Alcohol-mediated renal denervation in patients with hypertension in the absence of antihypertensive medications.

BACKGROUND: Ultrasound and radiofrequency renal denervation (RDN) have been shown to safely lower blood pressure (BP) in hypertension. AIMS: The TARGET BP OFF-MED trial investigated the efficacy and safety of alcohol-mediated renal denervation (RDN) in the absence of antihypertensive medications. METHODS: This randomised, blinded, sham-controlled trial was conducted in 25 centres in Europe and the USA. Patients with a 24-hour systolic BP of 135-170 mmHg, an office systolic BP 140-180 mmHg and diastolic BP ≥90 mmHg on 0-2 antihypertensive medications were enrolled. The primary efficacy endpoint was the change in mean 24-hour systolic BP at 8 weeks. Safety endpoints included major adverse events up to 30 days. RESULTS: A total of 106 patients were randomised; the baseline mean office BP following medication washout was 159.4/100.4±10.9/7.0 mmHg (RDN) and 160.1/98.3±11.0/6.1 mmHg (sham), respectively. At 8 weeks post-procedure, the mean (±standard deviation) 24-hour systolic BP change was â2.9±7.4 mmHg (p=0.009) versus â1.4±8.6 mmHg (p=0.25) in the RDN and sham groups, respectively (mean between-group difference: 1.5 mmHg; p=0.27). There were no differences in safety events between groups. After 12 months of blinded follow-up, with medication escalation, patients achieved similar office systolic BP (RDN: 147.9±18.5 mmHg; sham: 147.8±15.1 mmHg; p=0.68) with a significantly lower medication burden in the RDN group (mean daily defined dose: 1.5±1.5 vs 2.3±1.7; p=0.017). CONCLUSIONS: In this trial, alcohol-mediated RDN was delivered safely but was not associated with significant BP differences between groups. Medication burden was lower in the RDN group up to 12 months.

Effects of six-week sprint interval or endurance training on calculated power in maximal lactate steady state.

The purpose of the study was to evaluate and compare the influence of sprint interval training (SIT) and endurance training (ET) on calculated power in maximal lactate steady state (PMLSS) (influenced by the maximal lactate production rate (⩒Lamax) and maximal oxygen uptake (⩒O2max)). Thirty participants were randomly assigned to the a) SIT, b) ET, or c) control group (n = 10 each). Each session consisted of four to six repetitions of 30 s all-out effort Wingate anaerobic tests (SIT) or 60 min cycling at 1.5 to 2.5 mmol∙L-1 blood lactate (analysed every 10 min). Both groups performed training on three days per week, over a period of six weeks. To measure ⩒Lamax and ⩒O2max, and to calculate PMLSS, sprint and ramp tests were performed at baseline and after two, four and six weeks of intervention. While SIT resulted in a significant reduction of ⩒Lamax (-0.08 ± 0.05 mmol∙L-1∙s-1, p=0.003) after two weeks and remained subsequently stable, ⩒O2max (+2.6 ± 2.4 ml∙min-1∙kg-1, p = 0.044) and PMLSS (+25 ± 14 W, p=0.002) increased, but not before six weeks of SIT. After two weeks of ET, ⩒Lamax remained unchanged, but ⩒O2max increased by increased by +2.9 ± 2.4 ml∙min-1∙kg-1, p=0.03, and after six weeks by 5.6 ± 3.5 ml∙min-1∙kg-1. The increase of PMLSS was significant after four weeks of ET (+16 ± 14 W, p=0.036) and increased to +32 ± 17 W after six weeks. Comparison of SIT and ET revealed no significant differences for ⩒Lamax, ⩒O2max or PMLSS after six weeks. The control group remained stable in all parameters. In both exercising groups there was a significant improvement of the calculated PMLSS due to different influences of ⩒Lamax and ⩒O2max.