Blood Pressure-Lowering Effect of Renal Denervation in Isolated Systolic Hypertension

Study Questions:

What is the blood pressure (BP)-lowering effect of catheter-based renal artery denervation (RDN) in patients with isolated systolic hypertension (ISH) compared with combined systolic–diastolic hypertension (CH)?

Methods:

This study pooled data from 1,103 patients from the SYMPLICITY HTN-3 trial and the Global SYMPLICITY Registry. Multivariable predictors of the office systolic BP (SBP) change at 6 months were determined by multiple linear regression. The following covariates were considered for each model: ISH vs. CH, baseline office SBP, age, male sex, body mass index, number of medication classes at baseline, history of type 2 diabetes mellitus, history of coronary artery disease, obstructive sleep apnea, history of stroke, estimated glomerular filtration rate (eGFR) at baseline, and heart rate at baseline.

Results:

A total of 429 patients had ISH, and 674 had CH. Patients with ISH were significantly older than those with CH (66 vs. 55 years), had more type 2 diabetes mellitus (52.9 vs. 34.6%), and had a lower eGFR (71.8 vs. 78.6 ml/min/1.73 m2); all p < 0.001. At 6 months, the SBP drop for CH patients was −18.7 ± 23.7 mm Hg compared with a reduction of −10.9 ± 21.7 mm Hg for ISH patients (−7.8 mm Hg, 95% confidence interval [CI], −10.5 to −5.1; p < 0.001). The change in 24-hour SBP at 6 months was −8.8 ± 16.2 mm Hg in patients with CH versus −5.8 ± 15.4 mm Hg in ISH (−3.0 mm Hg, 95% CI, −5.4 to −0.6; p = 0.015). Presence of ISH at baseline, but not age, was associated with less pronounced BP changes following the procedure. The strongest predictor of office SBP reduction at 6 months was CH, followed by aldosterone antagonist use and nonuse of vasodilators.

Conclusions:

The authors concluded that reduction in BP among patients with ISH following RDN was less pronounced than the reduction in patients with CH.

Perspective:

This study reports that among patients with uncontrolled hypertension, the documented BP-lowering effect of RDN was significantly less pronounced in patients with ISH than in patients with CH. The strongest predictor of office SBP reduction at 6 months was combined systolic–diastolic hypertension, followed by aldosterone antagonist use and nonuse of vasodilators. These predictors may help inform the design of future trials with catheter-based RDN.


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