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.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Hypertension, Sleep Apnea

Keywords: Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Body Mass Index, Coronary Artery Disease, Denervation, Diabetes Mellitus, Type 2, Glomerular Filtration Rate, Hypertension, Mineralocorticoid Receptor Antagonists, Primary Prevention, Renal Artery, Sleep Apnea, Obstructive, Stroke, Systole, Vasodilator Agents


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