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ESPACIO de hipertensión arterial › Bloque G › G4

Guías y evidencia

Lo que recomiendan las guías y lo que demuestran los estudios, separando siempre lo aprobado de lo que se investiga.

G4

Todas las fuentes citadas en el ESPACIO, en formato Vancouver, con DOI y PMID verificados, filtrables por tema y descargables para un gestor bibliográfico.

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Artículos y guías en PubMed (225)

  1. Abalos E, Duley L, Steyn DW, Gialdini C. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2018;10(10):CD002252. doi:10.1002/14651858.CD002252.pub4 · PMID 30277556I1
  2. ACCORD Study Group, Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575-85. doi:10.1056/NEJMoa1001286 · PMID 20228401C6G2
  3. Adler GK, Stowasser M, Correa RR, Khan N, Kline G, McGowan MJ, et al. Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2025;110(9):2453-2495. doi:10.1210/clinem/dgaf284 · PMID 40658480H3
  4. Agarwal R, Rossignol P, Romero A, Garza D, Mayo MR, Warren S, et al. Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronic kidney disease (AMBER): a phase 2, randomised, double-blind, placebo-controlled trial. Lancet. 2019;394(10208):1540-1550. doi:10.1016/S0140-6736(19)32135-X · PMID 31533906B7C6G2G5I1
  5. Agarwal R, Sinha AD, Cramer AE, Balmes-Fenwick M, Dickinson JH, Ouyang F, et al. Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease. N Engl J Med. 2021;385(27):2507-2519. doi:10.1056/NEJMoa2110730 · PMID 34739197C1C5C6G2I1
  6. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288(23):2981-97. doi:10.1001/jama.288.23.2981 · PMID 12479763C5G2I1
  7. Araujo-Castro M, Paja Fano M, González Boillos M, Pla Peris B, Pascual-Corrales E, García Cano AM, et al. Adrenal venous sampling in primary aldosteronism: Experience of a Spanish multicentric study (Results from the SPAIN-ALDO Register). Endocrine. 2022;78(2):363-372. doi:10.1007/s12020-022-03122-8 · PMID 35751774H2
  8. Araujo-Castro M, Pascual-Corrales E, Martín Rojas P, Parra Ramírez P. Epidemiology and diagnosis of primary aldosteronism. What have we learned from the SPAIN-ALDO registry? Endocrine. 2024;83(3):527-536. doi:10.1007/s12020-023-03573-7 · PMID 37884825H2
  9. Araujo-Castro M, Ruiz-Sánchez JG, Parra Ramírez P, Martín Rojas-Marcos P, Aguilera-Saborido A, Gómez Cerezo JF, et al. Screening and diagnosis of primary aldosteronism. Consensus document of all the Spanish Societies involved in the management of primary aldosteronism. Endocrine. 2024;85(1):99-121. doi:10.1007/s12020-024-03751-1 · PMID 38448679F1
  10. Araujo-Castro M, Ruiz-Sánchez JG, Ramírez PP, Martín Rojas-Marcos P, Aguilera-Saborido A, Gómez Cerezo JF, et al. Practical consensus for the treatment and follow-up of primary aldosteronism: a multidisciplinary consensus document. Endocrine. 2024;85(2):532-544. doi:10.1007/s12020-024-03773-9 · PMID 38507182F1
  11. ASTRAL Investigators, Wheatley K, Ives N, Gray R, Kalra PA, Moss JG, et al. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med. 2009;361(20):1953-62. doi:10.1056/NEJMoa0905368 · PMID 19907042H3
  12. Azizi M, Schmieder RE, Mahfoud F, Weber MA, Daemen J, Davies J, et al. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial. Lancet. 2018;391(10137):2335-2345. doi:10.1016/S0140-6736(18)31082-1 · PMID 29803590G2I3
  13. Azizi M, Sanghvi K, Saxena M, Gosse P, Reilly JP, Levy T, et al. Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, sham-controlled trial. Lancet. 2021;397(10293):2476-2486. doi:10.1016/S0140-6736(21)00788-1 · PMID 34010611B7G2I3
  14. Azizi M, Saxena M, Wang Y, Jenkins JS, Devireddy C, Rader F, et al. Endovascular Ultrasound Renal Denervation to Treat Hypertension: The RADIANCE II Randomized Clinical Trial. JAMA. 2023;329(8):651-661. doi:10.1001/jama.2023.0713 · PMID 36853250B7G2I3
  15. Azizi M, Brown JM, Dwyer JP, Flack JM, Jones ESW, Kurlyandskaya R, et al. Effect of baxdrostat on ambulatory blood pressure in patients with resistant hypertension (Bax24): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet. 2026;407(10532):988-999. doi:10.1016/S0140-6736(25)02549-8 · PMID 41794437D1G2G5H1
  16. Baena-Díez JM, Félix FJ, Grau M, Cabrera de León A, Sanz H, Leal M, et al. Tratamiento y control de los factores de riesgo según el riesgo coronario en la población española del estudio DARIOS. Rev Esp Cardiol. 2011;64(9):766-73. doi:10.1016/j.recesp.2011.04.019 · PMID 21764497G3
  17. Bakris GL, Fonseca V, Katholi RE, McGill JB, Messerli FH, Phillips RA, et al. Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. JAMA. 2004;292(18):2227-36. doi:10.1001/jama.292.18.2227 · PMID 15536109I1
  18. Bakris GL, Saxena M, Gupta A, Chalhoub F, Lee J, Stiglitz D, et al. RNA Interference With Zilebesiran for Mild to Moderate Hypertension: The KARDIA-1 Randomized Clinical Trial. JAMA. 2024;331(9):740-749. doi:10.1001/jama.2024.0728 · PMID 38363577G2G5H1
  19. Banegas JR, Graciani A, de la Cruz-Troca JJ, León-Muñoz LM, Guallar-Castillón P, Coca A, et al. Achievement of cardiometabolic goals in aware hypertensive patients in Spain: a nationwide population-based study. Hypertension. 2012;60(4):898-905. doi:10.1161/HYPERTENSIONAHA.112.193078 · PMID 22949530G3H2
  20. Banegas JR, Ruilope LM, de la Sierra A, de la Cruz JJ, Gorostidi M, Segura J, et al. High prevalence of masked uncontrolled hypertension in people with treated hypertension. Eur Heart J. 2014;35(46):3304-12. doi:10.1093/eurheartj/ehu016 · PMID 24497346G3H2
  21. Banegas JR, Sánchez-Martínez M, Gijón-Conde T, López-García E, Graciani A, Guallar-Castillón P, et al. Numerical values and impact of hypertension in Spain. Rev Esp Cardiol (Engl Ed). 2024;77(9):767-778. doi:10.1016/j.rec.2024.03.011 · PMID 38701882H2
  22. Barbato E, Azizi M, Schmieder RE, Lauder L, Böhm M, Brouwers S, et al. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2023;44(15):1313-1330. doi:10.1093/eurheartj/ehad054 · PMID 36790101I3
  23. Barrios V, Navarro A, Esteras A, Luque M, Romero J, Tamargo J, et al. Antihypertensive efficacy and tolerability of lercanidipine in daily clinical practice. The ELYPSE Study. Eficacia de Lercanidipino y su Perfil de Seguridad. Blood Press. 2002;11(2):95-100. doi:10.1080/08037050211265 · PMID 12035878I1
  24. Beaney T, Schutte AE, Stergiou GS, Borghi C, Burger D, Charchar F, et al. May Measurement Month 2019: The Global Blood Pressure Screening Campaign of the International Society of Hypertension. Hypertension. 2020;76(2):333-341. doi:10.1161/HYPERTENSIONAHA.120.14874 · PMID 32419505G3
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  27. Bhatt DL, Kandzari DE, O'Neill WW, D'Agostino R, Flack JM, Katzen BT, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014;370(15):1393-401. doi:10.1056/NEJMoa1402670 · PMID 24678939G2I3
  28. Bhatt DL, Vaduganathan M, Kandzari DE, Leon MB, Rocha-Singh K, Townsend RR, et al. Long-term outcomes after catheter-based renal artery denervation for resistant hypertension: final follow-up of the randomised SYMPLICITY HTN-3 Trial. Lancet. 2022;400(10361):1405-1416. doi:10.1016/S0140-6736(22)01787-1 · PMID 36130612I3
  29. Bi Y, Li M, Liu Y, Li T, Lu J, Duan P, et al. Intensive Blood-Pressure Control in Patients with Type 2 Diabetes. N Engl J Med. 2025;392(12):1155-1167. doi:10.1056/NEJMoa2412006 · PMID 39555827C6G2
  30. Black HR, Elliott WJ, Grandits G, Grambsch P, Lucente T, White WB, et al. Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial. JAMA. 2003;289(16):2073-82. doi:10.1001/jama.289.16.2073 · PMID 12709465I1
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  37. Brown JM, Siddiqui M, Calhoun DA, Carey RM, Hopkins PN, Williams GH, et al. The Unrecognized Prevalence of Primary Aldosteronism: A Cross-sectional Study. Ann Intern Med. 2020;173(1):10-20. doi:10.7326/M20-0065 · PMID 32449886G3H2H3
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Fichas técnicas (CIMA, AEMPS) (54)

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  2. Ficha técnica de amilorida. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 53265I1I2
  3. Ficha técnica de amlodipino. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 59162C5I1I2
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  5. Ficha técnica de bisoprolol. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 57655C5I1I2
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  7. Ficha técnica de captopril. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 62318I2
  8. Ficha técnica de carvedilol. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 59695C5I1I2
  9. Ficha técnica de clonidina. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 50669I2
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  13. Ficha técnica de enalapril. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 57789C1C5I1I2
  14. Ficha técnica de eplerenona. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 66756C1C5I2
  15. Ficha técnica de espironolactona. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 54900C1C5I2
  16. Ficha técnica de felodipino. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 64832I2
  17. Ficha técnica de finerenona. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 1211616002I2
  18. Ficha técnica de hidroclorotiazida. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 90834C1C5I1I2
  19. Ficha técnica de indapamida. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 53338C5I2
  20. Ficha técnica de irbesartán. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 97046022I1I2
  21. Ficha técnica de labetalol. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 54527C1
  22. Ficha técnica de labetalol. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 55318I1
  23. Ficha técnica de lacidipino. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 59897I2
  24. Ficha técnica de lercanidipino. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 71633I1I2
  25. Ficha técnica de losartán. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 64971C1C5I1I2
  26. Ficha técnica de manidipino. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 64634I2
  27. Ficha técnica de metildopa. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 37932I1I2
  28. Ficha técnica de moxonidina. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 61156I2
  29. Ficha técnica de nebivolol. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 83604C5I2
  30. Ficha técnica de nifedipino. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 59538C1C5I1I2
  31. Ficha técnica de olmesartán. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 65498I1I2
  32. Ficha técnica de prazosina. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 55064I2
  33. Ficha técnica de ramipril. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 59564C1C5I1I2
  34. Ficha técnica de registro 39059. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 39059I1
  35. Ficha técnica de registro 54503. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 54503C5I1
  36. Ficha técnica de registro 55285. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 55285I1
  37. Ficha técnica de registro 56967. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 56967I1
  38. Ficha técnica de registro 58369. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 58369C5I1I2
  39. Ficha técnica de registro 58860. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 58860I1
  40. Ficha técnica de registro 59127. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 59127I1I2
  41. Ficha técnica de registro 59911. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 59911I1
  42. Ficha técnica de registro 60200. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 60200C5I1
  43. Ficha técnica de registro 61252. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 61252I1
  44. Ficha técnica de registro 61369. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 61369I1
  45. Ficha técnica de registro 61428. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 61428I1
  46. Ficha técnica de registro 66356. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 66356I1
  47. Ficha técnica de registro 68827. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 68827I1I2
  48. Ficha técnica de registro 79824. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 79824I1
  49. Ficha técnica de registro 81034. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 81034C1
  50. Ficha técnica de registro 85873. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 85873I1
  51. Ficha técnica de registro 89082. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 89082I1
  52. Ficha técnica de telmisartán. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 98090002I1I2
  53. Ficha técnica de urapidilo. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 76741I1
  54. Ficha técnica de valsartán. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Centro de Información online de Medicamentos (CIMA). Consultada el 25/10/2026. CIMA, registro 70323C1C5I1I2

Estudios en marcha (ClinicalTrials.gov) (6)

  1. EMBRACE. Denervación renal en pacientes con enfermedad coronaria multivaso e hipertensión resistente a los que se hace una intervención coronaria en dos tiempos; objetivo principal, una variable combinada jerarquizada (razón de victorias), con la seguridad del acceso, el daño renal por contraste y las complicaciones de la arteria renal. ClinicalTrials.gov, NCT07602790; 1.000 pacientes · aleatorizado; aún sin reclutar · resultados primarios previstos: noviembre de 2030 · promotor: industria. Consultado el 25/10/2026. NCT07602790I3
  2. RADAR. Inyección de alcohol frente a procedimiento simulado, sin fármacos; la sistólica ambulatoria a las 8 semanas. ClinicalTrials.gov, NCT07083765; 202 pacientes · aleatorizado; aún sin reclutar · resultados primarios previstos: mayo de 2028 · promotor: industria. Consultado el 25/10/2026. NCT07083765I3
  3. RDN-ADPKD. Denervación renal en la hipertensión no controlada con poliquistosis renal autosómica dominante; la sistólica de 24 horas. ClinicalTrials.gov, NCT05460169; 44 pacientes · aleatorizado; activo, sin reclutar · resultados primarios previstos: marzo de 2028 · promotor: Universidad de Erlangen-Núremberg. Consultado el 25/10/2026. NCT05460169I3
  4. RDN-DA. La duración de cada aplicación de radiofrecuencia y su efecto sobre la presión, en la hipertensión y la hipertensión resistente; la sistólica de 24 horas a los 6 meses. ClinicalTrials.gov, NCT07876479; 220 pacientes · aleatorizado; reclutando · resultados primarios previstos: diciembre de 2028 · promotor: Hospital Ruijin, Shanghái. Consultado el 25/10/2026. NCT07876479I3
  5. REDs. Denervación renal en la fase subaguda del ictus; la sistólica de 24 horas a los 12 meses. ClinicalTrials.gov, NCT07114757; 108 pacientes · aleatorizado; aún sin reclutar · resultados primarios previstos: septiembre de 2027 · promotor: Centro per la Lotta Contro l'Infarto, Italia. Consultado el 25/10/2026. NCT07114757I3
  6. WHY-RDN. Denervación renal o arteriografía sola en mujeres hipertensas que planean un embarazo; la normalización de la presión de 24 horas. ClinicalTrials.gov, NCT05563337; 80 pacientes · aleatorizado; reclutando · resultados primarios previstos: mayo de 2025, fecha ya pasada; el registro lo sigue dando como abierto · promotor: Hospital Universitario de Burdeos. Consultado el 25/10/2026. NCT05563337I3
La lista se hace sola con lo que citan las páginas de este ESPACIO (PubMed por el PMID; el DOI, en PubMed o en Crossref; las fichas técnicas, en CIMA; los estudios en marcha, en ClinicalTrials.gov) y se rehace cada vez que se actualiza el ESPACIO; seis autores y «et al.», como pide el estilo Vancouver.