Oral free session 2: Renal denervation, sympathetic activity and obesity
| Thursday, December 3, 2026 |
| 9:30 AM - 10:30 AM |
Speaker
Prof Markus Schlaich
University of Western Australia
Effects of renal denervation on albuminuria: two-year results from the Global SYMPLICITY-Registry
Abstract
Background: Increased urinary albumin/creatinine ratio (uACR) is independently associated with renal disease progression, and all-cause mortality. uACR reduction improves cardiorenal prognosis. Data on the effect of renal denervation (RDN) on uACR in patients with uncontrolled hypertension and albuminuria is scarce.
Methods: The Global SYMPLICITY Registry DEFINE is a RDN registry of real-world patients undergoing radiofrequency (RF) RDN with Symplicity RDN system (Medtronic, Plc). Two groups of patients with either microalbuminuria (uACR 30-299 mg/g) or macroalbuminuria (uACR ≥300mg/g) at baseline were analysed. UACR, estimated glomerular filtration rate (eGFR), office systolic BP (OSBP) and prescribed number of antihypertensive medication classes (AH med classes) were assessed at 3, 6, 12, and 24 months after RDN. UACR values were log-transformed to compare changes from baseline using paired t-tests.
Results: Five hundred-fifty-five patients had uACR spot measurements evaluable at baseline. Among these, 125 (23%) patients had microalbuminuria (median uACR 69 [IQR: 46-128] mg/g) with mean eGFR 77 mL/min/1.73 m², and 56 (10%) patients had macroalbuminuria (median uACR 829 [IQR: 437 - 1966] mg/g) with mean eGFR 56 mL/min/1.73 m². In the microalbuminuria group, OSBP was 168±23 mmHg, with 4.8±1.3 prescribed AH med classes. In the macroalbuminuria group, OSBP was 166±26 mmHg, with 5.1±0.9 prescribed AH med classes, 63% had diabetes, and 73% had renal disease history. 2 years after RDN, the uACR was significantly reduced by 50% (95% CI: -68%, -23%) and 66% (95% CI: -82%, -33%) in the micro- and macroalbuminuria groups, respectively (Figure). Log-transformed uACR showed significant reductions from baseline at all timepoints (p<0.05). OSBP reduced by 21.9 ± 26.6 mmHg and 16.0 ± 24.4 mmHg at 2 years in the micro- and macroalbuminuria groups, respectively.
Multivariable linear regression showed a significant association between OSBP and uACR changes with a 10mmHg reduction in OSBP being associated with a 14% reduction in uACR (p<0.0001).
Conclusion: RF RDN was associated with significant uACR reductions in patients with uncontrolled hypertension and albuminuria. The magnitude of the UACR reduction was more pronounced than expected from the BP lowering effect per se, indicative of a potential additional nephroprotective effects of RF RDN. Further prospective study is warranted.
Methods: The Global SYMPLICITY Registry DEFINE is a RDN registry of real-world patients undergoing radiofrequency (RF) RDN with Symplicity RDN system (Medtronic, Plc). Two groups of patients with either microalbuminuria (uACR 30-299 mg/g) or macroalbuminuria (uACR ≥300mg/g) at baseline were analysed. UACR, estimated glomerular filtration rate (eGFR), office systolic BP (OSBP) and prescribed number of antihypertensive medication classes (AH med classes) were assessed at 3, 6, 12, and 24 months after RDN. UACR values were log-transformed to compare changes from baseline using paired t-tests.
Results: Five hundred-fifty-five patients had uACR spot measurements evaluable at baseline. Among these, 125 (23%) patients had microalbuminuria (median uACR 69 [IQR: 46-128] mg/g) with mean eGFR 77 mL/min/1.73 m², and 56 (10%) patients had macroalbuminuria (median uACR 829 [IQR: 437 - 1966] mg/g) with mean eGFR 56 mL/min/1.73 m². In the microalbuminuria group, OSBP was 168±23 mmHg, with 4.8±1.3 prescribed AH med classes. In the macroalbuminuria group, OSBP was 166±26 mmHg, with 5.1±0.9 prescribed AH med classes, 63% had diabetes, and 73% had renal disease history. 2 years after RDN, the uACR was significantly reduced by 50% (95% CI: -68%, -23%) and 66% (95% CI: -82%, -33%) in the micro- and macroalbuminuria groups, respectively (Figure). Log-transformed uACR showed significant reductions from baseline at all timepoints (p<0.05). OSBP reduced by 21.9 ± 26.6 mmHg and 16.0 ± 24.4 mmHg at 2 years in the micro- and macroalbuminuria groups, respectively.
Multivariable linear regression showed a significant association between OSBP and uACR changes with a 10mmHg reduction in OSBP being associated with a 14% reduction in uACR (p<0.0001).
Conclusion: RF RDN was associated with significant uACR reductions in patients with uncontrolled hypertension and albuminuria. The magnitude of the UACR reduction was more pronounced than expected from the BP lowering effect per se, indicative of a potential additional nephroprotective effects of RF RDN. Further prospective study is warranted.
Biography
Prof Markus Schlaich is a renal physician and a European Society of Hypertension (ESH) accredited hypertension specialist. Markus is Chair of Hypertension Australia and Co-Chair of the National Hypertension Taskforce. He has a strong background in clinical research with a focus on the pathophysiology of hypertension, the role of the sympathetic nervous system, involvement of the kidneys, and hypertension mediated organ damage. He has a specific interest in treatment modalities targeting the sympathetic nervous system and has been a pioneer of renal denervation and other interventional and pharmacological approaches to treat hypertension. He has authored more than 550 articles in peer reviewed journals and serves on the Editorial Board of Hypertension, Journal of Hypertension, and Hypertension Research.
Mrs Sandi Robinson
Research Officer
The University Of Western Australia
Sympathoinhibition as a preferred second-line treatment strategy for obesity-related hypertension
Abstract
Background: Obesity-related hypertension (OHT) is highly prevalent and frequently characterised by sympathetic overactivity, yet optimal second-line pharmacotherapy remains uncertain. We compared the antihypertensive and metabolic effects of the centrally acting sympatholytic agent moxonidine with the calcium channel blocker amlodipine, each added to renin–angiotensin-aldosterone system (RAAS) blockade. We hypothesised that sympathoinhibition may represent a preferred 2nd line choice as a targeted therapy.
Aims: To compare the efficacy of sympathoinhibitory (perindopril+moxonidine) versus standard combination anti-hypertensive (perindopril+amlodipine) therapy on systolic blood pressure (SBP) reduction and muscle sympathetic nervous activity (MSNA) in OHT patients.
Methods: This randomised, double-blind, placebo-controlled crossover study enrolled 43 adults with obesity (BMI ≥30 kg/m²) and uncontrolled hypertension despite background RAAS blockade with perindopril. Participants received moxonidine 0.4 mg/day or amlodipine 5 mg/day for 12 weeks, followed by a 6-week washout and crossover to the alternative treatment for 12 weeks. Assessments included 24-hour ambulatory blood pressure monitoring, office blood pressure, muscle sympathetic nerve activity (MSNA) by microneurography, anthropometry, glucose metabolism, lipid profile, urinary albumin creatinine ratio and inflammatory markers. Outcomes were analysed using 2-way ANOVA. Major endpoints were change in ambulatory daytime SBP and MSNA.
Results: Both treatments significantly reduced office, 24-h ambulatory SBP (moxonidine −7.7mmHg, amlodipine −10.1mmHg;) and average day ambulatory SBP (moxonidine –8.7mmHg, amlodipine –10.6mmHg) compared to baseline, with no difference between groups. Amlodipine produced a significantly greater reduction in nighttime systolic blood pressure (moxonidine –1.6mmHg, amlodipine –8.8mmHg; p<0.0001) and maximum systolic blood pressure (moxonidine –9.5mmHg, amlodipine –13.5mmHg; p=0.0063). Treatment effects on MSNA differed significantly: moxonidine was associated with a 4.2% reduction in standardised burst frequency from baseline, whereas amlodipine increased MSNA by 22.8% (p=0.0033). There was no significant change in weight for either group (moxonodine 0.15kg, amlodipine –0.30kg; p=ns).
Conclusions: Both treatments provide clinically meaningful BP reduction when combined with RAAS blockade. Moxonidine was non-inferior to amlodipine in 24-h ambulatory BP reduction. Amlodipine was associated with significant further exaggeration of central sympathetic outflow from an already elevated baseline level. This supports moxonidine as a potent option for 2nd line antihypertensive therapy for OHT and provides rationale for longer-term studies examining dose optimisation and cardiometabolic outcomes.
Aims: To compare the efficacy of sympathoinhibitory (perindopril+moxonidine) versus standard combination anti-hypertensive (perindopril+amlodipine) therapy on systolic blood pressure (SBP) reduction and muscle sympathetic nervous activity (MSNA) in OHT patients.
Methods: This randomised, double-blind, placebo-controlled crossover study enrolled 43 adults with obesity (BMI ≥30 kg/m²) and uncontrolled hypertension despite background RAAS blockade with perindopril. Participants received moxonidine 0.4 mg/day or amlodipine 5 mg/day for 12 weeks, followed by a 6-week washout and crossover to the alternative treatment for 12 weeks. Assessments included 24-hour ambulatory blood pressure monitoring, office blood pressure, muscle sympathetic nerve activity (MSNA) by microneurography, anthropometry, glucose metabolism, lipid profile, urinary albumin creatinine ratio and inflammatory markers. Outcomes were analysed using 2-way ANOVA. Major endpoints were change in ambulatory daytime SBP and MSNA.
Results: Both treatments significantly reduced office, 24-h ambulatory SBP (moxonidine −7.7mmHg, amlodipine −10.1mmHg;) and average day ambulatory SBP (moxonidine –8.7mmHg, amlodipine –10.6mmHg) compared to baseline, with no difference between groups. Amlodipine produced a significantly greater reduction in nighttime systolic blood pressure (moxonidine –1.6mmHg, amlodipine –8.8mmHg; p<0.0001) and maximum systolic blood pressure (moxonidine –9.5mmHg, amlodipine –13.5mmHg; p=0.0063). Treatment effects on MSNA differed significantly: moxonidine was associated with a 4.2% reduction in standardised burst frequency from baseline, whereas amlodipine increased MSNA by 22.8% (p=0.0033). There was no significant change in weight for either group (moxonodine 0.15kg, amlodipine –0.30kg; p=ns).
Conclusions: Both treatments provide clinically meaningful BP reduction when combined with RAAS blockade. Moxonidine was non-inferior to amlodipine in 24-h ambulatory BP reduction. Amlodipine was associated with significant further exaggeration of central sympathetic outflow from an already elevated baseline level. This supports moxonidine as a potent option for 2nd line antihypertensive therapy for OHT and provides rationale for longer-term studies examining dose optimisation and cardiometabolic outcomes.
Biography
Sandi Robinson is a Research Officer at the Dobney Hypertension Centre, The University of Western Australia (UWA), where she contributes to clinical research investigating hypertension and cardiovascular health. Her research interests include cardiovascular risk assessment, vascular health, blood pressure regulation, and novel biomarkers and physiological measures relevant to cardiovascular disease. She has contributed to peer-reviewed research investigating platelet-derived extracellular vesicles, pulse wave velocity, circulating short-chain fatty acids and retinal microvascular changes. Sandi holds a Master’s degree from UWA with her postgraduate research investigating a multidisciplinary intervention for type 2 diabetes mellitus. Sandi has extensive clinical experience as an Accredited Exercise Physiologist with her clinical background including cardiac rehabilitation, cardiovascular disease prevention, chronic disease management, cancer survivorship and lifestyle interventions. Combining clinical exercise physiology with cardiovascular research, Sandi brings a clinical perspective to cardiovascular research, with a focus on improving the prevention, assessment and management of hypertension and cardiovascular risk.
Prof Ross Tsuyuki
Professor Of Medicine (cardiology)
University Of Alberta, Faculty Of Medicine And Dentistry
Obesity Care is Hypertension Care: The RxOC-IT Trial Community Pharmacy Obesity Program
Abstract
Background and Aim: Obesity and overweight affects about 60% of adults. Treatments are available, but many people do not have access to a primary care physician or to specialized obesity experts. Alberta pharmacists have one of the world’s broadest scopes of practice, including prescriptive authority and their accessibility makes them uniquely positioned to bridge this care gap. The primary objective of RxOC-IT was to determine the effect of a pharmacist-led weight management program on the change in weight from baseline to 6 months of follow-up. Secondary objectives for this analysis included changes in blood pressure (BP).
Methods: This prospective before-and-after study was conducted across one core and three satellite community pharmacy clinics in Alberta. Pharmacists completed a preceptorship-style training program at the core clinic. Eligible participants were 18 years of age or older with a BMI ≥30 kg/m2 or ≥27 kg/m2 with an obesity-related comorbidity. The intervention followed Obesity Canada’s 5As framework and included medical nutrition therapy, physical activity recommendations, medication prescribing and pharmacotherapy support. Participants were enrolled by their pharmacist and received an initial one-hour consultation, followed by ten 15- to 30-minute follow-up appointments over 6 months.
Results: A total of 205 patients provided informed consent and were enrolled in the study. The baseline cohort had a mean age of 50.2 years (standard deviation14.7), 79.0% were female, and 74.6% self-identified as White.
In the intention-to-treat analysis, the mean weight loss from baseline was 8.2 kg (95% confidence interval [95% CI]: 7.4, 9.0), p<0.0001), a mean weight loss of 8.0% (95% CI 7.2%, 8.7%) at 6 months.
Overall BP was reduced by 7.8 (95% CI 5.9, 9.7)/4.0 (95%CI 2.6, 5.4) mmHg at 6 months (p<0.0001/p<0.0001). BP reduction was greater in the73 (35.6%) subjects with baseline BP>140/90mmHg: 16.7 (95% CI 13.7, 19.6)/8.6 (6.3, 10.9) mmHg (p<0.0001/p<0.0001).
Conclusion: The RxOC-IT study suggests that pharmacist-led interventions represent a promising and accessible model for weight management and for hypertension management.
By leveraging a full scope of pharmacist practice, this model has the potential to provide a scalable approach to expanding access to evidence-based obesity and hypertension care in community pharmacy settings.
Methods: This prospective before-and-after study was conducted across one core and three satellite community pharmacy clinics in Alberta. Pharmacists completed a preceptorship-style training program at the core clinic. Eligible participants were 18 years of age or older with a BMI ≥30 kg/m2 or ≥27 kg/m2 with an obesity-related comorbidity. The intervention followed Obesity Canada’s 5As framework and included medical nutrition therapy, physical activity recommendations, medication prescribing and pharmacotherapy support. Participants were enrolled by their pharmacist and received an initial one-hour consultation, followed by ten 15- to 30-minute follow-up appointments over 6 months.
Results: A total of 205 patients provided informed consent and were enrolled in the study. The baseline cohort had a mean age of 50.2 years (standard deviation14.7), 79.0% were female, and 74.6% self-identified as White.
In the intention-to-treat analysis, the mean weight loss from baseline was 8.2 kg (95% confidence interval [95% CI]: 7.4, 9.0), p<0.0001), a mean weight loss of 8.0% (95% CI 7.2%, 8.7%) at 6 months.
Overall BP was reduced by 7.8 (95% CI 5.9, 9.7)/4.0 (95%CI 2.6, 5.4) mmHg at 6 months (p<0.0001/p<0.0001). BP reduction was greater in the73 (35.6%) subjects with baseline BP>140/90mmHg: 16.7 (95% CI 13.7, 19.6)/8.6 (6.3, 10.9) mmHg (p<0.0001/p<0.0001).
Conclusion: The RxOC-IT study suggests that pharmacist-led interventions represent a promising and accessible model for weight management and for hypertension management.
By leveraging a full scope of pharmacist practice, this model has the potential to provide a scalable approach to expanding access to evidence-based obesity and hypertension care in community pharmacy settings.
Biography
Professor Tsuyuki is a Professor of Medicine, Division of Cardiology and Director of EPICORE Centre in the Faculty of Medicine and Dentistry at the University of Alberta, in Edmonton, Alberta, Canada
Mrs Ancy Jose
Research Nurse
Dobney Hypertension Centre
Renal Denervation Effects on Sympathetic Activity and Blood Pressure: RESURRECT Interim Results
Abstract
Background: Sympathetic drive increases across the chronic kidney disease (CKD) spectrum, with both muscle sympathetic nerve activity (MSNA) and noradrenaline spillover increasing as glomerular filtration falls. Blood pressure control in these patients is therefore difficult to manage given ongoing sympathoexcitation and resulting increased total peripheral resistance. Renal denervation (RDN) is a guideline-endorsed adjunct therapy for resistant hypertension providing clinically significant blood pressure reductions via ablating sympathetic fibres to the kidney, disrupting RAAS activation and sodium reabsorption. While observational data suggests clinical benefit in advanced CKD and end-stage kidney disease (ESKD), current guidelines are yet to endorse RDN in these cohorts due to an absence of clinical trial evidence.
Aim: To examine the sympathoinhibitory effect of ultrasound-based RDN in patients with Stage 3a or lower CKD and subsequent impact upon 24-hour ambulatory blood pressure.
Methods: RESURRECT is an open-label, non-randomised, pilot clinical trial of the ultrasound-based Paradise renal denervation system (ReCor Medical). Primary outcome was a significant reduction in MSNA at 12 months. Secondary outcome was significant ambulatory blood pressure reduction at 12 months. 9 participants (BSL eGFR 51.0ml/min/1.73m2, 2 on haemodialysis, 67% male, age 65.4±14.9 ) underwent RDN.
Results: Standardised MSNA burst incidence (burst/10heartbeats) fell by 25.69% (95%CI:5.7%, 45.7%) between baseline and 12-month follow-up (p=0.016). Standardised MSNA burst frequency (bursts/minute) fell by 23.9% over the same period but did not achieve significance (p=0.11). Mean 24-hour systolic blood pressure fell by 13.8 (95%CI: 0.38, 27.2) mmHg at 12-month follow-up. 24-hour DBP fell by 4.9mmHg but did not achieve significance (p=0.61, 95%CI: -13.5, 23.4). Office systolic BP fell by 8.2mmHg (p=0.01; 95%CI: -6.2, 22.7) alongside a reduction of 1.6mmHg office diastolic blood pressure. (p=0.61, 95%CI: -7.4,4.2). No procedural adverse events were reported alongside no adverse events related to RDN at 12-month follow-up.
Conclusion: Ultrasound-based RDN markedly reduced directly measured sympathetic drive in patients with CKD and ESKD alongside clinically-relevant blood pressure reductions at 12-month follow-up.
Aim: To examine the sympathoinhibitory effect of ultrasound-based RDN in patients with Stage 3a or lower CKD and subsequent impact upon 24-hour ambulatory blood pressure.
Methods: RESURRECT is an open-label, non-randomised, pilot clinical trial of the ultrasound-based Paradise renal denervation system (ReCor Medical). Primary outcome was a significant reduction in MSNA at 12 months. Secondary outcome was significant ambulatory blood pressure reduction at 12 months. 9 participants (BSL eGFR 51.0ml/min/1.73m2, 2 on haemodialysis, 67% male, age 65.4±14.9 ) underwent RDN.
Results: Standardised MSNA burst incidence (burst/10heartbeats) fell by 25.69% (95%CI:5.7%, 45.7%) between baseline and 12-month follow-up (p=0.016). Standardised MSNA burst frequency (bursts/minute) fell by 23.9% over the same period but did not achieve significance (p=0.11). Mean 24-hour systolic blood pressure fell by 13.8 (95%CI: 0.38, 27.2) mmHg at 12-month follow-up. 24-hour DBP fell by 4.9mmHg but did not achieve significance (p=0.61, 95%CI: -13.5, 23.4). Office systolic BP fell by 8.2mmHg (p=0.01; 95%CI: -6.2, 22.7) alongside a reduction of 1.6mmHg office diastolic blood pressure. (p=0.61, 95%CI: -7.4,4.2). No procedural adverse events were reported alongside no adverse events related to RDN at 12-month follow-up.
Conclusion: Ultrasound-based RDN markedly reduced directly measured sympathetic drive in patients with CKD and ESKD alongside clinically-relevant blood pressure reductions at 12-month follow-up.
Biography
Ancy Jose is a healthcare professional, nurse educator, and clinical researcher with a strong interest in cardiovascular medicine, hypertension, and sympathetic nervous system activity. Her research focuses on innovative approaches to hypertension management and cardiovascular risk reduction, with particular interest in emerging device-based therapies. As a member of the RESURRECT Study team, she contributes to research investigating the effects of ultrasound-based renal denervation on sympathetic activity and blood pressure in individuals at high cardiovascular risk. Alongside her research, Ancy is passionate about nursing education and teaches and mentors nursing students, fostering clinical knowledge, critical thinking, evidence-based practice, and lifelong learning. She is committed to translating contemporary research into meaningful clinical practice and integrating evidence into nursing education. Through her combined roles in research and education, Ancy aims to advance cardiovascular health, improve patient outcomes, and inspire future nurses to embrace clinical inquiry, innovation, and excellence in professional practice.
