10779/rcsi.10782275.v1 Christian Ott Christian Ott Melvin D. Lobo Melvin D. Lobo Paul A. Sobotka Paul A. Sobotka Felix Mahfoud Felix Mahfoud Alice V. Stanton Alice V. Stanton John Cockcroft John Cockcroft Neil Sulke Neil Sulke Eamon Dolan Eamon Dolan Markus van der Giet Markus van der Giet Joachim Hoyer Joachim Hoyer Stephen S. Furniss Stephen S. Furniss John P. Foran John P. Foran Adam Witkowski Adam Witkowski Andrzej Januszewicz Andrzej Januszewicz Danny Schoors Danny Schoors Konstantinos Tsioufis Konstantinos Tsioufis Benno J. Rensing Benno J. Rensing Manish Saxena Manish Saxena Benjamin Scott Benjamin Scott G André Ng G André Ng Stephan Achenbach Stephan Achenbach Roland E. Schmieder Roland E. Schmieder Effect of Arteriovenous Anastomosis on Blood Pressure Reduction in Patients With Isolated Systolic Hypertension Compared With Combined Hypertension. Royal College of Surgeons in Ireland 2019 Arteriovenous Shunt Surgical Blood Pressure Blood Pressure Monitoring Ambulatory Female Follow-Up Studies Humans Hypertension Iliac Artery Iliac Vein Male Middle Aged Prospective Studies Treatment Outcome Clinical Pharmacology and Therapeutics 2019-11-22 16:18:57 Journal contribution https://repository.rcsi.com/articles/journal_contribution/Effect_of_Arteriovenous_Anastomosis_on_Blood_Pressure_Reduction_in_Patients_With_Isolated_Systolic_Hypertension_Compared_With_Combined_Hypertension_/10782275 BACKGROUND: Options for interventional therapy to lower blood pressure (BP) in patients with treatment-resistant hypertension include renal denervation and the creation of an arteriovenous anastomosis using the ROX coupler. It has been shown that BP response after renal denervation is greater in patients with combined hypertension (CH) than in patients with isolated systolic hypertension (ISH). We analyzed the effect of ROX coupler implantation in patients with CH as compared with ISH. METHODS AND RESULTS: The randomized, controlled, prospective ROX Control Hypertension Study included patients with true treatment-resistant hypertension (office systolic BP ≥140 mm Hg, average daytime ambulatory BP ≥135/85 mm Hg, and treatment with ≥3 antihypertensive drugs including a diuretic). In a post hoc analysis, we stratified patients with CH (n=31) and ISH (n=11). Baseline office systolic BP (177±18 mm Hg versus 169±17 mm Hg, P=0.163) and 24-hour ambulatory systolic BP (159±16 mm Hg versus 154±11 mm Hg, P=0.463) did not differ between patients with CH and those with ISH. ROX coupler implementation resulted in a significant reduction in office systolic BP (CH: -29±21 mm Hg versus ISH: -22±31 mm Hg, P=0.445) and 24-hour ambulatory systolic BP (CH: -14±20 mm Hg versus ISH: -13±15 mm Hg, P=0.672), without significant differences between the two groups. The responder rate (office systolic BP reduction ≥10 mm Hg) after 6 months was not different (CH: 81% versus ISH: 82%, P=0.932). CONCLUSIONS: Our data suggest that creation of an arteriovenous anastomosis using the ROX coupler system leads to a similar reduction of office and 24-hour ambulatory systolic BP in patients with combined and isolated systolic hypertension. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01642498.