Denervacion Renal otras indicaciones

Denervacion Renal

Expandiendo las indicaciones

DrJuan Gaspar

Director Educacion Medica y Entrenamiento

Medtronic Cardiovascular LA

XI CONGRESO VENEZOLANO DE CARDIOLOGIacuteA

INTERVENCIONISTA - SOVECI 2013

XX JORNADAS REGIONALES SOLACI

Jueves 21 de Febrero de 2013

Afferent and efferent sympathetic nerve fibers

Afferent

Renal ischemia

Adenosine

Efferent

Renin secretion

Sodium retention

Proteinuria

Vasoconstriction

Atherosclerosis

LVH

Ischemia

Heart Failure

Gluconeogenesis uarr

Insulin resistance

Mahfoud F et al DMW 2010

Local versus systemic effect

Renal denervation reduces renal and total body NE spillover

Krum et al Lancet 2009 373(9671)1275-81

Schlaich et al N Engl J Med 2009 Aug 27361(9)932-4

Renal NE spillover 6 months (n=10)

0

25

-25

-50

-75

-47

significant reduction (plt005) compared to baseline

GLUCOSE PolyCystic Ovary Syndrome Atrial Fibrilation Cardiac Heart Failure Obstructive Sleep Apnea Chronic Kidney Disease

THE NEW FRONTIER

bull Spanish ABP Monitoring Registry

ndash N=68045 patients

ndash Patients with resistant hypertension = 8295 (12)

bull 63 true-resistance (ABPM sys gt130 mmHg)

bull 37 pseudo-resistance

De la Sierra Hypertension 2011 57898-902

Patientlsquos characteristics

Therapy resistant

N=5182

Age a 64

Male 55

History of hypertension a 114

Diabetes 351

LVH 185

Other CV diseases 191

gt4 antihypertensives 383



Therapy resistant

N=5182

Age a 64

Male 55


Diabetes 351

LVH 185




Huggett RJ Circulation 20031083097-3101

NT normo tensive controls DM diabetes HTN hypertension HTN+DM hypertension+diabetes

Background

Sympathetic activity mediates vascular resistance

Blood flow is shifted from striated muscle (insulin

sensitive) to visceral tissue (insulin resistant)

Sympathetic drive

Resistant hypertension Insulin resistance

Obesity

Hyperinsulinemia

Sympathetic drive uarr

Sceletal blood flow darr

Hypertension

Vasoconstriction

Insulin resistance

Hypertension and insulin resistance

bull 50 patients (RD 13 control)

bull 597 plusmn 14 a

bull BP 17896 plusmn 32 mmHg

bull antihypertensive drugs 56 plusmn 02

bull fasting glucose 121 plusmn 4 mgdl

bull insulin 193 plusmn 25 μIUml

bull HOMA-IR 57 plusmn 07

Mahfoud F et al Circulation 2011

BP reduction after RD

-40

-35

-30

-25

-20

-15

-10

-5

0 1 month 3 months

systolic

3 months 1 month

diastolic

Renal denervation (n=37)

Control (n=13)

-28 -8 -32 -5 -10 -4 -12 -3

Change in b

lood p

ressure

(m

mH

g)

plt0001

p=0192

plt0001

p=0494

plt0001 plt0001

p=0154 p=0277


RD reduces fasting glucose

-175

-125

-75

-25

25

75

125

175

Ch

an

ge

in

fa

stin

g g

luco

se

(m

gd

l)

1 month 3 months

Renal denervation (n=37) Control (n=13)

-89 -94

+39 +09

p=0043 p=0039

p=0402

p=0847


RD reduces fasting insulin

-15

-10

-5

0

5

10

15

Ch

an

ge

in

fa

stin

g in

su

lin (

microIU

ml)

1 month 3 months


-87 -116

+64 +05

p=0036 p=0006

p=0129

p=0984


RD reduces C-peptide

-40

-35

-30

-25

-20

-15

-10

-05

00

05

10

15

20

Ch

an

ge

in

fa

stin

g C

-pe

ptid

e (

ng

ml)

1 month 3 months


Control (n=13)

-20 -23

+02 +02

p=0006 p=0002

p=0699 p=0776


RD improves insulin sensitivity

-5

-4

-3

-2

-1

0

1

2

3

4

5

Ch

an

ge

in

HO

MA

-IR

(n

gm

l)

1 month 3 months


Control (n=13)

-31 -37

+21 +03

p=0008 p=0001

p=0085

p=0734


Improves glucose tolerance

-9 -27

-10

-20

-30

0

+10

-40

Reduction in g

lucose level (m

gd

l)

60-min glucose level


significant reduction (plt005)

compared to baseline

Glucose tolerance test 75 g glucose per os

3 months

Renal denervation


PCOS is associated with

increased sympathetic activity

insulin resistance

hypertension

Case report on 2 young patients with resistant

hypertension and PCOS with 3 months FU

Schlaich MP J Hypertens 2011

RDN reduced BP and MSNA activity


Reduced fasting glucose and improved insulin sensitivity


Symplicity inclusion and exclusion criteria

+ diagnosed OSA (AHI gt5 per hour)

10 pts underwent RD

Follow-up baseline 3 and 6 months

Witkowski A Hypertension 2011

Baseline 3 months 6 months

Improvement in AHI - 710 patients 810 patients

AHI eventshr 307 plusmn 265 200 plusmn 253

(p=ns)

161 plusmn 222

(p=ns)

Epworth Sleepiness Scale

Score points

9 65

(p=ns)

7

(plt005)

120 min glucose level

OGTT mmoll

84 plusmn 33 68 plusmn 25

(p=0051)

68 plusmn 29

(plt005)

HbA1C 64 plusmn 08 60 plusmn 07

(plt005)

59 plusmn 07

(plt005)


Improved glucose metabolism after RDN in patients with OSA

Open questions

bull Durability of the results remain to be

documented

bull Renal retinal and cardiovascular

consequences of these findings need to be

investiagated

baseline BP 174 plusmn 2291 plusmn 16 mmHg

56 plusmn 13 antihypertensive drugs

Hering D et al JASN 2012

RDN in CKD 3-4 ndash a pilot study

bull 15 patients with CKD 3-4

bull Baseline mean GFR 312 plusmn 89 mlmin173 m2


Renal sympathetic denervation for treatment of electrical storm first-in-man experience Ukena et al Clin Res Cardiol 2012 2 patients with chronic heart failure suffering from therapy resistant

electrical storm underwent renal denervation

Ventricular tachyarrhytmias were reduced blood pressure and

clinical status remained stable

Reduction of ventricular fibrillation episodes in one patient

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More news at EuroPCR 2013

Mahfoud F et al unpublished data

Muchas gracias

Percutaneous renal denervation

Nonpharmacologic and optimized pharmacologic treatment (encouragement of compliance)

Resistant hypertension

Who Is a Candidate for Renal Denervation

Uncontrolled hypertension

Screening for secondary causes bull OSA syndrome bull CKD bull Renal artery stenosis bull Primary hyperaldosteronism bull Pheochromocytoma bull Cushingrsquos syndrome bull Vasculitides bull Coarctation of the aorta bull Thyrotoxic crisis

Exclusion of pseudo-

resistance

Identification of reversible

lifestyle factors

Cessation of BP- elevating

medications

Specific therapy as appropriate

CKD=chronic kidney disease OSA=obstructive sleep apnea Mahfoud F et al Dtsch Arztebl Int 2011108725-731

Non-Response

No predictors of non-response (SBP lt10 mmHg)

available

bull Non-response rate 20

RRI = (V max sys ndash V max endiast) V max sys

Sobotka Henry Krum Bruno Scheller Markus Schlaich Ulrich Laufs and Michael BoumlhmDominik Linz Roland Schmieder Lars Christian Rump Ingrid Kindermann Paul Andrew Felix Mahfoud Bodo Cremers Julia Janker Britta Link Oliver Vonend Christian Ukena

Denervation in Patients With Resistant HypertensionRenal Hemodynamics and Renal Function After Catheter-Based Renal Sympathetic

Print ISSN 0194-911X Online ISSN 1524-4563 Copyright copy 2012 American Heart Association Inc All rights reserved

is published by the American Heart Association 7272 Greenville Avenue Dallas TX 75231Hypertension published online June 25 2012Hypertension

httphyperahajournalsorgcontentearly20120625HYPERTENSIONAHA112193870

World Wide Web at The online version of this article along with updated information and services is located on the

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is online at Hypertension Information about subscribing to Subscriptions

httpwwwlwwcomreprints Information about reprints can be found online at Reprints

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can be obtained via RightsLink a service of the Copyright Clearance Center not the EditorialHypertensionin Requests for permissions to reproduce figures tables or portions of articles originally publishedPermissions

by guest on June 26 2012httphyperahajournalsorgDownloaded from

Mahfoud F et al Hypertension 2012

RRI at baseline and BP reduction ndash Regression analysis

RRI at baseline was NOT associated with non-

response (SBP reduction gt10 mmHg after 6

months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)

Baseline 3 months after RD

plt00001 plt00001

plt00001

plt00001

plt0001

Ukena C Mahfoud F et al JACC 2011

No chronotropic incompetence after RDN

25 50 75 100 of maximum work rate

Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)


Mean SBP and heart rate after drug provocation

Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]

Responder Non-Responder Responder Non-Responder

p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation

Lenksi M Mahfoud F ESC 2012

Syncopes and presyncopes during tilt table testing

Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25

Baseline 3 Months Baseline 3 Months

Responder Non-Responder

[n]

30 ns

ns


BP

Change

ABPM reduction in Symplicity

Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic

Symplicity HTN-2 InvestigatorsThe Lancet 2010

p=0006

p=0014

p=051

p=075

Analysis on technically sufficient (gt70 of readings)

paired baseline and 6-month

Real world data on ABPM ndash patient characteristics

Mahfoud F ESC 2012

N=80

Age (years) 58 plusmn 12

Gender ( female) 35

Type 2 diabetes 44

eGFR (MDRD mlmin173m2) 72 plusmn 13


Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44


Antihypertensive drugs () 54 plusmn 15

SBP (mmHg) 169 plusmn 22

DBP (mmHg) 92 plusmn 15

HR (bpm) 69 plusmn 12

Mean SBP (mmHg) 151 plusmn 17

Mean DBP (mmHg) 85 plusmn 14

Real world experience ndash office BP reduction

Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg

difference between RDN and Control

(plt00001)

Systolic

Diastolic

Systolic Diastolic

Symplicity HTN-2 Investigators Lancet 2010

Real world experience - Changes in mean 24-hour BP

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012


Changes in daytime and nighttime BP

BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012

RDN reduces maximum and minimum SBP

BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012

24-hour BP changes are comparable to spironolactone treatment ndash ASPIRANT study

Vaacuteclaviacutek J et a Hypertension 2011571069-75

Mean ABP reductions in the subgroup of patients treated with spironolactone (n=26)

SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

Afferent and efferent sympathetic nerve fibers

Afferent

Renal ischemia

Adenosine

Efferent

Renin secretion

Sodium retention

Proteinuria

Vasoconstriction

Atherosclerosis

LVH

Ischemia

Heart Failure

Gluconeogenesis uarr

Insulin resistance

Mahfoud F et al DMW 2010



Krum et al Lancet 2009 373(9671)1275-81



0

25

-25

-50

-75

-47



THE NEW FRONTIER








Therapy resistant

N=5182

Age a 64

Male 55


Diabetes 351

LVH 185





Therapy resistant

N=5182

Age a 64

Male 55


Diabetes 351

LVH 185






Background




Sympathetic drive


Obesity

Hyperinsulinemia



Hypertension

Vasoconstriction

Insulin resistance











-40

-35

-30

-25

-20

-15

-10

-5

0 1 month 3 months

systolic

3 months 1 month

diastolic


Control (n=13)

-28 -8 -32 -5 -10 -4 -12 -3

Change in b

lood p

ressure

(m

mH

g)

plt0001

p=0192

plt0001

p=0494

plt0001 plt0001

p=0154 p=0277



-175

-125

-75

-25

25

75

125

175

Ch

an

ge

in

fa

stin

g g

luco

se

(m

gd

l)

1 month 3 months


-89 -94

+39 +09

p=0043 p=0039

p=0402

p=0847



-15

-10

-5

0

5

10

15

Ch

an

ge

in

fa

stin

g in

su

lin (

microIU

ml)

1 month 3 months


-87 -116

+64 +05

p=0036 p=0006

p=0129

p=0984



-40

-35

-30

-25

-20

-15

-10

-05

00

05

10

15

20

Ch

an

ge

in

fa

stin

g C

-pe

ptid

e (

ng

ml)

1 month 3 months


Control (n=13)

-20 -23

+02 +02

p=0006 p=0002

p=0699 p=0776



-5

-4

-3

-2

-1

0

1

2

3

4

5

Ch

an

ge

in

HO

MA

-IR

(n

gm

l)

1 month 3 months


Control (n=13)

-31 -37

+21 +03

p=0008 p=0001

p=0085

p=0734



-9 -27

-10

-20

-30

0

+10

-40

Reduction in g

lucose level (m

gd

l)






3 months

Renal denervation




insulin resistance

hypertension










10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













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Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019



Krum et al Lancet 2009 373(9671)1275-81



0

25

-25

-50

-75

-47



THE NEW FRONTIER








Therapy resistant

N=5182

Age a 64

Male 55


Diabetes 351

LVH 185





Therapy resistant

N=5182

Age a 64

Male 55


Diabetes 351

LVH 185






Background




Sympathetic drive


Obesity

Hyperinsulinemia



Hypertension

Vasoconstriction

Insulin resistance











-40

-35

-30

-25

-20

-15

-10

-5

0 1 month 3 months

systolic

3 months 1 month

diastolic


Control (n=13)

-28 -8 -32 -5 -10 -4 -12 -3

Change in b

lood p

ressure

(m

mH

g)

plt0001

p=0192

plt0001

p=0494

plt0001 plt0001

p=0154 p=0277



-175

-125

-75

-25

25

75

125

175

Ch

an

ge

in

fa

stin

g g

luco

se

(m

gd

l)

1 month 3 months


-89 -94

+39 +09

p=0043 p=0039

p=0402

p=0847



-15

-10

-5

0

5

10

15

Ch

an

ge

in

fa

stin

g in

su

lin (

microIU

ml)

1 month 3 months


-87 -116

+64 +05

p=0036 p=0006

p=0129

p=0984



-40

-35

-30

-25

-20

-15

-10

-05

00

05

10

15

20

Ch

an

ge

in

fa

stin

g C

-pe

ptid

e (

ng

ml)

1 month 3 months


Control (n=13)

-20 -23

+02 +02

p=0006 p=0002

p=0699 p=0776



-5

-4

-3

-2

-1

0

1

2

3

4

5

Ch

an

ge

in

HO

MA

-IR

(n

gm

l)

1 month 3 months


Control (n=13)

-31 -37

+21 +03

p=0008 p=0001

p=0085

p=0734



-9 -27

-10

-20

-30

0

+10

-40

Reduction in g

lucose level (m

gd

l)






3 months

Renal denervation




insulin resistance

hypertension










10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


THE NEW FRONTIER








Therapy resistant

N=5182

Age a 64

Male 55


Diabetes 351

LVH 185





Therapy resistant

N=5182

Age a 64

Male 55


Diabetes 351

LVH 185






Background




Sympathetic drive


Obesity

Hyperinsulinemia



Hypertension

Vasoconstriction

Insulin resistance











-40

-35

-30

-25

-20

-15

-10

-5

0 1 month 3 months

systolic

3 months 1 month

diastolic


Control (n=13)

-28 -8 -32 -5 -10 -4 -12 -3

Change in b

lood p

ressure

(m

mH

g)

plt0001

p=0192

plt0001

p=0494

plt0001 plt0001

p=0154 p=0277



-175

-125

-75

-25

25

75

125

175

Ch

an

ge

in

fa

stin

g g

luco

se

(m

gd

l)

1 month 3 months


-89 -94

+39 +09

p=0043 p=0039

p=0402

p=0847



-15

-10

-5

0

5

10

15

Ch

an

ge

in

fa

stin

g in

su

lin (

microIU

ml)

1 month 3 months


-87 -116

+64 +05

p=0036 p=0006

p=0129

p=0984



-40

-35

-30

-25

-20

-15

-10

-05

00

05

10

15

20

Ch

an

ge

in

fa

stin

g C

-pe

ptid

e (

ng

ml)

1 month 3 months


Control (n=13)

-20 -23

+02 +02

p=0006 p=0002

p=0699 p=0776



-5

-4

-3

-2

-1

0

1

2

3

4

5

Ch

an

ge

in

HO

MA

-IR

(n

gm

l)

1 month 3 months


Control (n=13)

-31 -37

+21 +03

p=0008 p=0001

p=0085

p=0734



-9 -27

-10

-20

-30

0

+10

-40

Reduction in g

lucose level (m

gd

l)






3 months

Renal denervation




insulin resistance

hypertension










10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019








Therapy resistant

N=5182

Age a 64

Male 55


Diabetes 351

LVH 185





Therapy resistant

N=5182

Age a 64

Male 55


Diabetes 351

LVH 185






Background




Sympathetic drive


Obesity

Hyperinsulinemia



Hypertension

Vasoconstriction

Insulin resistance











-40

-35

-30

-25

-20

-15

-10

-5

0 1 month 3 months

systolic

3 months 1 month

diastolic


Control (n=13)

-28 -8 -32 -5 -10 -4 -12 -3

Change in b

lood p

ressure

(m

mH

g)

plt0001

p=0192

plt0001

p=0494

plt0001 plt0001

p=0154 p=0277



-175

-125

-75

-25

25

75

125

175

Ch

an

ge

in

fa

stin

g g

luco

se

(m

gd

l)

1 month 3 months


-89 -94

+39 +09

p=0043 p=0039

p=0402

p=0847



-15

-10

-5

0

5

10

15

Ch

an

ge

in

fa

stin

g in

su

lin (

microIU

ml)

1 month 3 months


-87 -116

+64 +05

p=0036 p=0006

p=0129

p=0984



-40

-35

-30

-25

-20

-15

-10

-05

00

05

10

15

20

Ch

an

ge

in

fa

stin

g C

-pe

ptid

e (

ng

ml)

1 month 3 months


Control (n=13)

-20 -23

+02 +02

p=0006 p=0002

p=0699 p=0776



-5

-4

-3

-2

-1

0

1

2

3

4

5

Ch

an

ge

in

HO

MA

-IR

(n

gm

l)

1 month 3 months


Control (n=13)

-31 -37

+21 +03

p=0008 p=0001

p=0085

p=0734



-9 -27

-10

-20

-30

0

+10

-40

Reduction in g

lucose level (m

gd

l)






3 months

Renal denervation




insulin resistance

hypertension










10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


Therapy resistant

N=5182

Age a 64

Male 55


Diabetes 351

LVH 185






Background




Sympathetic drive


Obesity

Hyperinsulinemia



Hypertension

Vasoconstriction

Insulin resistance











-40

-35

-30

-25

-20

-15

-10

-5

0 1 month 3 months

systolic

3 months 1 month

diastolic


Control (n=13)

-28 -8 -32 -5 -10 -4 -12 -3

Change in b

lood p

ressure

(m

mH

g)

plt0001

p=0192

plt0001

p=0494

plt0001 plt0001

p=0154 p=0277



-175

-125

-75

-25

25

75

125

175

Ch

an

ge

in

fa

stin

g g

luco

se

(m

gd

l)

1 month 3 months


-89 -94

+39 +09

p=0043 p=0039

p=0402

p=0847



-15

-10

-5

0

5

10

15

Ch

an

ge

in

fa

stin

g in

su

lin (

microIU

ml)

1 month 3 months


-87 -116

+64 +05

p=0036 p=0006

p=0129

p=0984



-40

-35

-30

-25

-20

-15

-10

-05

00

05

10

15

20

Ch

an

ge

in

fa

stin

g C

-pe

ptid

e (

ng

ml)

1 month 3 months


Control (n=13)

-20 -23

+02 +02

p=0006 p=0002

p=0699 p=0776



-5

-4

-3

-2

-1

0

1

2

3

4

5

Ch

an

ge

in

HO

MA

-IR

(n

gm

l)

1 month 3 months


Control (n=13)

-31 -37

+21 +03

p=0008 p=0001

p=0085

p=0734



-9 -27

-10

-20

-30

0

+10

-40

Reduction in g

lucose level (m

gd

l)






3 months

Renal denervation




insulin resistance

hypertension










10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019



Background




Sympathetic drive


Obesity

Hyperinsulinemia



Hypertension

Vasoconstriction

Insulin resistance











-40

-35

-30

-25

-20

-15

-10

-5

0 1 month 3 months

systolic

3 months 1 month

diastolic


Control (n=13)

-28 -8 -32 -5 -10 -4 -12 -3

Change in b

lood p

ressure

(m

mH

g)

plt0001

p=0192

plt0001

p=0494

plt0001 plt0001

p=0154 p=0277



-175

-125

-75

-25

25

75

125

175

Ch

an

ge

in

fa

stin

g g

luco

se

(m

gd

l)

1 month 3 months


-89 -94

+39 +09

p=0043 p=0039

p=0402

p=0847



-15

-10

-5

0

5

10

15

Ch

an

ge

in

fa

stin

g in

su

lin (

microIU

ml)

1 month 3 months


-87 -116

+64 +05

p=0036 p=0006

p=0129

p=0984



-40

-35

-30

-25

-20

-15

-10

-05

00

05

10

15

20

Ch

an

ge

in

fa

stin

g C

-pe

ptid

e (

ng

ml)

1 month 3 months


Control (n=13)

-20 -23

+02 +02

p=0006 p=0002

p=0699 p=0776



-5

-4

-3

-2

-1

0

1

2

3

4

5

Ch

an

ge

in

HO

MA

-IR

(n

gm

l)

1 month 3 months


Control (n=13)

-31 -37

+21 +03

p=0008 p=0001

p=0085

p=0734



-9 -27

-10

-20

-30

0

+10

-40

Reduction in g

lucose level (m

gd

l)






3 months

Renal denervation




insulin resistance

hypertension










10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

Obesity

Hyperinsulinemia



Hypertension

Vasoconstriction

Insulin resistance











-40

-35

-30

-25

-20

-15

-10

-5

0 1 month 3 months

systolic

3 months 1 month

diastolic


Control (n=13)

-28 -8 -32 -5 -10 -4 -12 -3

Change in b

lood p

ressure

(m

mH

g)

plt0001

p=0192

plt0001

p=0494

plt0001 plt0001

p=0154 p=0277



-175

-125

-75

-25

25

75

125

175

Ch

an

ge

in

fa

stin

g g

luco

se

(m

gd

l)

1 month 3 months


-89 -94

+39 +09

p=0043 p=0039

p=0402

p=0847



-15

-10

-5

0

5

10

15

Ch

an

ge

in

fa

stin

g in

su

lin (

microIU

ml)

1 month 3 months


-87 -116

+64 +05

p=0036 p=0006

p=0129

p=0984



-40

-35

-30

-25

-20

-15

-10

-05

00

05

10

15

20

Ch

an

ge

in

fa

stin

g C

-pe

ptid

e (

ng

ml)

1 month 3 months


Control (n=13)

-20 -23

+02 +02

p=0006 p=0002

p=0699 p=0776



-5

-4

-3

-2

-1

0

1

2

3

4

5

Ch

an

ge

in

HO

MA

-IR

(n

gm

l)

1 month 3 months


Control (n=13)

-31 -37

+21 +03

p=0008 p=0001

p=0085

p=0734



-9 -27

-10

-20

-30

0

+10

-40

Reduction in g

lucose level (m

gd

l)






3 months

Renal denervation




insulin resistance

hypertension










10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019










-40

-35

-30

-25

-20

-15

-10

-5

0 1 month 3 months

systolic

3 months 1 month

diastolic


Control (n=13)

-28 -8 -32 -5 -10 -4 -12 -3

Change in b

lood p

ressure

(m

mH

g)

plt0001

p=0192

plt0001

p=0494

plt0001 plt0001

p=0154 p=0277



-175

-125

-75

-25

25

75

125

175

Ch

an

ge

in

fa

stin

g g

luco

se

(m

gd

l)

1 month 3 months


-89 -94

+39 +09

p=0043 p=0039

p=0402

p=0847



-15

-10

-5

0

5

10

15

Ch

an

ge

in

fa

stin

g in

su

lin (

microIU

ml)

1 month 3 months


-87 -116

+64 +05

p=0036 p=0006

p=0129

p=0984



-40

-35

-30

-25

-20

-15

-10

-05

00

05

10

15

20

Ch

an

ge

in

fa

stin

g C

-pe

ptid

e (

ng

ml)

1 month 3 months


Control (n=13)

-20 -23

+02 +02

p=0006 p=0002

p=0699 p=0776



-5

-4

-3

-2

-1

0

1

2

3

4

5

Ch

an

ge

in

HO

MA

-IR

(n

gm

l)

1 month 3 months


Control (n=13)

-31 -37

+21 +03

p=0008 p=0001

p=0085

p=0734



-9 -27

-10

-20

-30

0

+10

-40

Reduction in g

lucose level (m

gd

l)






3 months

Renal denervation




insulin resistance

hypertension










10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


-175

-125

-75

-25

25

75

125

175

Ch

an

ge

in

fa

stin

g g

luco

se

(m

gd

l)

1 month 3 months


-89 -94

+39 +09

p=0043 p=0039

p=0402

p=0847



-15

-10

-5

0

5

10

15

Ch

an

ge

in

fa

stin

g in

su

lin (

microIU

ml)

1 month 3 months


-87 -116

+64 +05

p=0036 p=0006

p=0129

p=0984



-40

-35

-30

-25

-20

-15

-10

-05

00

05

10

15

20

Ch

an

ge

in

fa

stin

g C

-pe

ptid

e (

ng

ml)

1 month 3 months


Control (n=13)

-20 -23

+02 +02

p=0006 p=0002

p=0699 p=0776



-5

-4

-3

-2

-1

0

1

2

3

4

5

Ch

an

ge

in

HO

MA

-IR

(n

gm

l)

1 month 3 months


Control (n=13)

-31 -37

+21 +03

p=0008 p=0001

p=0085

p=0734



-9 -27

-10

-20

-30

0

+10

-40

Reduction in g

lucose level (m

gd

l)






3 months

Renal denervation




insulin resistance

hypertension










10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


-15

-10

-5

0

5

10

15

Ch

an

ge

in

fa

stin

g in

su

lin (

microIU

ml)

1 month 3 months


-87 -116

+64 +05

p=0036 p=0006

p=0129

p=0984



-40

-35

-30

-25

-20

-15

-10

-05

00

05

10

15

20

Ch

an

ge

in

fa

stin

g C

-pe

ptid

e (

ng

ml)

1 month 3 months


Control (n=13)

-20 -23

+02 +02

p=0006 p=0002

p=0699 p=0776



-5

-4

-3

-2

-1

0

1

2

3

4

5

Ch

an

ge

in

HO

MA

-IR

(n

gm

l)

1 month 3 months


Control (n=13)

-31 -37

+21 +03

p=0008 p=0001

p=0085

p=0734



-9 -27

-10

-20

-30

0

+10

-40

Reduction in g

lucose level (m

gd

l)






3 months

Renal denervation




insulin resistance

hypertension










10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


-40

-35

-30

-25

-20

-15

-10

-05

00

05

10

15

20

Ch

an

ge

in

fa

stin

g C

-pe

ptid

e (

ng

ml)

1 month 3 months


Control (n=13)

-20 -23

+02 +02

p=0006 p=0002

p=0699 p=0776



-5

-4

-3

-2

-1

0

1

2

3

4

5

Ch

an

ge

in

HO

MA

-IR

(n

gm

l)

1 month 3 months


Control (n=13)

-31 -37

+21 +03

p=0008 p=0001

p=0085

p=0734



-9 -27

-10

-20

-30

0

+10

-40

Reduction in g

lucose level (m

gd

l)






3 months

Renal denervation




insulin resistance

hypertension










10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


-5

-4

-3

-2

-1

0

1

2

3

4

5

Ch

an

ge

in

HO

MA

-IR

(n

gm

l)

1 month 3 months


Control (n=13)

-31 -37

+21 +03

p=0008 p=0001

p=0085

p=0734



-9 -27

-10

-20

-30

0

+10

-40

Reduction in g

lucose level (m

gd

l)






3 months

Renal denervation




insulin resistance

hypertension










10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


-9 -27

-10

-20

-30

0

+10

-40

Reduction in g

lucose level (m

gd

l)






3 months

Renal denervation




insulin resistance

hypertension










10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019



insulin resistance

hypertension










10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019







10 pts underwent RD






(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019




(p=ns)

161 plusmn 222

(p=ns)


Score points

9 65

(p=ns)

7

(plt005)


OGTT mmoll


(p=0051)

68 plusmn 29

(plt005)


(plt005)

59 plusmn 07

(plt005)



Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

Open questions


documented



investiagated













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019













04032013

28

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

04032013

32

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

04032013

33

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

04032013

35

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

04032013

36

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

04032013

37

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

04032013

38



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019



Muchas gracias








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019








resistance


lifestyle factors


medications



Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

Non-Response


available




















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019



















months)

bull gt070 (R=0421 p=0447)

bull gt075 (R=0032 p=0960)

bull gt080 (R=1074 p=0755)

bull gt085 (R=1285 p=0667)


0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

0

120

140

160

180

200

220

240

0 25 50 75 100

of maximum workload

Sys

toli

c b

loo

d p

res

su

re (

mm

Hg

)


plt00001 plt00001

plt00001

plt00001

plt0001




Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019



Rest Recovery 0

20

40

60

80

100

120

140

p=0028

p=0006

p=0121

p=0074

p=0141

p=0001


Heart

rate

(bpm

)



Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


Baseline

3 months

0

120

140

160

0

50

60

70

80

90

100

p=00592

he

art

rate

[1

min

]


p=04509 p=09909 p=08300

SBP

[m

mH

g]

Drug provocation



Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


Pre-syncope

Syncope

No symptoms

4 4 1

6 5

3 2

16 17

7 7

0

5

10

15

20

25



[n]

30 ns

ns


BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

BP

Change


Home BP

Change

(mmHg)

Systolic

Diastolic

Systolic

Diastolic


p=0006

p=0014

p=051

p=075




Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44



Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


Mahfoud F ESC 2012

N=80


Gender ( female) 35

Type 2 diabetes 44









Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


Ch

an

ges i

n o

ffic

e B

P (

mm

Hg

)

SBP

DBP

SBP

DBP

plt0001

plt0001

plt0001

plt0001

Mahfoud F ESC 2012

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

∆ from

Baseline

to

6 Months

(mmHg)

3311 mmHg


(plt00001)

Systolic

Diastolic

Systolic Diastolic



BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

BP

ch

an

ges (

mm

Hg

)

p=0019

p=0025

p=0018

p=0022 SBP

DBP

SBP

DBP

Mahfoud F ESC 2012



BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


BP

ch

an

ges (

mm

Hg

)

p=0025

SBP

DBP

SBP

SBP

SBP

DBP

DBP

DBP

p=0001

p=0001

p=0001 p=0002

p=0004

p=0004

p=0002

daytime nighttime

Mahfoud F ESC 2012


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019


BP

ch

an

ges (

mm

Hg

)

Max

SBP Max

SBP

Min

SBP Min

SBP

p=0009

p=0003

p=0013 p=0011

Mahfoud F ESC 2012




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019




SBP

DBP

DBP

SBP

Mahfoud F ESC 2012

p=0011

p=0022

p=0014

p=0019

Denervacion Renal otras indicaciones

Health & Medicine

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