perirenal adipose tissue modification (PRATM) by focused power ultrasound at both kidneys will be performed after the randomisation of eligible patients. After 1 month, if 24-h BP was uncontrolled and of at least 145/100 mmHg, alisartan /indapamide 240/1.5mg once daily will be replaced by sacubitril alisartan 232/248mg and indapamide 1.5mg once daily. At the 3-month after the treatment, if BP was uncontrolled, amlodipine will be uptitrated to 5mg twice a day. The duration of the follow-up after randomisation will be 6 months.	Procedure: Perirenal adipose tissue modification by focused power ultrasound; Perirenal adipose tissue modification by focused power ultrasound at both kidneys
Sham Comparator: Sham; Sham procedure will be performed at both kidneys after the randomisation of eligible patients. After 1 month, if 24-h BP was uncontrolled and of at least 145/100 mmHg, alisartan /indapamide 240/1.5mg once daily will be replaced by sacubitril alisartan 232/248mg and indapamide 1.5mg once daily. At the 3-month after the treatment, if BP was uncontrolled, amlodipine will be uptitrated to 5mg twice a day. The duration of the follow-up after randomisation will be 6 months.	Procedure: Sham; Sham procedure of focused ultrasound at both kidneys

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Reduction in 24h systolic blood pressure at the 6-month after treatment	6 months after treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reduction in 24h ambulatory systolic/diastolic blood pressure		1 month after treatment
Reductions in 24h ambulatory systolic/diastolic blood pressure		3 months after treatment
Reduction in 24h ambulatory diastolic blood pressure		6 months after treatment
Reduction in clinic systolic/diastolic blood pressure		1 month after treatment
Reduction in clinic systolic/diastolic blood pressure		3 months after treatment
Reduction in clinic systolic/diastolic blood pressure		6 months after treatment
Drug burden of antihypertensive treatment	number of drugs * dosage of drugs	6 months after the treatment

Other Outcome Measures

Outcome Measure	Time Frame
The incidence rate of all-cause death	6 months after treatment
The incidence of cardiovascular events	6 months after treatment
The incidence of renal failure	6 months after treatment

Collaborators and Investigators

• Sponsor: Yan Li

Study record dates

Study Major Dates

• Study Start (Estimated): November 20, 2025
• Primary Completion (Estimated): December 31, 2028
• Study Completion (Estimated): June 30, 2029

Study Registration Dates

• First Submitted: November 14, 2025
• First Submitted That Met QC Criteria: November 14, 2025
• First Posted (Actual): November 18, 2025

Study Record Updates

• Last Update Posted (Actual): November 18, 2025
• Last Update Submitted That Met QC Criteria: November 14, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: focused ultrasound; perirenal adipose tissue
• Additional Relevant MeSH Terms: salicylhydroxamic acid
• Other Study ID Numbers: 2025148

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No