ACC 2022: Late-breaking Science Video Collection
Published: 05 April 2022
ACC 22: 3-year Efficacy Outcomes from the SPYRAL HTN-ON MED Med Pilot Study
- ACC 22: Findings from the VALOR-HCM Trial
- ACC 22: MAVA-LTE Shows Improvement in NYHA Class in Patients Treated with Mavacamten
- ACC 22: Results From the PACIFIC AF Trial
- ACC 22: FAME 3 Suggests CABG Outperforms FFR-Guided PCI in Patients with Multivessel Disease
- ACC 22: Results from the TRANSLATE-TIMI 70 Trial
- ACC 22: Results from the POISE-3 Trial
- ACC 22: ICD Shock Therapies and the Burden of Ventricular Tachycardia
- ACC 22: PACMAN-AMI Shows Reduced Plaque Regression in AMI Patients Treated with Alirocumab
- ACC 22: Magnitude & Duration of Effects of a siRNA Targeting Lp(a)
- ACC 22: Results From a sub-study of the POISE-3 Trial
- ACC 22: Findings from the CoreValve US Pivotal & SURTAVI Trials
- ACC 22: ADAPT-TAVR Shows SLT Does Not Affect CO for Patients After TAVR
- ACC 22: Results From the Chocolate-Touch Study
- ACC 22: Results from the GIPS-IV Trial
- ACC 22: FFR vs. IVUS-guided PCI in Intermediate Coronary Artery Stenosis: The FLAVOUR Trial
- ACC 22: Results From the EMPULSE Study – Empagliflozin Proves Beneficial for Patients With HF
- ACC 22: Secondary Analysis of CANTOS Finds LDL & HDL Predict Residual Risk of Atherosclerotic Events
- ACC 22: 3-year Efficacy Outcomes from the SPYRAL HTN-ON MED Med Pilot Study
- 2022 AHA/ACC/HFSA Guideline for HF Management: Highlights & Implementation
Our regular review series View from the Thoraxcenter hosted by Prof Nicolas Van Mieghem and Dr Joost Daemen (Thoraxcentre, Erasmus MC, Rotterdam, NL) provide a concise analysis of the late-breaking science results and spotlight impactful data.
For a deeper dive into key clinical trial data, Dr Harriette Van Spall (McMaster University, Hamilton, CA)talks with principal investigators in her regular Late-Breaker Discussion Series.
Short, accessible Expert Interviews were conducted with select faculty focusing on the results, applicability, and impact on future research.
More from this programme
View from the Thoraxcenter
Late-breaker Discussion Series
Professor Felix Mahfoud is an Associate Professor and senior physician of Internal Medicine and Cardiology at Saarland University Hospital, and Affiliate/Visiting Professor Harvard-MIT Biomedical Engineering, Institute of Medical Engineering and Science, Cambridge, US. Professor Mahfoud completed training in Cardiology and Interventional Cardiology at the Department for Internal Medicine III, Saarland University Hospital, Germany in 2014. Since 2017, he has served as Vice Chairman of the ‘Working Group on Interventional Hypertension Treatment’ for the European Society of Hypertension, and as a Committee Member of the 2018 Hypertension Guidelines.
Importance of the SPYRAL HTN-ON MED Pilot Study
Well, we all know that high blood pressure is worldwide risk factor number one, thus, by the availability of safe and effective antihypertensive drugs and lifestyle modification, many patients remain uncontrolled. So there is an unmet need for additional treatment approaches to lower blood pressure in hypertensive patients, and the SPYRAL ON-MED study investigated catheter-based renal denervation in uncontrolled hypertensive individuals treated with one, two, or three antihypertensive drugs.
Design, Patient Cohort and Endpoints
This study included patients with uncontrolled hypertension. Office blood pressure was in between 150 to 180, ambulatory blood pressure was in between 140 to 170, and patients were treated with guideline recommended drug therapy. Indeed, they received one, two, or three antihypertensive drugs, and despite the intake of these drugs, they were uncontrolled. We randomised these patients to an invasive placebo, a sham, and renal denervation using a radio frequency catheter and we followed these patients out to three years.
So first we showed a continued and progressive decline in blood pressure over time. Ambulatory blood pressure was reduced up to 19 millimetres of mercury at 36 month of follow up, and that was significantly larger as compared to the sham group. Although medication was no different between the two groups, when you carefully look into it, detailed look into it, you'll appreciate that the sham group numerically received more drugs although their blood pressure lowering was less pronounced than in the denervation group. And that adds to the knowledge of renal denervation, that indeed, in combination with antihypertensive agents, you can appreciate a significant reduction in blood pressure.
Influence on Guideline Recommendations
This is another piece of the puzzle, adding to the evidence that renal denervation effectively and safely lowers blood pressure in hypertensive patients. We have to documented this in patients without concomitant antihypertensive drugs, we have seen it in patients with antihypertensive agents, one, two, or three, and even on a triple fixed combination. And we have a large cohort of patients being treated in a registry, so 3000 patients. And again, this is a piece of the puzzle showing that in a sham-controlled fashion, you appreciate a sustained reduction in blood pressure, even a progressive reduction in blood pressure out to three years, and that speaks to the relevance of the sympathetic nerves and the capability of renal denervation to lower blood pressure, even over time.
Remaining Questions and What is Left for Renal Denervation
There is an extension to that SPYRAL ON-MED study ongoing with another 260 patients being randomised. And other continued access programme trials are ongoing, registries are ongoing, and these will complement the evidence. I think we have achieved a significant and we have acquired a significant body of evidence indicating that it is efficacious and safe in lowering blood pressure, and that this is an attractive and alternative treatment option in patients with hypertension.
So this is an important piece of evidence, because it shows in a sham-controlled fashion that denervation can lower blood pressure out to three years, so there is no indication of reinnervation of sympathetic nerves, functional reinnervation of sympathetic nerves. And it also shows that when you add denervation to medication you can appreciate really significant and clinical meaningful reductions in blood pressure, as said, 20 millimetre of mercury reduction. That's a really important number, that is relevant for patient care.