SPYRAL HTN-ON MED試験
Symplicity Spyral™ 多電極腎除神経システムを用いた腎除神経のグローバルな臨床研究で、標準的な医学療法を受けているコントロール不良の高血圧患者を対象としています (SPYRAL HTN-ON MED)
調査の概要
詳細な説明
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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Galway、アイルランド
- Galway University Hospital
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Alabama
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Huntsville、Alabama、アメリカ、35801
- Heart Center Research, LLC
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California
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Stanford、California、アメリカ、94305
- Stanford Hospital and Clinics
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Connecticut
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New Haven、Connecticut、アメリカ、06520
- Yale New Haven Hospital
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District of Columbia
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Washington D.C.、District of Columbia、アメリカ、20422
- Washington DC VA Medical Center
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Florida
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Jacksonville、Florida、アメリカ、32207
- Baptist Medical Center Jacksonville
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Jacksonville、Florida、アメリカ、32216
- Memorial Hospital Jacksonville
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Tallahassee、Florida、アメリカ、32308
- Tallahassee Research Institute
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Georgia
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Atlanta、Georgia、アメリカ、30308
- Emory University Hospital Midtown
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Atlanta、Georgia、アメリカ、30309
- Piedmont Heart Institute
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Iowa
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West Des Moines、Iowa、アメリカ、50266
- Iowa Heart Center
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Kentucky
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Lexington、Kentucky、アメリカ、40536
- University of Kentucky
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Michigan
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Pontiac、Michigan、アメリカ、48341
- St Joseph Mercy Oakland
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Southfield、Michigan、アメリカ、48075
- Providence Hospital
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Minnesota
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Minneapolis、Minnesota、アメリカ、55407
- Minneapolis Heart Institute Foundation
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Mississippi
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Hattiesburg、Mississippi、アメリカ、39401
- Hattiesburg Clinic
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Tupelo、Mississippi、アメリカ、38801
- Cardiology Associates Research LLC
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Missouri
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St Louis、Missouri、アメリカ、63110
- Barnes-Jewish Hospital
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New Jersey
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Livingston、New Jersey、アメリカ、07039
- Saint Barnabas Medical Center
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New York
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Manhasset、New York、アメリカ、11030
- North Shore University Hospital
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New York、New York、アメリカ、10029
- Mount Sinai Medical Center
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New York、New York、アメリカ、10021
- Weill Cornell Medical College/The New York Presbyterian Hospital
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North Carolina
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Durham、North Carolina、アメリカ、27710
- Duke University Medical Center
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Ohio
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Cleveland、Ohio、アメリカ、44106
- University Hospitals Cleveland Medical Center
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Oregon
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Portland、Oregon、アメリカ、97239
- Oregon Health & Science University Hospital
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Pennsylvania
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Harrisburg、Pennsylvania、アメリカ、17011
- PinnacleHealth Cardiovascular Institute
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Philadelphia、Pennsylvania、アメリカ、19104
- Hospital of the University of Pennsylvania
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Rhode Island
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Providence、Rhode Island、アメリカ、02906
- The Miriam Hospital
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South Carolina
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Anderson、South Carolina、アメリカ、29621
- AnMed Health
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Tennessee
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Nashville、Tennessee、アメリカ、37203
- Centennial Medical Center
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Texas
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Dallas、Texas、アメリカ、75226
- Baylor Heart & Vascular Hospital
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West Virginia
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Charleston、West Virginia、アメリカ、25304
- Charleston Area Medical Center
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Wisconsin
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Milwaukee、Wisconsin、アメリカ、53215
- Aurora St. Luke's Medical Center
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Bournemouth、イギリス
- Royal Bournemouth Hospital
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Cardiff、イギリス
- Cardiff and Vale University Health Board - University Hospital of Wales
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Exeter、イギリス、EX2 5DW
- Royal Devon & Exeter NHS Foundation Trust
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London、イギリス、W12 0HS
- Imperial College Healthcare NHS Trust
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Kogarah、オーストラリア
- St. George Hospital
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Perth、オーストラリア
- Royal Perth
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Victoria
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Melbourne、Victoria、オーストラリア、3004
- Alfred Hospital
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Wels、オーストリア、4600
- Klinikum Wels-Grieskirchen
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Ontario
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Hamilton、Ontario、カナダ
- Hamilton Heath
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Toronto、Ontario、カナダ
- St. Michael's Hospital
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Athens、ギリシャ、11527
- Hippokration General Hospital of Athens
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Thessaloniki、ギリシャ、54621
- University General Hospital of Thessaloniki (AHEPA)
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Bad Krozingen、ドイツ、79189
- Universitäts-Herzzentrum Freiburg - Bad Krozingen GmbH
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Erlangen、ドイツ、91054
- Universitätsklinikum Erlangen
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Homburg、ドイツ、66421
- Universitatsklinikum des Saarlandes
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Leipzig、ドイツ、04289
- Herzzentrum Leipzig, Universitätsklinik
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Lübeck、ドイツ、23560
- Sana Kliniken Lubeck
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Toulouse、フランス
- Clinique Pasteur
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Osaka、日本
- Saiseikai Nakatsu Hospital
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Hyōgo
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Takarazuka、Hyōgo、日本
- Higashi Takarazuka Satoh Hospital
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Okamoto
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Kamakura、Okamoto、日本
- Shonan Kamakura General Hospital
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Tochigi
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Shimotsuke、Tochigi、日本、329-0498
- Jichi Medical University Hospital
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Tokyo
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Chiyoda City、Tokyo、日本、101-8643
- Mitsui Memorial Hospital
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
説明
包含基準:
- -個人はオフィス収縮期血圧(SBP)≧150 mmHgであり、
- -個人は、24時間の外来血圧モニタリング(ABPM)の平均SBPが140 mmHg以上で170 mmHg未満です。
除外基準:
- 個人は適切な腎動脈の解剖学的構造を欠いています。
- 個人の推定糸球体濾過率 (eGFR) は
- 個人は1型糖尿病またはコントロール不良の2型糖尿病を患っています。
- 個人は、起立性低血圧のエピソードを 1 つ以上持っています。
- 個人は、睡眠時無呼吸のための夜間の呼吸サポート以外に、慢性的な酸素サポートまたは機械的換気を必要とします。
- 個人は原発性肺高血圧症を患っています。
- 個人が妊娠中、授乳中、または妊娠を計画している。
- -個人は、登録前の月に週に2日以上、非ステロイド性抗炎症薬(NSAID)による治療をもたらす断続的または慢性的な痛みを頻繁に抱えています
- -個人は、登録から3か月以内に安定または不安定狭心症、登録から3か月以内に心筋梗塞を患っています。心不全、脳血管障害、一過性脳虚血発作、または心房細動のいずれか。
- 個々の作業は夜勤です。
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:独身
武器と介入
参加者グループ / アーム |
介入・治療 |
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実験的:腎除神経
腎血管造影および腎除神経 (Symplicity Spyral™ 多電極腎除神経システム)
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標準手順による腎血管造影後、被験者は盲検のままであり、無作為化後、直ちに腎除神経手順で治療される。
他の名前:
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偽コンパレータ:偽の手順
腎血管造影
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標準的な手順による腎血管造影の後、被検者は盲検のままで、導入シースを取り外す前に少なくとも 20 分間、カテーテル検査室のテーブルにとどまります。
他の名前:
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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24 時間外来血圧モニタリング (ABPM) によって測定された最高血圧の変化
時間枠:ベースラインから処置後6か月まで
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24 時間外来血圧モニタリング (ABPM) によって測定された、ベースライン (スクリーニング訪問 2) から処置後 6 か月までの収縮期血圧 (SBP) のベースライン調整変化 (共分散分析を使用)。
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ベースラインから処置後6か月まで
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Acute and Chronic Safety by Evaluating Incidence of Major Adverse Events
時間枠: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 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 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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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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降圧薬の使用と6か月間の変化
時間枠:ベースラインから処置後6か月まで
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ベースライン(スクリーニング来院 2)から処置後 6 か月までの薬剤数
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ベースラインから処置後6か月まで
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降圧薬の負担は6か月に及ぶ
時間枠:ベースラインから処置後6か月まで
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報告された処方薬に基づいて、投薬負荷は、降圧薬の用量に処方薬の数を乗じた複合指数である投薬指数 2 スコアを使用して計算されました。すべてのクラス(ACE/ARB、カルシウムチャネル遮断薬など)は、効力において同等であると考えられました。 スコアが高いほど、標準用量を超える用量が処方されていることを示します。 最小値 0;なし 最大値 |
ベースラインから処置後6か月まで
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薬の変更
時間枠:ベースラインから処置後6か月まで
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Medication Index 2 の薬物検査データに基づいて投薬変更を受けた患者。
Medication Index 2 スコアは、降圧薬の投与量に処方薬の数を乗じた複合指数です。すべてのクラス(ACE/ARB、カルシウムチャネル遮断薬など)は、効力において同等であると考えられました。
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ベースラインから処置後6か月まで
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目標オフィス最高血圧の達成率
時間枠:ベースラインから処置後6か月まで
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手術後 6 か月での目標診察室収縮期血圧 (SBP<140 mmHg) の達成率。
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ベースラインから処置後6か月まで
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Change in Office Systolic Blood Pressure to 6-months
時間枠: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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Change in Systolic Blood Pressure as Measured by 24-hour ABPM 12 Months
時間枠:From Baseline to 12 months post procedure
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Change in systolic blood pressure from baseline (screening visit 2) to 12 months as measured by 24-hour Ambulatory Blood Pressure Monitoring (ABPM)
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From Baseline to 12 months post procedure
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Change in Systolic Blood Pressure as Measured by 24-hour ABPM 24-months
時間枠:From baseline to 24 months post-procedure
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Change in systolic blood pressure from baseline (screening visit 2) to 24 months as measured by 24-hour Ambulatory Blood Pressure Monitoring (ABPM).
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From baseline to 24 months post-procedure
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Change in Systolic Blood Pressure as Measured by 24-hour ABPM 36-months
時間枠:From baseline to 36 months post-procedure
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Change in systolic blood pressure from baseline (screening visit 2) to 36 months as measured by 24-hour Ambulatory Blood Pressure Monitoring (ABPM).
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From baseline to 36 months post-procedure
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Change in Office Systolic Blood Pressure to 12-months
時間枠:From Baseline to 12 months post procedure
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Change in office systolic blood pressure from baseline (screening visit 2) to 12 months.
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From Baseline to 12 months post procedure
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Change in Office Systolic Blood Pressure to 24-months
時間枠:From baseline to 24 months post-procedure
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Change in office systolic blood pressure from baseline (screening visit 2) to 24 months.
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From baseline to 24 months post-procedure
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Change in Office Systolic Blood Pressure to 36-months
時間枠:From baseline to 36 months post-procedure
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Change in office systolic blood pressure from baseline (screening visit 2) to 36 months.
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From baseline to 36 months post-procedure
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Change in Diastolic Blood Pressure as Measured by 24-hour ABPM 12-months
時間枠:From Baseline to 12 months post procedure
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Change in diastolic blood pressure from baseline (screening visit 2) to 12 months as measured by 24-hour Ambulatory Blood Pressure Monitoring (ABPM).
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From Baseline to 12 months post procedure
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Change in Diastolic Blood Pressure as Measured by 24-hour ABPM 24-months
時間枠:From baseline to 24 months post-procedure
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Change in diastolic blood pressure from baseline (screening visit 2) to 24 months as measured by 24-hour Ambulatory Blood Pressure Monitoring (ABPM).
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From baseline to 24 months post-procedure
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Change in Diastolic Blood Pressure as Measured by 24-hour ABPM 36-months
時間枠:From baseline to 36 months post-procedure
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Change in diastolic blood pressure from baseline (screening visit 2) to 36 months as measured by 24-hour Ambulatory Blood Pressure Monitoring (ABPM).
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From baseline to 36 months post-procedure
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Change in Office Diastolic Blood Pressure 12 Months
時間枠:From baseline to 12 months post-procedure
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Change in office diastolic blood pressure from baseline (screening visit 2) to 12 months.
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From baseline to 12 months post-procedure
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Change in Office Diastolic Blood Pressure 24 Months
時間枠:From baseline to 24 months post-procedure
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Change in office diastolic blood pressure from baseline (screening visit 2) to 24 months.
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From baseline to 24 months post-procedure
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Change in Office Diastolic Blood Pressure 36 Months
時間枠:From baseline to 36 months post-procedure
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Change in office diastolic blood pressure from baseline (screening visit 2) to 36 months.
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From baseline to 36 months post-procedure
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Number of Participants Achieving Target Office Systolic Blood Pressure 12 Months
時間枠:From baseline to 12 months post-procedure
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Incidence of Achieving Target Office Systolic Blood Pressure (SBP <140 mmHg)
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From baseline to 12 months post-procedure
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Number of Participants Achieving Target Office Systolic Blood Pressure 24 Months
時間枠:From baseline to 24 months post-procedure
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Incidence of Achieving Target Office Systolic Blood Pressure (SBP <140 mmHg).
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From baseline to 24 months post-procedure
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Number of Participants Achieving Target Office Systolic Blood Pressure. 36 Months
時間枠:From baseline to 36 months post-procedure
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Incidence of Achieving Target Office Systolic Blood Pressure (SBP <140 mmHg)
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From baseline to 36 months post-procedure
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Number of Participants With All Cause Mortality
時間枠:From Baseline to 36-months post procedure
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From Baseline to 36-months post procedure
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Number of Participants With End-Stage Renal Disease (ESRD)
時間枠:From Baseline to 36-months post-procedure
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End-stage Renal Disease (ESRD) - defined as two or more eGFR measurements <15 mL/min/1.73m2 at least 21 days apart and requiring dialysis for one of more of the following:
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From Baseline to 36-months post-procedure
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Number of Participants With Significant Embolic Event Resulting in End-organ Damage
時間枠:From Baseline to 36 months post-procedure
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From Baseline to 36 months post-procedure
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Number of Participants With Renal Artery Perforation Requiring Intervention
時間枠:From Baseline to 36 month post-procedure
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Renal artery perforation requiring intervention
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From Baseline to 36 month post-procedure
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Number of Participants With Renal Artery Dissection Requiring Intervention
時間枠:From Baseline to 36 months post-procedure
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Number of Participants with Renal artery dissection requiring intervention
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From Baseline to 36 months post-procedure
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Number of Participants With Vascular Complications
時間枠:From Baseline to 36 months post-procedure
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Vascular complications (e.g., clinically significant groin hematoma, arteriovenous fistula, pseudoaneurysm, excessive bleeding) requiring surgical repair, interventional procedure, thrombin injection, or blood transfusion (requiring more than 2 units of packed red blood cells within any 24 hour period during the first 7 days post renal denervation procedure).
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From Baseline to 36 months post-procedure
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Number of Participants With Hospitalization for Hypertensive Crisis Not Related to Confirmed Non-adherence With Medications and/or the Protocol.
時間枠:From Baseline to 36 months post-procedure
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From Baseline to 36 months post-procedure
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Number of Participants With New Renal Artery Stenosis > 70%, Confirmed by Angiography and as Determined by the Angiographic Core Laboratory
時間枠:From Baseline to 36 months post-procedure
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From Baseline to 36 months post-procedure
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Number of Participants With ≥ 40% Decline in eGFR
時間枠:From baseline to 36 months post-procedure
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From baseline to 36 months post-procedure
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Number of Participants With Increase in Serum Creatinine >50% From Screening Visit 2 (Baseline)
時間枠:From baseline to 36 months post-procedure
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From baseline to 36 months post-procedure
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Number of Participants With New Myocardial Infarct
時間枠:From baseline to 36 months post-procedure
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From baseline to 36 months post-procedure
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Number of Participants With New Stroke
時間枠:From baseline to 36 months post-procedure
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From baseline to 36 months post-procedure
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Number of Participants With Renal Artery Re-intervention
時間枠:From baseline to 36 months post-procedure
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From baseline to 36 months post-procedure
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Number of Participants With Major Bleeding According to TIMI Definition
時間枠:From baseline to 36 months post-procedure
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Major bleeding according to TIMI definition (i.e.
intracranial hemorrhage, ≥5g/dl decrease in hemoglobin concentration, a ≥15% absolute decrease in hematocrit, or death due to bleeding within 7 days of the procedure
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From baseline to 36 months post-procedure
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Change in Diastolic Blood Pressure as Measured by 24-hour (ABPM) 6-months
時間枠:From baseline to 6 months post-procedure
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Change in diastolic blood pressure from baseline (screening visit 2) to 6 months 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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Change in Office Diastolic Blood Pressure to 6-months
時間枠:From baseline to 6 months post-procedure
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Change in office diastolic 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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その他の成果指標
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Antihypertensive Medication Burden to 36-months
時間枠:From baseline to 36 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. There are no clinically established thresholds. Minimum Value 0; No Maximum value (See Secondary Outcome Measure #5 for comparison) |
From baseline to 36 months post-procedure
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Antihypertensive Medication Burden to 24-months
時間枠:From baseline to 24 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. There are no clinically established thresholds. Minimum Value 0; No Maximum value (See Secondary Outcome Measure #5 for comparison) |
From baseline to 24 months post-procedure
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Antihypertensive Medication Burden to 12-Months
時間枠:From Baseline to 12 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. There are no clinically established thresholds. Minimum Value 0; No Maximum value (See Secondary Outcome Measure #5 for comparison) |
From Baseline to 12 months post-procedure
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協力者と研究者
スポンサー
捜査官
- 主任研究者:Raymond Townsend, MD、University of Pennsylvania
- 主任研究者:David Kandzari, MD、Piedmont Hospital
- 主任研究者:Michael Böhm, MD、Universitätskliniken des Saarlandes
- 主任研究者:Kazuomi Kario, MD、Jichi Medical University
出版物と役立つリンク
一般刊行物
- 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.
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米国FDA規制機器製品の研究
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