Renal denervation therapy for hypertension: pathways for moving development forward

Area of Science:

• Cardiovascular Medicine
• Hypertension Treatment
• Medical Device Development

Background:

• Hypertension device therapies require rigorous evaluation for safety and efficacy.
• Regulators request comprehensive data during development programs for novel treatments.
• A cardiovascular Think Tank convened experts to discuss optimal study designs.

Purpose of the Study:

• To summarize key considerations for designing clinical trials of device therapies for hypertension.
• To outline a framework for evaluating the safety and efficacy of hypertension devices.
• To provide guidance for regulatory submissions of device-based hypertension treatments.

Main Methods:

• The study summarizes discussions from a Think Tank co-sponsored by the American Society of Hypertension (ASH), the U.S. Food and Drug Administration (FDA), and the National Heart, Lung, and Blood Institute (NHLBI).
• Key considerations for device therapy studies were identified and categorized into preclinical, early human, and pivotal trial phases.

Main Results:

• Preclinical assessment should evaluate the likelihood of human benefit and identify plausible mechanisms of action.
• Early human trials must establish an acceptable benefit-to-risk balance in the target population, independent of drug therapy.
• Pivotal Phase III trials need to demonstrate effectiveness in broad populations, minimizing confounding factors.

Conclusions:

• A structured approach to clinical trial design is crucial for the successful development of hypertension device therapies.
• Establishing safety and efficacy requires distinct evaluation phases, from preclinical research to large-scale clinical studies.
• The Think Tank provided consensus on essential elements for regulatory approval of new hypertension devices.