Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Renal Denervation in Treatment Resistant Hypertension
Brief Summary: In patients with treatment resistant hypertension renal nerve ablation emerged as an effective interventional approach of treating hypertensive disease with a progressively increasing fall in blood pressure. Decreased activity of the sympathetic nervous system is one of the major underlying pathogenetic mechanism of the fall in blood pressure but the precise mechanisms that causes the fall in blood pressure in the short-term and, in particular, long-term remains elusive. The objective of the study is to understand the pathogenetic mechanisms of renal denervation beyond the reduced activity of the sympathetic nervous system. In 100 hypertensive patients most advanced technology will be applied, before and repeatedly after renal denervation, throughout the follow-up period of 1 year. Systemic activity of the renin angiotensin aldosterone system, renal perfusion (by MRI spin labeling technique), local activity of the renin angiotensin system in the kidney (urinary angiotensinogen concentrations), sodium excretion and total sodium content (23 Na-MRI technique) and vascular remodelling of small (retinal arterioles 50 - 150 µm) and large arteries (carotid - femoral pulse wave velocity and augmentation index, both measured over 24 hours) will be assessed. Identification of the pathogenetic mechanisms involved in the fall in blood pressure after renal denervation may help to identify those hypertensive patients that profit most from renal nerve ablation in terms of blood pressure reduction.

The investigators propose the following hypotheses why a progressive decrease in blood pressure happens, in addition to the decreased activity of the central nervous system, after renal nerve ablation:

Short term effects:

A)Preservation of renal function and perfusion B)Reduction of local RAS activity in the kidney C)Exaggerated sodium excretion immediately after renal nerve ablation

Long term effects:

D)Decrease of total sodium content after 6 and 12 months E)Improvement of vascular wall properties after 6 and 12 months


Options:
A: Arm Label: Renal denervation; Type: N/A; Interventions: Device: Renal denervation using Symplicity Catheter system | Intervention Type: DEVICE; Name: Renal denervation using Symplicity Catheter system; Assigned to Arm(s): Renal denervation
B: Arm Label: Renal Denervation plus Medications; Type: EXPERIMENTAL; Interventions: Device: Radiofrequency ablation catheter, Drug: Amlodipine, losartan potassium and hydrochlorothiazide | Arm Label: Medications; Type: ACTIVE_COMPARATOR; Interventions: Drug: Amlodipine, losartan potassium and hydrochlorothiazide | Intervention Type: DEVICE; Name: Radiofrequency ablation catheter; Assigned to Arm(s): Renal Denervation plus Medications | Intervention Type: DRUG; Name: Amlodipine, losartan potassium and hydrochlorothiazide; Assigned to Arm(s): Medications, Renal Denervation plus Medications
C: Intervention Type: DEVICE; Name: Symplicty(TM) Catheter System; Assigned to Arm(s): N/A
D: Arm Label: Control group; Type: OTHER; Interventions: Procedure: Renal denervation | Arm Label: Intervention group; Type: EXPERIMENTAL; Interventions: Procedure: Renal denervation | Intervention Type: PROCEDURE; Name: Renal denervation; Assigned to Arm(s): Control group, Intervention group

Answer: A