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October 10, 2019

Where did renal denervation stand at the time of ESC 2014 7 years after its first clinical
promise and 4 months after the negative results of SIMPLICITY III? This is a viable technique, in the appropriate patient but there are a number of technical issues
that still need to be sorted out in particular this major issue of are you technically achieving denervation and sympathetic abrogation on the table before the patient leaves
the cath lab? Denervation remains viable in appropriate patients, if appropriately conducted and, as I’ve said, most importantly that
if we appropriately and aggressively treat our
patients before we get to denervation many won’t need it Advance-On is a 6 years post trial follow-up of ADVANCE, a study in which 11,140 patients with type 2 diabetes and high blood pressure were treated either with a fixed combination of perindopril plus indapamide or placebo for 4.4 years The main result was that there were indeed persisting benefits in all-cause mortality and
cardiovascular death There was still evidence at a total of 9.9 years of complete follow-up 6 years after the randomized treatment
had stopped with a 9 percent reduction in all-cause mortality and a 12 percent reduction in cardiovascular death First you have to consider the aorta as a full
organ and the division between the abdominal
and thoracic is somehow artificial and there are many patients
who can have lesions on both sides, so take the
aorta as a full organ and also when you go to consider the
imaging and methods you also have to balance the benefits and the risk specifically in the younger patients we
have to think about the radiation issues and
finally, regarding the treatment endovascular therapy has really well-developed and pushed the surgery a bit in the specific

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