Search research articles

ABOUT JoVE

Overview Leadership Blog JoVE Help Center

AUTHORS

Publishing Process Editorial Board Scope & Policies Peer Review FAQ Submit

LIBRARIANS

Testimonials Subscriptions Access Resources Library Advisory Board FAQ

RESEARCH

JoVE Journal Methods Collections JoVE Encyclopedia of Experiments Archive

EDUCATION

JoVE Core JoVE Business JoVE Science Education JoVE Lab Manual Faculty Resource Center Faculty Site

Terms & Conditions of Use

Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...

Heart Failure V: Medical Management

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...

Antihypertensive Drugs: Direct Renin Inhibitors

Antihypertensive Drugs: Direct Renin Inhibitors

The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...

Hypertension IV: Drug Therapy and Lifestyle Modifications

Hypertension IV: Drug Therapy and Lifestyle Modifications

Multiple classes of antihypertensive medications are employed in treating hypertension. The most commonly recommended first-line treatments include:Thiazide Diuretics, such as chlorthalidone, increase sodium and water excretion from the body, reducing blood volume and blood pressure.Angiotensin-converting enzyme inhibitors, like lisinopril, block the conversion of angiotensin I to II, a potent vasoconstrictor lowering blood pressure.Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II...

Pre-Procedural Guidelines for Assessing Blood Pressure

Pre-Procedural Guidelines for Assessing Blood Pressure

Accurate blood pressure assessment is crucial for diagnosing and managing various health conditions. To ensure the reliability of these measurements, healthcare professionals must adhere to standardized pre-procedural guidelines. These guidelines enhance patient safety and improve the overall quality of healthcare. The following steps are essential for obtaining accurate and consistent blood pressure readings, from using the appropriate tools to ensuring effective communication with the...

Hypertension III: Clinical Manifestations and Diagnostic Studies

Hypertension III: Clinical Manifestations and Diagnostic Studies

Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...

You might also read

Related Articles

Articles linked to this work by shared authors, journal, and citation graph.

Sort by

Same author

Three-Year Durability of Radiofrequency Renal Denervation: SPYRAL HTN-ON MED.

Journal of the American Heart Association·2026

Same author

Long-term clinical benefit after radiofrequency renal denervation: pooled 36-month results from the SPYRAL Clinical Program.

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·2026

Same author

Sex-Based Outcomes in Patients With High Bleeding Risk After PCI With 1-Month DAPT: Results From the Onyx ONE Clear Study.

Journal of the Society for Cardiovascular Angiography & Interventions·2026

Same author

Clinical Experience With a Novel Percutaneous LV Assist Device in High-Risk PCI: Primary Results From the SUPPORT I Study.

Circulation. Cardiovascular interventions·2026

Same author

Early Feasibility Study of a Novel Mechanical Circulatory Support Device for High-Risk PCI.

Circulation. Cardiovascular interventions·2026

Same author

Aligning Coronary Stent Trial Enrollment With the U.S. Intended-Use Population: Implications of Site Selection.

Journal of the American College of Cardiology·2026

Search research articles

Related Experiment Video

Updated: Nov 29, 2025

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

Published on: May 26, 2022

Prioritised endpoints for device-based hypertension trials: the win ratio methodology.

David E Kandzari¹, Graeme L Hickey, Stuart J Pocock

¹Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA, USA.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

|November 23, 2020

Summary

Renal denervation (RDN) significantly improved blood pressure and reduced medication burden in patients with uncontrolled hypertension. The win ratio analysis demonstrated RDN

More Related Videos

Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension

Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension

Published on: June 6, 2025

Author Spotlight: Exploring Huotan Jiedu Tongluo Decoction as an Antihypertensive Drug

Author Spotlight: Exploring Huotan Jiedu Tongluo Decoction as an Antihypertensive Drug

Published on: May 17, 2024

Related Experiment Videos

Last Updated: Nov 29, 2025

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

Published on: May 26, 2022

Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension

Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension

Published on: June 6, 2025

Author Spotlight: Exploring Huotan Jiedu Tongluo Decoction as an Antihypertensive Drug

Author Spotlight: Exploring Huotan Jiedu Tongluo Decoction as an Antihypertensive Drug

Published on: May 17, 2024

Area of Science:

Cardiovascular Medicine
Interventional Cardiology
Hypertension Management

Background:

Assessing device-based treatments for hypertension requires robust endpoints.
Traditional hypertension trials face challenges with variable blood pressure measures and medication changes.
Renal denervation (RDN) is a device-based treatment for uncontrolled hypertension.

Purpose of the Study:

To propose and apply a novel, prioritised endpoint framework using a win ratio analysis.
To determine the treatment benefit of RDN compared to sham control in patients with uncontrolled hypertension.
To evaluate the efficacy of RDN in the SPYRAL HTN-ON MED pilot study.

Main Methods:

Utilised data from the SPYRAL HTN-ON MED pilot study (sham-controlled, randomised trial).
Employed a prioritised hierarchical endpoint: 24-hour ambulatory systolic blood pressure (SBP), office SBP, and medication burden.
Extended generalised pairwise comparisons (win ratio) with clinically relevant thresholds for SBP changes (5 mmHg ambulatory, 10 mmHg office).

Main Results:

A total of 1,596 unmatched pairs were analysed.
The win ratio favoured RDN, with 1,050 'winner' pairs, 378 'loser' pairs, and 168 ties.
The overall win ratio for RDN was 2.78 (95% CI: 1.58 to 5.48; p<0.001), with a net benefit statistic of 0.42 (95% CI: 0.20 to 0.63).
Sensitivity analyses confirmed consistent results across different thresholds and adherence levels.

Conclusions:

The win ratio method effectively incorporates patient-oriented outcomes and prioritises clinical importance.
RDN demonstrated superiority over sham control in the SPYRAL HTN-ON MED pilot study based on the hierarchical endpoint.
This approach provides a more comprehensive assessment of treatment efficacy for device-based interventions in hypertension.